AMH Decline from 71 to 45: Clinical Significance
Yes, an AMH of 45 pmol/L remains markedly elevated and is still consistent with polycystic ovarian morphology (PCOM), though the decline from 71 to 45 pmol/L over 10 months is noteworthy and warrants clinical attention.
Current AMH Level Interpretation
Your current AMH of 45 pmol/L is substantially elevated compared to normal reference ranges:
- Diagnostic thresholds for PCOM range from 20-57 pmol/L across different studies, with most guidelines using cutoffs between 30-50 pmol/L 1
- An AMH of 45 pmol/L places you well above the typical threshold for PCOM diagnosis 1
- This level remains in the range associated with polycystic ovary syndrome (PCOS) features, where AMH levels are characteristically 2-3 times higher than age-matched controls 1
Significance of the Decline
The 36% decrease (from 71 to 45 pmol/L) over approximately 10 months is clinically meaningful:
Natural AMH Fluctuations
- AMH can fluctuate throughout the menstrual cycle, particularly in young women, with variations of 17-23% being documented 1
- However, your 36% decline exceeds typical physiologic variation 1
Potential Explanations for Decline
Hormonal suppression or treatment effects:
- If you were taking combined oral contraceptives during this period, AMH levels can decrease by 17-23% 1
- Pregnancy causes significant AMH suppression, with levels dropping progressively through each trimester 2
Age-related decline:
- AMH naturally declines with age in all women, with the rate of decline accelerating after age 25 1
- The correlation between age and AMH is strong (r = -0.83 to -0.93) 1, 3
Ovarian reserve changes:
- AMH directly reflects the primordial follicle pool size (r = 0.83-0.93) 3
- A decline in AMH indicates a reduction in the number of growing follicles, which correlates with the primordial follicle pool 3
Clinical Implications
For fertility potential:
- Despite the decline, your AMH remains elevated, suggesting preserved ovarian reserve 4
- AMH levels above normal ranges do not predict better fertility outcomes; rather, very low AMH (<0.7 ng/ml or ~5 pmol/L) is associated with reduced fertility 5
- Your current level of 45 pmol/L is far above any threshold associated with diminished fertility 5
For PCOS/PCOM diagnosis:
- Both values (71 and 45 pmol/L) remain diagnostic for PCOM 1
- The decline does not exclude PCOS, as AMH levels in PCOS women can vary but typically remain elevated 1
Monitoring recommendations:
- Repeat AMH measurement in 6-12 months to establish a trend 1
- Ensure measurements are taken at consistent points in your menstrual cycle to minimize variability 1
- Correlate with clinical symptoms: menstrual regularity, hyperandrogenism signs, and metabolic parameters 1
Important Caveats
- AMH assays can vary between laboratories and methods; ensure the same assay type was used for both measurements 4
- A single decline does not predict premature ovarian insufficiency at your current elevated levels 6
- Women with AMH <8 pmol/L before age 36 have a 17% risk of premature ovarian insufficiency within 5-10 years, but your level of 45 pmol/L is nowhere near this threshold 6
The decline is noteworthy enough to warrant continued monitoring, but your current AMH level remains substantially elevated and does not suggest any immediate fertility concerns.