Does Anti-Mullerian Hormone (AMH) level predict ability to conceive without intervention?

AMH Does Not Reliably Predict Natural Conception Ability

Current evidence does not support using Anti-Müllerian Hormone (AMH) as a predictor of ability to conceive naturally without intervention. 1, 2

Understanding AMH and Fertility

• AMH is a glycoprotein secreted by granulosa cells of pre-antral and small antral ovarian follicles, serving as a quantitative marker of ovarian reserve 3
• While AMH accurately reflects the size of the pool of antral follicles and remaining primordial follicles, this does not directly translate to fertility potential 4
• AMH levels naturally decline with age, reaching undetectable levels approximately 5 years before menopause 3

Evidence Against AMH as a Natural Fertility Predictor

• Multiple studies have failed to demonstrate a significant association between AMH levels and natural conception rates:
  • A small initial study suggested AMH <0.7 ng/ml might be associated with lower conception probability, but larger follow-up cohorts did not confirm this finding 1
  • Women with low AMH values (<0.7 ng/ml) had similar pregnancy rates after 12 cycles of attempting to conceive as women with normal AMH values after adjusting for age 1
  • A secondary analysis of the NICHD EAGER trial including over 1,200 women confirmed no significant relationship between AMH and natural fertility 1

AMH's Clinical Utility

• AMH is primarily useful for:

  • Predicting ovarian response to stimulation in IVF treatment 2, 4
  • Identifying patients at risk of poor response or ovarian hyperstimulation syndrome 2
  • Detecting iatrogenic damage to ovarian follicle reserve 3
  • Diagnosing polycystic ovary syndrome (PCOS) as a potential alternative to antral follicle count 5

• AMH is NOT reliable for:

  • Predicting chances of spontaneous pregnancy 2
  • Predicting success rates of ovarian stimulation with/without intrauterine insemination 2
  • Predicting live birth chances after IVF 2

Relationship Between AMH and Miscarriage Risk

• Some evidence suggests a potential relationship between diminished ovarian reserve (low AMH) and miscarriage risk:
  • Meta-analysis found women with low AMH have a modestly increased risk of miscarriage compared to those with medium/high AMH (OR 1.35 [1.10-1.66]) 5
  • The absolute increase in miscarriage risk is modest - if baseline risk is 20%, low AMH would increase it to approximately 27% 5
  • This association may reflect qualitative aspects of ovarian reserve, not just quantitative 5

Age Considerations

• In women under 25 years, AMH testing has limited value as:
  • AMH rises to a peak at approximately age 25 years 5
  • There is no evidence that low AMH indicates reduced fertility or low ovarian reserve in females under 25 years 5
  • Data do not support routine AMH testing for preconception counseling in young, fertile women 5

Clinical Implications

• AMH should not be used as a standalone "fertility test" in women trying to conceive naturally 1
• Low AMH should not be used as the sole criterion for rejecting fertility treatment, especially in young patients 6
• The absence of an international standard for AMH measurement remains a key issue affecting test reliability 3

Common Pitfalls to Avoid

• Don't confuse AMH's ability to predict ovarian response to stimulation with ability to predict natural conception 2
• Don't assume a low AMH level means a woman cannot conceive naturally - no discriminating threshold has been established below which pregnancy cannot occur 6
• Don't overlook the significant individual variability in AMH levels among women of the same age 3
• Be aware that certain conditions like prolonged oral contraceptive use can influence AMH levels and should be considered in clinical assessment 3