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Alternatives to the AMH Fertility Test

We recently wrote an educational article on the Anti-Mullerian Hormone (AMH) Fertility Test, explaining why a woman trying to conceive should take it. While cutting-edge fertility treatments, advanced embryology, and cryopreservation (egg freezing) can provide women with the ability to control their reproductive destiny, fertility does not last forever. Despite amazing breakthroughs in reproductive medicine and alternative family planning, a woman’s age is still the greatest determining factor in her ability to become pregnant.

The AMH fertility test is a critically important test that allows women to accurately track their reproductive potential. Furthermore, the Anti-Mullerian Hormone is widely considered to be the optimal blood test to assess a woman’s supply of follicles in her ovary. However, there are many alternative fertility tests to AMH that are currently used to assess the supply of follicles in ovaries. Unfortunately, each of these fertility tests come with serious drawbacks.

The Follicle Stimulating Hormone (FSH) and Estradiol Test

The most common of these tests is Follicle Stimulating Hormone (FSH) and Estradiol, which are measured on the third day of the menstrual cycle. There are several disadvantages to this test.  First, this fertility test is time sensitive – that is, it must be performed on either the second, third, or fourth day of the menstrual cycle. On the other hand, the AMH fertility test can be measured any time of the menstrual cycle. Second, Day 3 FSH & Estradiol results become abnormal once the supply of follicles in the ovaries has diminished substantially. Therefore, it is possible to have a somewhat low reserve of follicles but a normal Day 3 FSH & Estradiol result. This provides a woman with a false reassurance that she has an ample supply of follicles and thus, ample time to become pregnant. In contrast, AMH decreases with the gradual decline in the supply of follicles over time. Studies have shown that AMH is the earliest indicator that the supply of follicles is diminishing. Finally, Day 3 FSH & Estradiol levels from one menstrual cycle may be different from the levels repeated at a subsequent menstrual cycle. While studies suggest that the highest FSH value is most predictive of egg quantity, a woman may be falsely reassured if she sees a subsequent lower FSH value. The value of the AMH fertility test, however, remains comparatively constant cycle-to-cycle.

The Fertility Test for Antral Follicle Count (AFC)

Another common test used to assess the reserve of follicles is measuring the number of Antral follicles visible on transvaginal ultrasound. The Antral follicles are those which have the ability to grow into mature follicles each month. The greater the number of follicles in the ovary, the greater the number of Antral follicles seen on ultrasound. Therefore, the AFC fertility test is a reflection of the total reserve of follicles present.  AFC is a good test of a woman’s ovarian supply of follicles and can be performed any time of the menstrual cycle.  However, there are some serious disadvantages to Antral follicle count.

First, acquiring the information requires a vaginal ultrasound, whereas measuring the Anti-Mullerian Hormone requires only a blood test. Second, it is natural for the number of Antral follicles to vary monthly. This means that the AFC count may not be a consistent indicator of total follicle reserves. In contrast, AMH levels show little monthly change. Third, the AFC fertility test is subjective because it is merely a measurement of Antral follicles actually seen. Therefore, different doctors measuring the same ovary at the same time may count slightly different numbers of Antral follicles. AMH, however, is an objective fertility test performed by measuring the level of the hormone in the blood. Therefore,  the result is not subjectively determined by the medical professional administering it.

If you would like more information regarding fertility treatment or the AMH test, please contact the expert team at Lane Fertility Institute today.

This is a revised article based on “Anti-Mullerian Hormone Why You Should be Asking for This Test” by Susanna J Park, M.D. in the Summer 2012 issue of Lane Fertility Magazine.

Dr. Danielle Lane Danielle E Lane, MD, Reproductive Endocrinology and Infertility Specialist

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