It’s normal for you to be curious about your ovarian health and wonder if you will have difficulty getting pregnant in the near or distant future. While it isn’t an easy question to answer, there are several tests that can help patients and doctors predict whether a they have a biological clock that is ticking slower or faster than expected. To help you better plan for your future, testing is available to provide you with helpful information about ovarian reserve.
Anti-mullerian hormone, or AMH, is a hormone that does many different things and has important functions. As a fertility specialist, AMH helps me every day because it gives me a small snapshot of an individual's ovarian health. This is because AMH is secreted by important cells in the ovary throughout the reproductive years of life. Since you are born with all the eggs you will ever have, and the number of eggs decreases until menopause, AMH levels are expected to slowly decrease with age.
Checking your AMH is important because it is similar to “checking how much gas is left in the tank.” Since we know what normal AMH values are for an individual in their 20s, 30s and 40s, we can measure your fertility by comparing your AMH to your expected AMH value for your age. In people above age 30, AMH is actually quite good at predicting pregnancy rates for couples who are trying to conceive naturally. However, AMH is more commonly used to predict response to IVF.
That’s only partially true. For most, age is the easiest way to predict the chance of getting pregnant each month since there’s no blood or medical testing involved. However, an individual's body is very complicated and every person has unique ovarian characteristics so age isn’t always the most precise way to measure fertility. There are many young people, for example, who have regular menstrual cycles and who have a biological clock that is ticking faster than normal. These people are at risk of losing their fertility sooner than expected and can be easily identified with the AMH blood test.
It’s really important to remember that AMH is not a perfect test. In fact, there are multiple other ways to check ovarian reserve such as measuring follicle stimulating hormone (FSH), and an ultrasound where the number of antral follicles on each ovary are counted (AFC). No one test is considered the best, so whenever possible, I like to obtain multiple measures or tests to give patients a more complete description of their reproductive health.
Once a patient with true low ovarian reserve is identified, there is usually an improvement in fertility once fertility treatment is started. Because fertility treatments have become so effective, some patients with low AMH can “overcome” this problem by using medications to improve ovarian function each month.
Absolutely. AMH levels that are very high or very low can hint at other problems that are important to identify and treat.
For patients who have AMH values that are very high, or “off the charts”, I tell them that it is very likely that they were born with many more eggs than the average person. While this may sound like a good thing, women with very high AMH levels commonly have irregular menstrual cycles and should be screened for polycystic ovarian syndrome (PCOS). PCOS is an important diagnosis to make because, in addition to problems with fertility, there are serious metabolic and health implications that can persist for 5, 10 and even 30 years if not properly addressed.
Conversely, patients with very low AMH may have other underlying issues that have caused their ovarian reserve to prematurely fall. Because the ovaries are involved in many other functions outside of fertility (such as cardiovascular, bone, mental health, etc.), identifying people with abnormally low ovarian reserve is important.
If you have questions, I recommend that you see a fertility specialist for a consult and evaluation.
Dr. Jason Yeh completed his residency and subspecialty training in infertility at Duke University. He is a born and raised Texan who graduated from the Plan II Honors Program at the University of Texas at Austin. After college, he was awarded a tuition scholarship to attend the University of Texas Southwestern Medical Center at Dallas and went on to complete residency training in Obstetrics and Gynecology at Duke University Medical Center in Durham, North Carolina. There, he won multiple teaching and research awards, and was elected to serve as the administrative chief of the Duke Obstetrics and Gynecology Department, where he remained to complete his fellowship training in Reproductive Endocrinology and Infertility. Dr. Yeh has specialized interest in the relationship between dietary habits, irregular ovulation, fertility and polycystic ovarian syndrome (PCOS). Furthermore, Dr. Yeh has been invited to lecture nationally and internationally on topics ranging from women's health and infertility to technology in healthcare. In addition, his mission is to add to the tremendous talent already at Houston Fertility Institute as Director of Patient Education and care for patients using the most effective and up-to-date approaches in minimal stimulation ovulation induction techniques (“Mini-” or "Micro-Stim" IVF), advanced reproductive technology, preimplantation diagnosis/screening, and third party reproduction.
Check out the products for TTC through parenthood in the Babies After 35 Amazon shop, online courses and other services that come "Dr. Clark-approved"!Check out my favorite things