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IVF AND amh explained

IVF and AMH

When you’re struggling to conceive, you start to encounter plenty of acronyms, such as FET, PGT, OHSS, IVF, and AMH. If you’re planning fertility treatments, you’ll undergo AMH testing, as this test measures the number of eggs in her egg reserve.

What is AMH?

AMH stands for Anti-Mullerian Hormone. This hormone is produced by the granulosa cells found in your ovarian follicles and can provide an accurate prediction of your ovarian reserve. Did you know that female babies are born with all of the eggs they’ll ever have for their lifetime? Unfortunately, over time, this egg supply depletes, and cannot be replenished.

AMH testing has its downfalls – it can’t predict the quality of your remaining eggs. However, it can provide part of the picture of your fertility. If you have a low AMH level, you likely have a diminished ovarian reserve (DOR). That said, AMH levels do not always correspond to DOR, so further investigations are necessary.

You’ll sometimes see people refer to an AMH test as a ‘female fertility test,’ but as mentioned above, this is not true or useful. Some doctors prescribe this test for women who aren’t struggling to get pregnant as a way to determine their future fertility, and that can be downright misleading.

Understanding AMH Test Results

Once you’ve got your AMH test results, it can be hard to decipher what they mean. Normal AMH levels are considered to fall between 1.0 ng/mL to 3.0 ng/mL. Low AMH is anything below 0.9 ng/ml, while below 0.16 ng/ml is considered ‘undetectably low.’ 

Over time, your AMH levels will decrease, and this is completely normal. However, if you have an unusually high or low AMH level for your age group, you may be experiencing other medical issues. For example, low AMH levels can point to early menopause, while high AMH levels can point to polycystic ovary syndrome (PCOS).

Remember, your AMH results don’t provide information on the health or quality of your eggs. For example, you may have a high AMH level, but your eggs could be of low quality. Alternatively, you could have fewer remaining eggs, but they could be of high quality. According to Dr Jessica Scotchie of Tennessee Reproductive Medicine, “in a non-infertile population, AMH levels don’t predict the time it will take to conceive, and they don’t predict infertility.” (Non-infertile people are those who have never tried and struggled to conceive). However, when they are a part of a broader panel of infertility tests, these results do help predict the best medication and dosages for IVF stimulation.  

In addition to AMH levels, it’s important to find out your antral follicle count (AFC). This information, which counts the number of follicles (small sacs from which eggs are produced) on each ovary, is only accessible with an internal scan. Once you combine AMH levels with AFC information, you can gain a better idea of both your egg quality and quantity.

What is a good AMH level?

A ‘good’ AMH level is different for every woman, but any numbers above the averages listed above are considered above average. Of course, even if your numbers are higher than those in the tables above, it doesn’t mean that you won’t have trouble conceiving. There are many other causes of infertility in women, including endometriosis and problems with ovulation.

Low AMH and IVF

While it may seem daunting, it is possible to have successful IVF treatments with low AMH levels. However, it’s important to be realistic. Remember, the more eggs you produce during stimulation, the higher the chances of creating good quality embryos to transfer. Unfortunately, not every egg will go on to create a healthy embryo, so having a high number of eggs gives you the best odds.

As Dr Trolice says, “as a woman ages, the percentage of chromosomally abnormal eggs contributing to abnormal embryos increases. So, the lower the number of eggs retrieved, the less percentage of embryos.”

Every woman has a finite number of eggs and a finite number of ‘good’ eggs. Over time, your total number of eggs decreases, along with the number of ‘good eggs.’ However, even a young woman with a low AMH level has a higher number of ‘good eggs’ than an older woman with a low AMH level. Even if you have a high AMH level, if you are 35, you have a lower percentage of remaining ‘good eggs.’

Low AMH levels (below 1 ng/mL) are correlated with lower egg yields, abnormal fertilisation, and failed transfers. They can also lead to your cycle being cancelled midway through if your doctor isn’t seeing enough follicles developing.

Speak with your IVF doctor and nurses about your concerns. They will create a protocol specifically designed around your needs. In some cases, they may recommend using donor eggs.

Normal AMH levels by age

the treatment options for PCOS through lifestyle, testing and medication

You’ll often see AMH levels expressed as nanograms per millilitre. These numbers represent the average normal AMH levels by age.

 Age Range

 AMH (ng/mL)

 20-29 years old

 3.0 ng/mL

 30-34 years old

 2.5 ng/mL

 35 – 39 years old

1.5 ng/ mL

 40-44 years old

 1 ng/mL

 45 – 50 years old

 0.5 ng/mL

You might also see AMH levels displayed with a measure of picomoles per litre (pmol/l). Normal levels are displayed below.

 Age Range

 AMH (pmol/l)

 20-29 years old

 13.1 – 53.8 pmol/l

 30-34 years old

 6.8 – 47.8 pmol/l

 35 – 39 years old

 5.5 – 37.4 pmol/l

 40-44 years old

 0.7 – 21.2 pmol/l

 45 – 50 years old

 0.3 – 14.7 pmol/l

These are all considered very conservative estimates of a ‘normal’ AMH level. Anyone with AMH levels lower than 1.6 ng/mL will likely have a lower number of eggs retrieved during their IVF cycle. Women with levels below 0.4 ng/mL are considered to have a severely low egg reserve and are unlikely to respond to IVF stimulation.

It’s important to remember that all women have fewer and fewer eggs as they age. So an AMH level that declines over time is normal. While  test results are helpful, it’s also important to note that as you age, you have fewer eggs.

Having high AMH levels

Broadly speaking, if you have high AMH levels you should find it easier to conceive. But as we’ve mentioned above, this isn’t always the case. Not only does a high AMH not predict the quality of your eggs, but it can also signify other health problems.

High AMH is correlated with polycystic ovary syndrome (PCOS). While there is no cure for this syndrome, its symptoms can be managed with lifestyle changes and medications. Many women with PCOS conceive naturally and have healthy pregnancies.

Can an AMH test help diagnose anything?

So, can an AMH test actually help to diagnose anything. The answer is yes – and no. While it can’t give you the entire picture of your fertility, it can help doctors get a better understanding of your egg reserve.

When paired with your AFC and other hormonal tests and scans, AMH testing can help diagnose potential fertility problems. Speak with your doctor for more accurate and personalised information.

AMH test - NHS or private?

If you are having fertility treatment on the NHS, your AMH testing will be included in the process. However, if you do not qualify for NHS-funded treatment or you have chosen to go private for your fertility treatment, your AMH testing will not be covered by the NHS. You will need to seek your AMH test privately, either with your fertility clinic or an independent bloods clinic.  

With that said, it’s always a good idea to speak with your GP. In some cases, they can order the tests for other reasons, and provide you with the information you need.

Testing your fertility

why not take a fertility test to understand where you are on your fertility timeline

Test your AMH

It’s important to understand your fertility status to help you make the right choices for you. This fertility test covering AMH, FSH and Oestradiol can be done from the comfort of your home with results within 72 hours

Request a consultation

If you’re experiencing issues trying to conceive and would like guidance from a fertility specialist, we can organise a free 15 mins call. If you would like an hour’s consultation with a leading expert, we can arrange online or at a clinic close to you

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Reference

With thanks for the fantastic contribution from IVF Spain

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