Antimullerian Hormone (AMH) & PCOS.
AMH or Antimullerian hormone is a blood test looking at ovarian reserve, but has also been recently included in the 2023 PCOS International Guidelines under the diagnostic criteria. AMH is commonly ordered to understand the quantity or number of eggs/follicles in the ovary. Although AMH does include egg quantity in PCOS, it also reflects the function of the ovary in PCOS. In PCOS there are more follicles and each follicle makes more AMH! In PCOS, AMH tends to fluctuate depending on the patient’s condition.
There are 3 criteria used to diagnosis PCOS:(1)
1) Irregular cycle or no cycles
2) Androgen excess -either in lab work or symptoms (basically hormones like testosterone are too high)
3) Polycystic ovaries on ultrasound OR…. HIGH levels of AMH on blood work.
The ultrasound method of diagnosis has long been controversial as the “cysts” seen on ultrasound are actually follicles (eggs), which haven’t gone through the normal development process and can be a normal finding in younger patients. AMH, however, remains elevated in PCOS even when the ultrasound is not positive.
AMH is age dependent and normally goes down with age, but is generally, NOT a good predictor of getting pregnant naturally. Most of the the time, AMH is ordered to see what kind of success or response the patient would have using assisted reproductive technology (ART), like IVF. I have had numerous patients who had a suboptimal or low AMH based on their age. We spend some time talking in their visit on the ranges of AMH and what potentially it could mean for them if they chose to do ART. Some tears have been shed and then the next month or two, that same patient is pregnant, naturally!! AMH levels are low in women with diminished ovarian reserve, however, it’s very important to remember that AMH is not a good predictor of getting pregnant in the wild (naturally) or cannot tell you anything about your egg QUALITY.
We now know to also include AMH to also see if a patient has PCOS in their fertility work up. If AMH is 2-3X higher than excepted for someone’s age, then PCOS is likely along 1 or 2 listed criteria above. When looking at AMH, age is key -a level that is normal in your 20s would be considered high in your 40s.
If you need help understanding your AMH level or wonder if you have PCOS, book in for a fertility initial visit! Knowledge is power. Understanding your labs can be very helpful and shed more light on your health and fertility journey.
References:
1) American Society of Reproductive Medicine -Recommendation from the 2023 International Evidence Based Guideline for the Assessment and Management of PCOS.