What are the indications for the Anti-Mullerian Hormone (AMH) blood test?

Indications for AMH Blood Test

AMH testing is primarily indicated for assessing ovarian reserve in women ≥25 years, predicting ovarian response to IVF stimulation, and as a potential adjunct (though not replacement) for diagnosing polycystic ovary syndrome (PCOS).

Primary Clinical Indications

Ovarian Reserve Assessment

• AMH is most reliable in women ≥25 years where it inversely correlates with age and provides information about remaining reproductive lifespan 1
• The American Society for Reproductive Medicine recommends AMH as a clinically useful marker of ovarian reserve in this age group, though antral follicle count (AFC) by transvaginal ultrasound remains the most established primary method 1
• AMH should NOT be used routinely for preconception counseling in young, fertile women under 25 years due to limited value and potential fluctuations in this population 2

Assisted Reproductive Technology (ART) Planning

• AMH is highly valuable for predicting ovarian response to stimulation and selecting appropriate gonadotropin dosing protocols 3
• It helps identify women at risk for ovarian hyperstimulation syndrome (OHSS) or poor ovarian response, allowing protocol optimization 3, 4
• There is a linear relationship between AMH levels and oocyte yield after ovarian stimulation 5

PCOS Evaluation

• AMH serves as a potential alternative or adjunct to ultrasound for detecting polycystic ovarian morphology (PCOM), particularly when ultrasound is not accessible or acceptable 6
• Women with PCOS show markedly elevated AMH levels due to increased small antral follicles 5
• However, the Endocrine Society emphasizes that AMH should not yet replace established PCOS diagnostic criteria (oligoanovulation, hyperandrogenism, polycystic ovaries on ultrasound) due to significant overlap in AMH levels between women with and without PCOS 7
• AMH must NOT be used for PCOS diagnosis in adolescents within 8 years of menarche due to overlap with normal physiological values 7

Post-Treatment Ovarian Function Assessment

• AMH is recommended for evaluating ovarian reserve in cancer survivors treated with alkylating agents and/or radiotherapy 1
• It is useful for assessing gonadotoxic treatment impact and organizing fertility preservation strategies 3
• AMH can identify women at risk for premature ovarian insufficiency (POI), though there are no validated studies for AMH in diagnosing POI itself 1

Fertility Preservation Counseling

• AMH helps evaluate ovarian reserve before and after treatments potentially toxic to the ovaries 3
• It assists in determining appropriate timing and strategies for fertility preservation 3

Age-Specific Considerations

Women ≥25 Years

• AMH interpretation is most reliable with validated normative data available 1
• Provides meaningful information about ovarian reserve and reproductive lifespan 1

Women <25 Years

• AMH has limited clinical value and should be interpreted with extreme caution due to potential fluctuations throughout the menstrual cycle 1, 2
• No evidence supports that low AMH indicates reduced fertility in this age group 2

Adolescents

• Ultrasound should not be used for PCOS diagnosis within 8 years of menarche, making AMH potentially useful, but current guidelines do not support AMH use in this context either 6, 7

Important Clinical Caveats

Assay Limitations

• The lack of an international standard for AMH limits comparison between different assays, and direct comparison of results remains problematic 1
• AMH assays display differential responses to pre-analytical factors and show appreciable sample-to-sample variability 6
• Assay techniques continue to evolve, and technical issues persist 5

What AMH Does NOT Predict

• AMH does not predict live-birth chances after IVF 4
• AMH does not predict chances of spontaneous pregnancy 4
• AMH does not predict success rates of ovarian stimulation with or without intrauterine insemination 4

Inappropriate Uses

• At-risk postpubertal females without signs of POI who desire fertility assessment should be referred for specialist consultation rather than relying on AMH alone 1
• AMH should not be used as a standalone diagnostic test for PCOS given significant overlap with normal values 7
• Routine AMH testing for preconception counseling in young, fertile women is not supported by evidence 2

Clinical Context Requirements

• Age-specific reference ranges are essential when interpreting AMH levels, as values naturally decline with age 7
• AMH levels can fluctuate throughout the menstrual cycle, particularly in young women 1
• Prolonged oral contraceptive use may influence AMH levels and should be considered in clinical assessment 5