What does AMH actually tell us

I often speak to women undertaking fertility treatment who feel quite confused about what their AMH level means.  Ovarian reserve tests look at three hormonal biomarkers known to give a good indication of the number of remaining eggs: anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B.

Most women understand that AMH is an approximate measure of ovarian reserve, but what does it really say?  Can it predict our ability to fall pregnant in the short term?

New research http://www.sciencealert.com/common-fertility-test-results-are-dangerously-unreliable-says-new-researchsuggests that AMH is probably not as useful for predicting fertility in the short term as we had previously thought.  The study of 750 women aged 30-44 indicated:

“younger women with biomarker levels indicating lower ovarian reserve should not become anxious that they won’t be able to have a baby,” says one of the team, Anne Steiner from the University of North Carolina at Chapel Hill.

The results showed that the number of remaining eggs bore no correlation to the chances of conceiving.  In other words, many women with low ovarian reserves will be able to conceive without any problems, while some of those with good ovarian reserves will have issues getting pregnant.

“These tests are a great measures of ovarian reserve, how many eggs you have, but they don’t work to predict a woman’s reproductive potential,” Steiner told Julia Belluz at Vox.

The message is not to use these evaluations as a way of making decisions about pregnancies, and for women not to worry that a low ovarian reserve will necessarily lead to them having problems conceiving – at least through sex.

That said, ovarian reserve tests can still be useful for deciding on treatments for women already having fertility problems, and for weighing up potential responsiveness to IVF, the researchers said.

“Hormone levels change with time, so taking a snapshot today tells us very little about what women’s fertility will be like tomorrow,” fertility expert Channa Jayasena from Imperial College London in the UK, who wasn’t involved in the study, told the BBC.

“This study tells us that measuring these hormones to predict fertility in potentially worried and vulnerable women is wrong, and should be stopped.”

There are some limitations to the study, which didn’t look at long-term fertility rates beyond a year, and only looked at women without fertility problems.