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Limitations of AMH to Determine Ovarian Reserve

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a blog by Dr. Michael DiMattina, March 26, 2014

New information is available about the limitations of the current assay for serum Antimullerian Hormone (AMH) for determination of your ovarian reserve.

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.


Comments (9)

My AMH came back today and it's 1.2, should I go straight to DE?

AMH (but only in combination with FSH and ovarial volume) is considered the most reliable marker of ovarian reserve. in case of any issues with sensitivity, test quality etc, one should go for determining inhibin B - here is one publication which compared both predictors: and also here is a lot about what young women need to know about their ovarian reserve:

I have a 2 year old from IUI, at that time my AMH was 2.7 and my FSH was 9. We just started trying again and my ob ran the tests and my AMH is 0.3 and my FSH is 11. Could it be a lab error or could my AMH have gotten that bad so soon? I'm only 34 and previously we had an "unexplained" diagnosis so I'm panicking that I may have waited too long to try for another child.

Hi Ilona,

AMH is one of the most accurate predictors of fertility. It is possible that there could have been a lab error, but keep in mind your AMH does decrease with age, especially as we approach 35. If you would like to consult a fertility doctor, give us a call at 1-855-955-BABY(2229). We can help you connect with a fertility doctor in your area.


Please contact our PCAs at 855-955-BABY (2229) and we can further assist you.
Thank you,

Will you treat patients with low AMH, but FSH of 7?

Many patients have a low AMH and a normal FSH. These hormones are used to assess one's ovarian reserve but there are clinical limitations associated with both of these tests. Doctors also perform ovarian ultrasonography to determine one's antral follicle count. And ovarian reserve is dependent on one's age. To answer your question, we routinely see and treat patients with the hormonal profile you described. The type of treatment depends upon the patient and her partners entire profile. Thank you! Dr. DiMattina

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