By Dr Vassilis Athanassiou*
Low ovarian reserve – the limited stock of ovaries in follicles – is related to the reduced chance a woman might have to conceive with natural efforts. Ovarian reserve is assessed by measuring the serum levels of Anti-Müllerian Hormone (AMH). AMH is a type of protein produced by both genders, in women by the follicular cells of the ovarian follicles.
AMH levels have been shown to accurately reflect the ovarian reserve – and indirectly that of the ova. The normal AMH values range from 1 to 3 ng/ml. Exceeding values may indicate polycystic ovarian syndrome.
The polycystic ovarian syndrome is a hormonal disorder that is considered to be one of the most common causes of infertility among women. Symptoms include unstable menstrual cycles, acne, oily skin, obesity, immoderate hair growth, fertility issues and miscarriages. About 20% of the female population has polycystic ovaries though only 7% of this portion has the most severe form, the polycystic ovarian syndrome.
Low hormone level does not cause infertility by itself. If a woman who wants to have children has low levels of AMH, she is asked to decide with the assistance of the attending physician how she would like to try it. The most workable method – before deciding on going through an egg donation process – is immediately intensifying the conception with natural efforts and then undergoing In Vitro Fertilization with her own cryopreserved eggs.
AMH level is measured as part of a fertility test and is recommended to women who have not given birth after a certain period of time. This period is 12 months for women under 35 years old and 6 months for women over 35 years old. It is also recommended to women regardless of age who are about to undergo an assisted reproduction treatment – as a success probability indicator – as well as to former patients with cancer or with a history of an ovarian or endometrial surgery, provided they are interested in knowing their reproductive capacity.
AMH level is measured through a lab test which can be done at any stage of the menstrual cycle, is simple, affordable and is not affected by any medication. It is considered to be a valuable diagnostic tool for the fertility expert.
*Vassilis Athanassiou, MD PhD, is OB/GYN, Reproductive Endocrinology & Infertility,Co-founder & Scientific Director of IVF Athens Center