Ovarian reserve assessment
There are many tests to assess ovarian reserve: the most common and the cheapest is the measurement of day 3 FSH as well as the level of estradiol. Your doctor may also use the measurement of Antimullerian Hormone (AMH). The latter might be more sensitive. Dynamic tests have been devised including clomiphene challenge test and GnRH-a stimulation test (GAST). The purpose of all these tests is to assess the potential responsiveness of the ovary to stimulating agents.
The assessment of ovarian reserve can be beneficial to patients undergoing assisted conception treatment. As suggested above it helps in determining the dose of the medication to induce multiple follicular development. Patients with reduced reserve will require higher doses of medication and those with sensitive ovaries require a more measured approach. At Beloved Fertility, we use AMH level and basal day 2, 3 FSH level or other ovarian reserve tests as a screening tool to assess the chance of individual patients achieving a pregnancy or a live birth with IVF treatment.
AMH is the best predictor of ovarian reserve and function
Over the past year, studies have emerged that anti-Müllerian hormone (AMH) testing is the best and most accurate predictor of a woman’s remaining ovarian reserve (the number of eggs remaining in the ovaries). As a result, the anti-Müllerian hormone test has become a standard of care at Beloved Fertility. The test results provide your clinical team with a better understanding of how your ovaries will respond to ovarian stimulation and which treatment option will work best for you.
Currently, there are several studies on AMH that are advancing our knowledge of its role in fertility. Some specific areas of research include: investigating AMH and its effects on ovarian responsiveness, using AMH in predicting treatment success, and correlating AMH levels in predicting the occurrence of menopause. As our use and understanding evolves, we continue to modify our testing and protocols to maximize pregnancy success.
Ovarian reserve testing includes:
AMH (anti-Müllerian hormone):
- A hormone produced by the small immature follicles within the ovary.
- The AMH level is indicative of the size of the pool of follicles that remain. Therefore, in conditions where there are many immature follicles, the AMH level is high. As a woman grows older, and the pool of eggs decreases, the AMH level declines. Therefore, by the time a woman reaches menopause, AMH is undetectable.
- AMH is the most accurate predictor of a woman’s (estrogen): stimulates the growth of the follicles and the production of fertile mucus from the cervix; also, prepares the uterine lining for implantation of a fertilized egg. This test can be more accurate than FSH because there is no fluctuation from month to month and the test is not dependent on a woman’s menstrual cycle, which means women can have the test at any point.
- AMH is secreted by the small antral follicles found in the ovaries at the start of the cycle. A higher AMH level would indicate a large amount of antral follicles and a strong ovarian reserve where as a lower value would lead your physician to believe there has been a decrease in the ovarian reserve. It has now been established that the hormone AMH, which is made by the ovarian follicle containing the egg, can accurately predict how your ovaries will respond to fertility drugs.
- In a recent study found that women using combined contraceptive hormones had significantly lower AMH levels. Based on this study, if a woman is found to have a low AMH, we should ask her for contraceptive hormone usage and retest AMH after stopping the hormones more than one month AMH can be a predictor of ovarian reserve for a woman who is a good egg donor.
FSH (follicle-stimulating hormone):
- Releases from the brain and stimulates the ovary to recruit and mature an egg. High FSH levels can indicate to your doctor that the hypothalamus and pituitary glands are working harder than normal due to a decrease in ovarian reserve (egg supply). FSH levels can vary from cycle to cycle, so if your FSH level is higher than expected based on your age, the doctor may recommend repeating the test in the following month.
LH (luteinizing hormone):
- LH is produced in the pituitary glands. A surge of the LH hormone indicates ovulation is about to occur. The increased levels of LH provide final maturation to the egg within the follicle and set ovulation in motion by releasing a mature egg.
Our treatment strategies:
- The assessment of the levels of this hormone allows us to use different treatment strategies for different patients, taking into account your likely response to fertility drugs, thereby increasing treatment safety and pregnancy rates.
- When the AMH concentration is high, it indicates a risk of OHSS (ovarian hyperstimulation syndrome) when traditional treatment methods are used. We can therefore modify our strategy to accommodate this. If the scans, and other tests, show indications of polycystic ovary syndrome, we can modify our approaches accordingly.
- When the AMH concentration is low, it indicates that the response to traditional treatment methods will be below average, and therefore the chances of success in IVF / ICSI will be reduced. This is common in older women (>37y), where it is well known that success rates are reduced.
However, the predictive value of AMH is considerably better than using a patient’s age. With this information, however, our physicians will make adjustments to your treatment protocol to move your ovarian response more towards that of a patient with “normal” AMH levels.
- It should be remembered that Measuring AMH cannot predict whether a woman is able to become pregnant – there are other important factors that have to be taken into account – lifestyle, past medical history, anatomic and genetic abnormalities, quality of sperm and other male factors – but it is considered the best hormone to date to identify your potential reproductive capacity.