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Here we will have links to articles and medical organizations that can provide additional information on our specialties and a guide to understanding Anti Mullerian Hormone Levels and Antral Follicle Counts. Please note that the tables are only a guide to potential fertility and other factors such as maternal age and other fertility issues need to be considered.

Informational Links

BBC Health Information on Fertility

Childless Not By Choice

Infertility Network UK

Menopause Matters

ANTI MULLERIAN HORMONE - REFERENCE RANGES

AMH LEVEL (pmol/L)

OVARIAN FERTILITY POTENTIAL

0.0-2.2

Very Low Ovarian Reserve

2.2-15.7

Low Ovarian Reserve

15.7-28.6

Satisfactory Ovarian Reserve

28.6-48.5

Excellent Ovarian Reserve

Over 48.5

Suspicion of Polycystic Ovarian Syndrome (PCOS) or Granulosa Cell tumours rather than good ovarian reserve. Further investigation advised including transvaginal ultrasound scan of the ovaries.

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Anti-Müllerian Hormone (AMH)

A Useful Marker for Ovarian Reserve in Practice


Since a considerable proportion of subfertility is due to postponement of childbearing, measurement of ovarian reserve is of interest to women in general. AMH is becoming increasingly used in General, Oncology and Assisted Reproduction Practice. Assessment of ovarian reserve may provide insight into the remaining number of fertile years a woman has or may predict ovarian reserve prior to IVF treatment.

Ovarian reserve decreases in pre-menopausal women as the quality and number of ovarian follicles decline with age, resulting in the decrease of a woman’s reproductive function. AMH is a hormone marker for quantitative prediction of ovarian reserve, ovarian aging, ovarian dysfunction and ovarian responsiveness.

AMH levels correlate with the number of antral follicles. Women with lower AMH and antral follicular counts produce a significantly lower number of oocytes compared with women with higher levels. Fertilisation rates in women with lower AMH levels would seem significantly inferior compared with women with higher AMH levels, irrespective of the method used to achieve assisted fertilisation. Women with low AMH levels have fewer oocytes, have lower fertilisation rates, generate fewer embryos, and have a higher incidence of miscarriage during fresh transfers, ultimately culminating in a halving of the pregnancy rate per IVF cycle compared with women with high AMH levels***. When compared to using FSH and age, AMH acts as a superior predictor of live birth and anticipated oocyte yield.

AMH levels cannot measure the actual number of oocytes, but it strongly correlates with the size of the ovarian follicle pool. With AMH, clinicians have a reliable serum marker of ovarian response that can be measured independently of the day of the menstrual cycle (as opposed to FSH and Inhibin B which must be taken on Day 3) and which does not correlate with lifestyle factors (smoking, body mass index, alcohol consumption, ethnic origin, chronological age), or reproductive history (age at menarche, years since menarche and gravidity)****. Findings such as premature ovarian failure can be effectively diagnosed by unexpectedly low AMH levels and in instances of Polycystic Ovary Syndrome (PCOS), a well recognised endocrine disorder in women of reproductive age, a two or three fold increase in the number of growing follicles would be reflected in a two or three fold increase in the serum AMH levels.

It would seem that serum AMH is one of the best hormone markers to assess the quantitative aspect of ovarian reserve or dysfunction* Measuring AMH cannot predict whether a woman is able to become pregnant – there are other important factors that have to be taken into account – lifestyle, infection, genetic abnormality, quality of sperm and other male factors – but it is considered the best hormone to date to identify her potential reproductive capacity.


*    Fertil Steril. 2005; 83(4):979-87 (ISSN: 1556-5653)**     Hum Reprod. 2007 Mar;22(3)
***    Human Reproduction 2007 22(9):2414-2421; doi:10.1093/humrep/dem204
****    Reprod Biomed Online. 2007 May;14(5):602-10/Fertil Steril. 2007 Jan;87(1):223-6.




SAMPLE  TAKEN ANY TIME IN CYCLE
Gold/SST Bottle
REPORTING TIME 5 DAYS

Medical Links

London Women's Clinic - Cardiff

Royal College of Obstetricians and Gynaecologists

Human Fertilisation and Embryology Authority(HFEA)

ANTRAL FOLLICLE COUNT - REFERENCE RANGES

TOTAL NUMBER ANTRAL FOLLICLES

OVARIAN FERTILITY POTENTIAL

Under 4

Extremely low count
High risk of poor fertility

5-7

Very low count
Possible fertility issues soon

8-11

Intermediate count
Possible fertility issues even now or soon

12-14

Low end of normal range
Fertily issues may occur as count drops

Over 14

Normal count
Good fertility potential at present

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Egg freezing


Two of Britain’s leading fertility clinics launched  new egg freezing programmes in September 2007 designed for women who wish to postpone motherhood to pursue a career or find the right partner. It could transform women’s lives in a similar way to the con-traceptive pill by enabling them to beat their biological clocks and pick the moment in their lives when it best suits them to start a family.  It is expected this service will be available from the London Women’s Clinic in Cardiff from summer 2009.

The programmes have been made possible by a breakthrough in freezing technology that almost eliminates the risk of damage to eggs. Until now, egg freezing has largely been restricted by doctors to cancer patients left infertile by chemo-therapy. Clinics believed the success rates of the technology were so low that it was unethical to advise healthy women to use egg freezing for social reasons. Doctors feared the women would sacrifice their chance of conceiving naturally and later discover their frozen eggs were too damaged to use.

Now, however, new techniques with far higher success rates have been developed, and the two clinics believe they make it ethically justified to offer a service aimed at career women.

The clinics say the eggs frozen through techniques known as vitrification emerge from years in storage in almost the same condition as when they were released from the ovaries. Egg freezing costs between £25,00 and £3,000 per cycle.


Dr Simon Fishel, managing director of Care Fertility, which has 10 fertility clinics across Britain and will be marketing a new type of egg freezing to all women, said: “Until now, the conventional technology has been used to freeze eggs mainly only as a dire last resort for women who are preserving fertility before cancer treatment.
“With this new technology, which is almost as efficient as using fresh eggs, it might make a lot of sense for women in their twenties to have their own bank of eggs stored if they are not considering having a family until their late thirties. This new technology makes it ethical for us to offer egg freezing to all women.”


In Japan, where vitrification techniques were developed, scientists have shown that 90%-95% of eggs can survive the new freezing method compared with 50%-60% using conventional methods.
Vitrification has shown pregnancy rates of 30%-40%, which is comparable to the use of fresh eggs. The technique involves removing water from the eggs then freezing them at high speed in liquid nitrogen to prevent any damaging crystals from forming.


Professor Gedis Grudzinskas, medical director of the Bridge Fertility Centre, the second clinic launching a social egg freezing programme, said: “The contra-ceptive pill gave women more choice about when they started their families. Egg freezing now gives women the chance to delay having children until the time that is right for them.”


Doctors believe that, with the availability of more successful methods, thousands of British women over the next five years will freeze their eggs to postpone starting a family until it is more convenient. Egg freezing costs between £2,500 and £3,000 per cycle.


British clinics rarely implant eggs in women aged over 50, but postmenopausal women could take their frozen eggs for IVF treatment in countries with more lax approaches
.

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