Ovarian Reserve Assessment (AMH or AFC)

“Doctor, I am CEO of a company. I am 38 and have taken many fertility treatments which were not  successful. I have this blood test showing low AMH, what does it mean? I wanted to have test tube baby treatment but what are my chances of success?”. 

Blood tests confirmed a very low ovarian reserve with low AMH and ultrasound showed a smaller number of follicles, AFC (Antral Follicle Count) was 3.

It’s a very common practice to consult a fertility expert after a long period of halfhearted or inadequate treatments when already a lot of precious time has been wasted. Many women come to seek help near or above forty; there are also rare cases of fertility consultation above 45 years. What do you think is the actual problem? Is it ignorance about fertile age period and ovarian reserves? or lack of awareness about the importance of age factor on success rate of any fertility treatment?

This blog would guide you about fertility assessment by calculating ovarian reserve through important parameters of age, blood test of AMH (Anti-Mullerian Hormone ) and ultrasound guided count of ovarian follicles showing (AFC). This will also give answers to many commonly asked questions regarding fertility issues:

How common is fertility issues?
About 12 to 15 % of couples have problems in conceiving, now a days an increase in this percentage is noticeable.

Who is responsible for fertility problem?
Both, men and women both are equally responsible for problems of conception.

How important is age factor affecting fertility?
Age is the most sensitive factor affecting fertility of both women and men.

Does age affect both man and women?
Yes, the quality of genetic material of both eggs and sperms is affected with passage of time.

Why should one know about fertile period?
Every individual is different, fertile age time frame is also variable. If you have information about your internal clock, then it would be easy to plan a family.

What is ovarian reserve?
Every female is born with 2 million eggs, whose number and quality decline with age. Ovarian reserve estimates the total life time supply of eggs.

How ovarian reserve is estimated?
It is estimated by blood levels of Anti-Mullerian Hormone (AMH) and Antral Follicle Count (AFC ).

What is AFC?
It is counting total number of visible ovarian follicles on pelvic ultrasound scan.

What is AMH?
It’s a hormone which is absent in fetal life therefore, Mullerian ducts differentiate into uterus, fallopian tubes and upper part of vagina.

When and from where AMH is produced?
It is secreted after birth, from granulosa cells of ovaries (primary and secondary follicles). It  controls follicle recruitment, growth and development. It also inhibits continuous recruitment of follicles from resting pool of follicles.

Why to know about AMH?
It tells about the bank statement of ovarian reserve by giving information of actual number of eggs in ovaries at that time. It also predicts ovulatory potential of a women.

What is the significs of level of AMH?
It not only gives the true picture of number of eggs and best time to start planning a pregnancy but  also predicts the outcome of fertility treatments.

How accurate is AMH or AFC or age in predicting ovarian reserve?
AMH has proven to be the best predictor of ovarian reserve as compared to AFC and FSH (Follicle Stimulating Hormone) and age. Various scientific studies have proven more significant relationship between age and AMH as compared to AFC and age. 

How levels of AMH predict fertility treatments?

It’s values predict fertility treatment outcome:

How age affects AMH levels?

It starts declining with age, and there is a sharp decline after 35 years.

How AFC predicts treatment outcome?

These predict outcome of treatment: 

Remember, AMH is a useful parameter for predicting ovarian reserve and counselling women about reproductive lifespan and planning of tailored fertility treatment protocols.

Dr. Ayesha Azam Khan