I get lots of questions from viewers about their AMH levels. In combination with age,
AMH is a pretty good predictor of IVF success rates. But what if you
are not doing IVF? Will AMH predict success if you are using clomid or
fertility injections with intercourse or IUI? Great question. Stay tuned for the answer
Measurement of a woman’s AMH level in the blood is a valuable tool for determining the number of eggs
remaining in the ovaries. High AMH means there are more eggs remaining and low AMH levels indicate
fewer eggs remaining. During IVF treatment, this is very important. IVF is basically a numbers
game. Fertility medications are used during IVF in an attempt to mature multiple eggs in the ovaries
at once. These eggs are then removed from the ovaries in a procedure called an egg retrieval.
The more eggs we are able to get, the better our chances for finding eggs that will fertilize and
develop into healthy embryos that are capable of producing a live birth. Unfortunately, most of the
eggs in human beings are abnormal and therefore do not have the ability to produce a live birth.
Although IVF generally has the highest chance for pregnancy compared to other treatments,
women with low AMH levels tend not to respond to fertility medications as well. Often, they do not
reach the point of having an egg retrieval. When they do have an egg retrieval, they average less
eggs. High quality studies indicate that this lowers the chance for having a successful IVF.
Do AMH levels predict success if you are being treated with
oral fertility medications like Clomid or letrozole? During these treatments,
there are usually only one or a few eggs which mature at once so egg reserve may not
be as important. In order to study this, there are a few important things to remember. First,
pregnancy rates for all treatments decrease as women get older and second, AMH levels decrease
in women as they get older. So, a good study on this topic will control for age. In other words,
we need to compare AMH levels in younger women separately than from older women.
Recently, scientists from the US did just that. They divided women using
oral fertility medications into three groups based on their age. Group 1 were women under
the age of 35. Group 2 were aged 35-40 and group three were over the age of 40. Then
they divided them into those that had a low AMH level of less than 1 and compared them
to women in the same age groups who had an AMH of 1 or more. What did they find?
Within each age group, women with a low AMH had the same pregnancy rates
and miscarriage rates as those with a higher AMH. Having a low AMH did
not predict a lower success rate with oral fertility medications.
What about injections of fertility medications? Usually, when using fertility injections,
more eggs mature and are ovulated compared to oral medications. Because more eggs mature,
pregnancy rates with injections and IUI are higher than with oral medications.
You might expect that AMH would be a better predictor for pregnancy when using injections.
In the same study as before, the researchers found that for the two younger age groups,
women with lower AMH levels had lower pregnancy rates compared to those with
higher AMH levels. The miscarriage rates were the same. In the oldest age group,
women over age 40, there was no difference in pregnancy rates. It seems that as the
overall chance for pregnancy declines with age, AMH levels become less important.
Our infertility TV bottom line is this. AMH levels do not predict the chance
for pregnancy in women being treated with oral medications like clomid and
letrozole regardless of their age. AMH levels do predict lower success rates
when using injections in women under the age of 40 but not for older women