From the Guidelines
Managing fertility issues associated with anti-Müllerian hormone (AMH) antibodies requires a multifaceted approach focused on assisted reproductive technologies, with the primary recommendation being to pursue in vitro fertilization (IVF) with individualized ovarian stimulation protocols. The approach to managing fertility issues in patients with AMH antibodies should prioritize minimizing the risk of ovarian hyperstimulation syndrome (OHSS) and maximizing the chances of successful pregnancy.
- Key considerations include:
- Utilizing higher doses of gonadotropins, often starting with 300-450 IU of follicle-stimulating hormone (FSH) daily, combined with 75-150 IU of luteinizing hormone (LH) 1.
- Implementing antagonist regimens with medications like Cetrotide or Ganirelix (0.25mg daily when lead follicle reaches 14mm) to prevent premature ovulation.
- Considering adjuvant treatments such as growth hormone (Saizen or Genotropin 2-4 IU daily during stimulation), DHEA supplementation (25mg three times daily for at least 2-3 months before IVF), or CoQ10 (600mg daily) to improve egg quality in poor responders.
- Egg or embryo banking across multiple cycles may be necessary to accumulate enough embryos for future transfer attempts.
- Preimplantation genetic testing may be beneficial to select viable embryos.
The presence of AMH antibodies can interfere with normal AMH function, which regulates follicle development and recruitment, potentially accelerating follicle depletion and reducing ovarian response to stimulation 1. As such, standard fertility treatments may be less effective, necessitating these specialized approaches.
Given the complexity of managing fertility issues associated with AMH antibodies, it is crucial to individualize treatment plans based on the patient's specific needs and circumstances, taking into account factors such as age, ovarian reserve, and medical history.
From the Research
Managing Fertility Issues Associated with Anti-Mullerian (AM) Antibodies
- The measurement of circulating anti-Müllerian hormone (AMH) has been applied to various clinical applications, mainly based on its ability to reflect the number of antral and pre-antral follicles present in the ovaries 2.
- AMH levels decline across the reproductive lifespan, and multiple studies have demonstrated that AMH levels are reflective of a woman's ovarian reserve 3, 4.
- Data exist to support the use of AMH levels for the assessment of ovarian reserve in infertile women and to select ovarian stimulation protocols in this population 3, 4.
- However, using serum AMH levels for fertility counseling in women without a diagnosis of infertility is not currently supported by data from high-quality sources 3, 4.
Factors Influencing AMH Levels
- Age, estradiol, and total testosterone have been found to influence ovarian reserve in non-polycystic-ovary-syndrome (PCOS) euthyroid women undergoing in vitro fertilization (IVF) 5.
- A significant negative correlation exists between AMH levels and age, as well as follicle-stimulating hormone (FSH) 5.
- Positive correlations exist between AMH and estradiol, and total testosterone 5.
- No significant correlations were found between AMH levels and body mass index (BMI), luteinizing hormone (LH), or 25-hydroxyvitamin D 5.
Clinical Utility of AMH
- AMH may be useful in assessing the need for fertility preservation strategies and detecting post-chemotherapy or surgical damage to the ovarian reserve 2.
- AMH can identify 'poor responders' to ovarian stimulation, but it seems inappropriate to withhold IVF purely on this basis 2.
- The lack of an international standard for AMH limits comparison between AMH assays, and little is known about endogenous and exogenous factors that influence serum AMH levels 6.