Anti Mullerian Hormone (AMH) and

Ovarian Reserve
All womens ovaries produce eggs less well with increasing age. This deterioration makes it harder and harder
for women to have a baby as they get older. Deterioration happens faster for some women than for others; it
causes fertility problems for the average woman by her late thirties but for some unfortunate women a critical
change has already occurred by their early thirties.

Ovarian Reserve is the term used to describe how well a womans ovaries are still working with regard to
egg production and egg quality. Several tests are used to measure ovarian reserve. The traditional blood test
has been FSH - abnormally high levels indicating poor ovarian reserve. A disadvantage of FSH is that levels
can fluctuate from cycle to cycle, which can cause confusion.

Antral follicle count (AFC) is another measure (transvaginal ultrasonography is used to count the number of
antral follicles visible in each ovary) - a low AFC indicates poor ovarian reserve.
Anti Mullerian Hormone (AMH) is a newer blood test for quantifying ovarian reserve. It is produced by the
granulosa cells of antral follicles and it tends to correspond to AFC. The blood test for AMH can be carried out
on any day of the cycle (FSH must be measured on cycle day 3). Levels do not fluctuate from one cycle to
another, making AMH a more reliable measure of poor ovarian reserve than FSH.

If AMH levels are found to be low the couple concerned will find it harder to have a baby, either naturally or
with fertility treatment, compared with couples where AMH levels are normal. The likelihood of miscarriage is
also higher with low AMH levels. Low AMH levels also indicate a degree of urgency with regard to starting
fertility treatment or moving from simpler treatments to IVF; the concern would be that deferring treatment
could result in a smaller chance of success. Extremely low levels of AMH would suggest that the woman
concerned could find it almost impossible to have a baby with her own eggs; in this situation egg donation
might be the only treatment with a realistic prospect of success.

The test is relatively new and is not being carried out by all laboratories. It should become one of the routine
hormone tests carried out by GPs for women with fertility problems but this will take time. The current
system at Cork Fertility Centre is for the blood sample to be taken at the unit and sent by courier to the
testing laboratory. The charge for the test is 75, payable on the day of testing. Results are available within
seven days. The AMH level will fall either in the optimal fertility range (40.04-67.9pmol), the satisfactory
fertility range (21.98-40.03pmol), the low fertility range (3.08-21.97pmol) or the extremely low fertility range
(0.0-3.07pmol). The significance of the AMH result can be discussed with staff at Cork Fertility Centre.

At Cork Fertility Centre an AMH is now required for all new patients prior to their first consultation (at least ten
days before the appointment). Please contact reception or the nursing station to make arrangements.