The role of anti-Müllerian hormone testing for fertility prognosis

There is a growing demand for fertility care in British Columbia and an associated interest in ovarian reserve testing. Anti-M & uuml;llerian hormone (AMH) testing is a validated marker and one of the few direct measurements of ovarian reserve; AMH levels are stable throughout the menstrual cycle, and it is a readily accessible biochemical test in BC. Despite these advantages, providers must acknowledge that although AMH levels can be used to estimate the quantity of oocytes remaining, they cannot be used to estimate their quality. Furthermore, AMH levels are artificially lowered in women who are taking combined oral contraceptive pills, and this effect may be seen for up to 2 months after discontinuation of such pills. Clinical scenarios in which AMH testing is a helpful tool include predicting response to controlled ovarian stimulation, titrating gonadotropin dosing in controlled ovarian stimulation, and supporting a diagnosis of polycystic ovary syndrome in adults. However, AMH testing should not be used to predict natural fertility, exclude patients from assisted reproductive technology, or predict age of menopause. It is, therefore, important to carefully consider the clinical question being asked when ordering AMH testing.