What AMH Reveals
Women struggling to conceive or seeking family planning options at a later age may need an anti-mullerian hormone (AMH) test. AMH is a hormone produced by cells within the ovarian follicles. This hormone is an excellent indicator of a woman’s ovarian reserve. Women with healthy ovaries contain a set number of follicles that decline with age. As ovarian quantity and quality decline, so does fertility. AMH levels will reflect the number of eggs within the ovaries. High AMH levels predict a greater number of remaining eggs, while a lower number suggests a diminished ovarian reserve. Women at menopause should have near-zero AMH. A woman’s AMH levels can guide in vitro fertilization (IVF) or other forms of fertility treatment. The fertility drugs must be adjusted accordingly to increase success rates.
Fertility drugs explained
IVF requires a specific combination of hormone medications at different stages of treatment. The process often starts with injectable gonadotropins, which stimulate the growth of multiple follicles within the ovaries. As the follicles develop into mature eggs, gonadotropin-releasing hormone (GnRH) antagonists are necessary to prevent premature release. At the appropriate time, a trigger medication, such as human chorionic gonadotropin (hCG), helps with final maturation and preparation for retrieval. Fertility specialists will select the best combination of fertility medications based on existing AMH levels as well as other critical hormones.
AMH treatment approaches
AMH helps fertility specialists determine the appropriate dose or combination of medication to stimulate the ovaries. Women with high AMH may require lower doses of gonadotropins to avoid overstimulation. The team will monitor for ovarian hyperstimulation syndrome (OHSS), an unwanted side effect of IVF treatment. Using leuprolide acetate instead of hCG may be necessary to manage high levels of AMH. Normal levels can benefit from standard medication protocols and should give an appropriate response with minimal side effects. Lower AMH levels can signal a high dose of fertility medication. Despite higher hormone doses, there remains a risk of a low egg yield or poor response.
Adjust as you go
As AMH is a strong indicator of how the ovaries will respond to IVF treatment, doctors can adjust medications to improve success rates. Some patients may need higher or lower gonadotropins in the next IVF cycle. The figure acts as a guide to the potential success of an IVF cycle and can be the catalyst for choosing the most effective fertility treatment. Doctors can counsel couples and suggest more appropriate options or aim for custom hormone medication doses. Some women will discover that severely low AMH may not produce effective results. Using donor eggs or embryo cryopreservation may be best.
Boosting fertility treatment success
AMH has a strong relationship with hormone medications used in fertility treatment. There is an expected AMH level based on factors like age and health. The patient’s current levels can guide what fertility drug options will work best. An AMH-guided medication protocol can enhance embryo success, transfer rates, pregnancy rates, and live birth rates. Side effects, such as OHSS, may be reduced. Follow the advice of the fertility specialist and work with a fertility pharmacist to obtain the best medication strategy based on ovarian reserve.
