Anti-Müllerian Hormone

What Does AMH Measure?

  • AMH (Anti-Müllerian Hormone) is produced by granulosa cells in small follicles in the ovaries.
  • It reflects the number of “recruitable” eggs remaining – the ovarian reserve.
  • AMH can be measured any time during the menstrual cycle.

 What AMH Does Not Tell You

  • AMH does not reflect egg quality.
    • Egg quality depends primarily on age (e.g., chromosome distribution, mitochondrial function).
    • A 42-year-old woman may have a “normal” AMH level, but still lower egg quality and a higher chance of failed fertilization or miscarriage.

 What Are Normal AMH Levels?

(May vary slightly by lab – applies to women of reproductive age)

AMH (ng/ml)

Interpretation

> 3.0

Very high ovarian reserve (e.g., PCOS)

1.0 – 3.0

Normal reserve

0.7 – 1.0

Borderline low

< 0.7

Low reserve (e.g., early ovarian insufficiency)

 AMH < 1.0 ng/ml may indicate reduced fertility, but many women still conceive naturally or with help.

 Additional Tools to Assess Fertility

  • Antral follicle count (AFC) via ultrasound
  • FSH & LH levels (measured on day 3 of the cycle)
  • Woman’s age
  • Possibly genetic diagnostics or egg vitality tests during IVF

 AMH in IVF Treatment

AMH is key to:

  1. Estimating ovarian reserve
    • Higher AMH → more follicles can respond to hormone stimulation
    • Lower AMH → careful stimulation needed to get a decent response
  2. Dosing of stimulation hormones (FSH)
    • AMH helps set the starting dose of meds like Gonal-F, Puregon, Menogon
    • Goal: Optimal egg count without overstimulation (OHSS)

 Example Dosing Guidelines:

AMH (ng/ml)

Reserve

FSH Starting Dose (approx.)

> 3.5

Very high (PCOS)

100–150 IU (low dose)

1.5–3.5

Normal

150–225 IU (standard)

< 1.5

Low

225–300 IU (higher dose)

(IU = International Units)
Final dose depends on age, weight, AMH, AFC, and past cycles.

 Why It Matters

  • Too high dose + high AMH → Risk of OHSS (Ovarian Hyperstimulation Syndrome)
  • Too low dose + low AMH → Poor response; few eggs, possibly no retrieval

 IVF vs. ICSI – What’s the Difference?

For the woman: No difference.
Both require:

  • Hormone stimulation
  • Injections
  • Ultrasounds
  • Egg retrieval (puncture)
  • Embryo transfer

Difference is in the lab:

  • IVF: Sperm and egg are placed together in a dish
  • ICSI: A single sperm is injected directly into the egg

 Why Not Just Do ICSI Every Time?

  1. ICSI is more complex in the lab
    • Requires more time, skill, and equipment
    • Often costs more (for lab and patients)
  2. Nature should play a role when possible
    • If no fertilization issues are known, IVF lets the sperm compete naturally
    • Slightly higher risk of minor health issues has been observed with ICSI (though still rare)
  3. IVF works well when both sperm and eggs are normal
    • If IVF fails, ICSI can be used in the next cycle

 When Is ICSI the Better Choice?

  • Poor sperm quality
  • Previous IVF attempt without fertilization
  • Repeated failed attempts
  • Use of frozen sperm
  • Genetic testing required (e.g., PGT)

 IVF vs. ICSI – Stats from Germany (DIR 2023 Report) Number of Treatments (2022)

  • Total cycles: ~131,000
  • 64.1% started with fresh egg retrieval
  • ICSI more common than IVF:
    • ICSI: 49,181 cycles
    • IVF: 21,066 cycles

 Pregnancy & Birth Rates per Embryo Transfer

Method

Pregnancy Rate

Birth Rate (“Take-home baby”)

IVF

~33%

~23.4%

ICSI

~33%

~19.1%

Age Impact on Success

  • <35 years: ~40% pregnancy, ~30% birth rate
  • 35–40 years: ~30% pregnancy, ~20% birth rate
  • >40 years: ~17% pregnancy, ~8.4% birth rate
  •  

 Twin/Triplet Rates

  • Dropped significantly due to single embryo transfers:
    • Fresh cycles: From 22% (2017) → 12% (2022)
    • Frozen cycles: From 15% → 8%

 Lifestyle & Supplements for Egg/Sperm Quality

  • For women & men:
    • Antioxidants: CoQ10, Omega-3, Vitamin D, Folate, Myo-Inositol
    • Healthy sleep, nutrition, and stress reduction
    • For men: L-carnitine, Zinc, Selenium, Vitamins C & E

 Advanced Lab Options

  • Time-lapse embryo monitoring (e.g., EmbryoScope)
  • Assisted hatching: Thinning the egg shell to help implantation – often used in older women or with frozen embryos

 Final Thoughts

  • IVF and ICSI have comparable pregnancy rates.
  • ICSI does not increase birth rates significantly, even though it can improve fertilization rates.
  • The choice between IVF and ICSI should be individual, based on medical factors and discussed with your fertility specialist.