What Is The Role of AMH Test in IVF?

Whenever we talk about IVF, you will always hear about the AMH test. Ask any gynaecologist, and they will tell you how crucial is the role of AMH test in IVF. This test determines the female fertility as it shows the total number of eggs in a woman. It can also determine the chances of a successful IVF.

In this article, we will explore everything you should know about AMH, from what it is to its role in IVF.

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What is the AMH Test?

AMH, or anti-mullerian hormone, is produced by the follicles, which are the tiny fluid-filled sacs containing the immature eggs in the ovaries. It determines the ovarian reserve in a woman’s body. This test can also be used for diagnosing PCOS or early menopause in women who might be facing difficulty in getting pregnant.

What is the Purpose of the AMH Test in Infertility? 

1. Age plays a very significant role in fertility. A woman is born with all the eggs she will have in her lifetime. As the number of eggs declines with age, so does the AMH level. The Anti-Müllerian hormone test can help compare the AMH level with the range expected in a woman’s age. 
2. AMH test is performed to check the Ovarian reserve in Women. The ovarian reserve plays a vital role in identifying women’s fertility potential and the health of their ovaries.
3. One of the main reasons to do this test is to check how a woman will respond to the fertility treatment. Women with a high AMH level will respond more quickly. On the other hand, Women with low fertility levels may need high doses of fertility drugs. 

When Do I Need an AMH test?

The AMH test is beneficial if:

• If you have been trying to conceive for over six months and are worried about your age, then it might be a good time to take the AMH test.
• Are you planning for IVF or any other fertility treatment?
• You are curious to know if your chemotherapy and ovarian reserve have any potential impact on your chances of conceiving in future.
• You suspect you might have an ovarian tumour.
• You don’t want to conceive anytime soon but in future and want to understand your current situation.
• You are planning to freeze your eggs for the future.

How is it done? Can it be done at home?

The AMH test requires a simple blood sample. This test can be performed on any day of your menstrual cycle. One can even take this test at home by booking it from any certified laboratory. It is always recommended that you consult your doctor to understand the results.

What are the different levels of AMH?

Women’s AMH levels vary according to their age. Women are born with a finite number of eggs, and the number decreases with age. A woman cannot get pregnant once the eggs are gone, so it is recommended to have your first baby in your 30s.

Here are some levels of AMH:

• Average: Between 1.0 ng/ml to 3.0 ng/ml 
• Low: Under 1.0 ng/ml
• Very low: 0.4 ng/ml

AMH levels by age: 

It’s not unusual to see lower levels of AMH in your 30s, 40s and 50s. AMH levels naturally decrease with age.

• 20-25 years old: 4.23 ng/ml
• 26-30 years old: 3.48 ng/ml
• 31-35 years old: 2.43 ng/ml
• 36-40 years old: 1.28 ng/ml
• 41- 45 years old: 0.52 ng/ml

What If My AMH Level is Low?

AMH levels are indicators of Ovarian reserve and not definitive indicators of infertility. The chances of getting pregnant are low when the number of eggs is depleted in ovarian reserve. Women’s fertility decreases with age, and the AMH level also decreases. Vitamin deficiency, Stress level, Birth control pills, medical history, and bad eating habits can also cause Low AMH levels. It is suggested to consult your doctor if your AMH is low and you are trying to conceive.

Treatment Pptions for Low AMH :

Managing low AMH revolves around improving and addressing the root causes. Treatment options include: 

• In-vitro Fertilization (IVF) involves retrieving the eggs. The eggs are fertilized with sperm in the laboratory. Once embryos are formed, they are implanted into the uterus.
• IVF with donor eggs: Women who have severely low AMH levels or no eggs are recommended to go for donor eggs. In this condition, doctors use good-quality donor eggs. 
• Fertility Medication: A few hormonal medicines are recommended to stimulate ovulation. This increases the chances of fertility. 
• Lifestyle Changes: A balanced diet, regular exercise, and low-stress levels lead to a good lifestyle, which can also support good reproductive health.

Low AMH and Fertility: 

The AMH level shows the quantity of oocytes in the ovaries. If the AMH level indicates a low ovarian reserve, then there are chances that fertility may be at risk. Low AMH also triggers the signs of early menopause. It is important to understand that AMH is just one contributing factor to fertility, not the only factor. Other factors like age and lifestyle also impact fertility. Low AMH reduces the quantity and quality (chromosomal abnormalities) of eggs and also increases the chances of miscarriages. 

What If My AMH is High?

High AMH indicates a high quantity of eggs in the ovaries and has a better chance of responding to fertility treatment. However, high AMH levels can also be linked to conditions such as PCOS. It is a hormonal disorder. People with PCOS have abnormal numbers of follicles in the ovaries. Common symptoms of PCOS are irregular periods, acne and excess hair growth. Not all the people who have AMH need to have PCOS. Diagnosis also requires a combination of symptoms, a doctor’s involvement and an Ultrasound. Women with higher levels of AMH may be at risk for Ovarian Hyperstimulation Syndrome (OHSS) during IVF treatment. 

Treatment Options for High AMH

1. Ovulation Induction: In cases where AMH (anti-mullerian hormone) is associated with PCOS (Polycystic Ovarian Syndrome), ovarian induction drugs may be given to stimulation. These drugs can regulate the menstrual cycle and spur the release of eggs.
2. In-vitro fertilization: IVF is a typical fertility treatment for those women who have high AMH levels. It decreases the chances of multiple pregnancies. However, it is essential to avoid Ovarian Hyperstimulation Syndrome (OHSS).
3. Oocyte Freezing: Egg freezing is a good option for Women who have an AMH level. They can preserve their eggs after egg retrieval. These eggs will be preserved in fertility centres at frozen temperatures. This is one of the best ways to preserve fertility. You can take these eggs out when you are planning to start your family.      

Antral Follicle Count Test

Antral follicle counts indicate the number of resting or unstimulated follicles in both ovaries. The antral follicle test is performed through the transvaginal ultrasound during an ongoing ultrasound between days 2 and 5. If each ovary has a 5-10 Antral follicle count, it is considered to have a normal Antral follicle count. 

1. High Antral follicle count (more than 10): This shows the more significant number of eggs.
2. Low Antral follicle count (less than 5): This indicates low ovarian reserve and a poor response to fertility treatment. 

Ovarian Reserve Testing:

Ovarian reserve means the total number of eggs you will have in your life, and these numbers naturally decrease with age. Ovarian reserve tests are suggested for those women who are facing difficulties in conceiving. These tests are performed to evaluate the fertility potential of a woman. Tests include blood tests and Vaginal Scans. 

Tests which are recommended to evaluate fertility are : 

1. Anti-mullerian Hormone (AMH): The AMH test can be performed at any time in your menstrual cycle. AMH is a hormone released by the follicle. If the AMH levels are high, it means there are a high number of eggs in the follicle. AMH levels decrease with age, as does the number of eggs.
2.  Follicle-stimulating hormone (FSH): These hormones are released by the pituitary gland (in the brain) and are responsible for maturing the eggs in the ovary. A high FSH level indicates a poor ovarian reserve and a Low FSH indicates a good ovarian reserve. This test is usually advised on the third day of the cycle. 
3. Antral follicular Count (AFC): This is done through the transvaginal scan. The Antral follicle scan is the total number of follicles in the ovaries. Having more antral follicles means that a woman has more eggs in her ovaries. At the same time, low AFC indicates weak fertility potential. 

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