Testing Anti-Mullerian Hormone to Determine Egg Reserves by Scott Roseff, MD
EGG QUALITY starts declining when a woman is in her mid-20’s!
There is a slow decline in quality from about age 24 to age 30, followed by a fairly quick decline between age 30 and age 35, with a rapid decrease between ages 35 and 40. And, over age 40, egg quality is generally quite poor. All of this may make it difficult to get pregnant…
OVARIAN RESERVE describes a woman’s capacity to produce a reasonable quantity of good quality eggs. Of course, measuring a woman’s ovarian reserve is very important in determining why someone may not be getting pregnant, as well as in finding out the ease (if she has good eggs) or difficulty (if she has poor eggs) with which a pregnancy may be realized.
Women with normal ovarian reserve (good eggs) may conceive via simple therapies (such as timed intrauterine insemination), while women with abnormal ovarian reserve (poor eggs) may require in-vitro fertilization (IVF) or even IVF with donor eggs. Until now, we have only been able to INDIRECTLY measure a woman’s ovarian reserve via a cycle day 3 FSH/estradiol blood test, or through a “Clomiphene Citrate (Clomid) Challenge Test”, or CCCT. These tests measured the brain’s hormones which were INDIRECTLY affected by the ovary’s egg quality. While these tests were the best we had, we now have a more modern and sensitive blood test which DIRECTLY measures a woman’s ovarian reserve!
The human egg is “housed” inside a structure called the follicle. The follicle is comprised of specialized cells called granulosa cells. The granulosa cells produce a specific hormone directly and predictably linked to egg quality, and that hormone is called AMH. While other means of examining ovarian reserve may offer indirect, and possibly less accurate, less specific, and less predictive tests of egg quality (such as cycle day 3 FSH/estradiol levels and the CCCT), many reproductive endocrinologists believe women are better served by examining their AMH level — a more direct, more accurate, more specific, and more predictive test of egg quality.
The AMH test has been found particularly useful in the following clinical situations: Women who either need a Clomiphene Citrate Challenge Test (CCCT) or previously had a CCCT and want to confirm/refute the results; Women of advanced reproductive age (35 years or older); Any women with a diagnosis of “unexplained infertility”; Women who have shown a poor response to ovulation induction with either Clomid/Serophene or injectable fertility drugs; Women who have been told they need IVF with donor eggs — a normal AMH level may permit them to do IVF with their own eggs, while an abnormal AMH level may confirm the need for IVF with donor eggs. If you have individual questions about this article, please feel free to ask them on the General Infertility Medical forum: moderated by Dr. Scott Roseff.