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Limitations of AMH to Determine Ovarian Reserve
a blog by Dr. Michael DiMattina, March 26, 2014
A recent study published in the February, 2014 journal of Fertility and Sterility evaluated the current assay used to determine serum AMH and found that the values obtained in the newer current assay may be flawed, resulting in significant clinical implications for patients who are told they have decreased ovarian reserve when, in fact, they may not.
Formerly, two different companies made assays for measuring AMH. They were both bought out by Beckman Coulter, who merged the two assays to produce the new assay currently available. Problems immediately ensued, with recent publications suggesting a significant downward shift in the reported values using the new method, and instability of the hormone at usual room temperatures. The clinical significance of this is that some women have been incorrectly labelled as having "decreased ovarian reserve," and others at risk for ovarian hyperstimulation syndrome may not have been identified.
The company has taken measures to adjust the assay to improve stability and consistency of the AMH measurement but the changes now necessitate further work to re-establish a new "normal" range for AMH. At Dominion Fertility, we have found many inconsistencies in the patient's reported AMH level and their responses to ovarian stimulation drugs. AMH alone cannot diagnose decreased ovarian reserve. Day 3 serum FSH, estradiol, antral follicle count and the patient's age, all factor into evaluating one's ovarian reserve.
In the past several months I began to notice discrepancies in patient's serum AMH and their responses to ovarian stimulating drugs. This new study confirms my suspicions that something was not right. I should note that AMH is only an index of one's egg quantity and not one's fertility potential. More updates coming.