What is AMH testing?

Why is AMH testing done?

AMH has been found to be a very accurate test that tells us about the quantity and quality of the eggs in any woman. In medical terms AMH is one test that has stood the test of time because of its high sensitivity and specificity. It not only tells us about the quantity but also quality of the ovarian reserve. Every woman has a limited number of eggs that have been present since birth. When a woman reaches puberty (around the age of 13 or so) there are about 300,000 that remain. Out of these, only 500 or so will ever ovulate in her lifetime. Although the number of oocytes seem to be high, most are useless because they undergo a natural process called atresia in the process of ageing.

Hear from the best test tube baby centre in Delhi NCR, the best advantage of AMH testing is the values are not dependent on the day of the menstrual cycle. So it could be done at any day regardless of the day of the periods and its value will remain the same. A low value of AMH (below 90th percentile) tells us that there is a serious decline in the woman’s ovarian reserve and she should go for a definitive treatment like IVF as soon as possible. Even lower levels or close to zero levels indicate that there is hardly any remaining follicles (eggs) left and the lady should go for IVF with donor eggs.

Additionally, the AMH test also helps us to gauge the dose of Gonadotropin injections to be used for a particular patient and also predict the approximate number of eggs at the time of retrieval. Notwithstanding lab to lab variations, a value of 3 ng/ml or about 22 pmol/L is considered ‘satisfactory’.

What are the causes of Low AMH?

• Advancing age - as a woman’s age increases the AMH comes down.
• Some women have low AMH in spite of a young age. Indeed we as IVF specialists have seen many ladies coming in their twenties with low AMH levels. There are many reasons for this to happen. Some of them include auto-immune disorders, Hepatitis B infection, hereditary Galactosemia, HIV infection, X chromosome linked disorders, etc. But most common is idiopathic or unknown reason.
• Sometimes the declining AHM at young ages and premature ovarian failure is genetic and runs in the family. But most cases are sporadic with no similar family history.
• Previously operated ovaries - for example for Endometriotic cyst removal or aggressive ovarian drilling
• Cancer or therapy for cancer like radiotherapy or chemotherapy

Symptoms of Low AMH

Usually low AMH does not lead to any symptoms. In other words low AMH report comes as a surprise to most women. But sometimes symptoms like irregular periods or too frequent periods (coming earlier than before) are seen. If AMH is very low it is possible that periods have stopped altogether.

Is FSH blood test important? What does high FSH mean?

FSH is more of a ‘crude’ indicator of ovarian reserve. Low AMH and high FSH usually co-exist and confirm poor reserve or complete ovarian failure. FSH used to be very commonly done in the past, but not anymore. Disadvantage is it has to be done only on 2nd or 3rd day of periods. But FSH is still done sometimes because there is a condition called Hypogonadotropic Hypogonadism that can only be confirmed with FSH testing.

For whom is AMH blood test done?

• Single women wanting to know about their ovarian reserve. They can make better decisions for themselves knowing the “Time in hand”
• Single women who wish to go for fertility preservation or egg freezing because they do not want to be in a relationship as of now.
• Married women with infertility of more than 1 year as a part of comprehensive testing
• Any woman above 35 years of age desiring to have a child with her own eggs should get an AMH test
• Before every IVF or ICSI cycle we do it at Janini IVF. This helps us in determining the optimal dose of your injections
• If you had received cancer treatment in the past
• Patients with endometriosis either awaiting surgery or have undergone surgery in the past

Why choose Janini IVF?

Although the AMH blood test is highly accurate in determining the quality and quantity of your eggs, it cannot be taken as a final word to choose the best option for you. The practice of deciding when to go for donor egg services on AMH alone is flawed and not advisable. It takes a skilled and experienced clinician to take the holistic picture including the patient’s age, ultrasound picture of ovaries, previous response to stimulation and IVF Treatment outcomes, if any, into consideration. Low AMH alone is not the holy grail to conclude end of the road in IVF Treatment. Indeed, in many years of his practice, Dr. Dalal, the best infertility specialist doctor in Delhi, has successfully treated patients with low AMH with individualised ovarian stimulation protocols that enabled them to have a baby with their own eggs. At Janini IVF, the best IVF clinic in Delhi, our Cryo-accumulation program with excellent success rates is especially applicable to these kind of patients.