Anti‐müllerian hormone as a marker of ovarian reserve*

Abstract

Objective: To analyse the usefulness of plasma anti-müllerian hormone (AMH) measurement as a tool for assessing ovarian reserve in a general infertility population. Materials and methods: Plasma AMH levels were analysed in 238 women aged 18–46 years during day 3–5 of their menstrual cycle. All 238 patients had follicle stimulating hormone (FSH) levels less than 10 i.u./L, suggesting normal ovarian reserve on traditional FSH criteria. Eighty-seven patients gave their consent to correlate their AMH levels with IVF oocyte retrieval outcome. Patients producing ≥ 8 oocytes were classified as having normal ovarian reserve, while those producing ≤ 4 oocytes were classified as having poor ovarian reserve. Results: Plasma AMH levels remained relatively static (20–25 pmol/L) from 18 to 29 years of age. By 30 years of age, plasma AMH levels start to drop rapidly, reaching only 10 pmol/L by 37 years. Despite this 50% fall in AMH levels between 29 and 37 years of age, minimal changes in FSH levels were observed. Using a cut off value of 8.1 pmol/L, plasma AMH assessment could predict poor ovarian reserve on a subsequent IVF cycle with a sensitivity of 80% and a specificity of 85%. Conclusions: Plasma AMH assessments are superior to FSH in identifying women with reduced ovarian reserve. Anti-müllerian hormone assessment should be considered as a useful adjunct to FSH/oestradiol levels and antral follicle count when estimating ovarian reserve.