Ovary reserves are assessed by a test called Anti Mullerian Hormone. In conventional language or the Doctor’s language, it is also known as AMH Hormone. This is a blood test done to check the ovarian reserves of a woman. AMH is a beautiful hormone that is very accurate and it has no day-to-day variability and it can be done any time of the menstrual cycle. In the earlier days, ovary reserves were checked by some tests on the 2nd day of the menstrual cycle like the FSH hormone, the LH hormone, and the estrogen levels.
Subsequently, with the advent of the AMH test, the concept of ovarian testing has become simpler and the main reason for it becoming simpler is, it can be done any time of the day and any time of the menstrual cycle. Unlike in FSH hormone where it should be done on the 2nd day of the menstrual cycle, this test can be done at any time. The 2nd aspect is after the first and 2nd generation testing, in the current generation of AMH technology, the test has become very robust and repeatable, qualitatively and quantitatively accuracy is very high. This is also known as positive predictability, sensitivity, and specificity.
The normal Anti-Mullerian hormone levels are between 1.5 ng/mL to 5.0 ng/mL. if a person has less than 1.5 ng/mL, then they are considered on the lower side of the anti-Mullerian hormone, and in that situation, they should do not delay the pregnancy. If their Anti-Mullerian hormone is less than one, then they should not postpone their pregnancy more than six months to a year, because it will make a huge difference. When the levels are less than are <0.6 ng/ml then it’s a real crisis.
In such a situation, the number of eggs we get during the IVF treatment becomes very low and the treatment gets compromised. So Anti-Mullerian hormone helps us to understand what is the current status of the woman’s hormone reserves, how much time is there, and whether early decisions for reproduction should be taken. Sometimes, the anti-Mullerian hormone is also used to diagnose a polycystic ovary. This is not universally accepted, but if the anti-Mullerian hormone is more than 5.0 ng/mL in that situation, there is a high possibility of polycystic ovary.
The reliability and repeatability of these tests have few exceptions. If it is done immediately after delivery, the levels will be low and it should not be taken. If it is done after an ovarian surgery like endometriosis again the level has reliability issues. The 3rd is after you give Gonadotropins and if you measure AMH during that time, then you might get a false result.
The 4th and the most important is, if the woman is using an oral contraceptive pill at least wait for two or three months before you do an AMH test otherwise, it gives a false value the other parameter which can help to validate AMH result is antral follicle count in the ultrasound. so in the current era, the golden standard of measuring ovarian reserves is the anti-Mullerian hormones, and sometimes a combination of antral follicle count and AMH gives a very accurate status of where things stand so whenever you have an AMH test, it is telling you where things stand in terms of ovarian reserves and this will help you to speed up your decision in certain situations.