Wonder Woman: Hormone Tests Women for Fertility

 INTRODUCTION:

There is a hormone test used to read women's fertility called the 'Anti-Mullerian hormone' or 'egg timer' test. Anti-Mullerian hormone gives women a rough estimate of the number of eggs she will have for each month that are viable. Just not to be confused, this test provides women with the knowledge of how many eggs she has, however NOT the quality of her eggs. The results of this test help specialists and pathologists an idea of what drugs best qualifies for each and every women specifically. (A)
 
Anti-Mullerian hormone (or AMH) is produced by granulosa cells in ovarian follicles. Made in the primary follicles, where the follicles are microscopic and are unable to be seen with an ultrasound. AMH production is highest in the pre-antral and small antral stages of development. As the follicles grow, production of AMH decreases then eventually stops. Once the follicles reach over 8mm, there is no more production of AMH. Levels of AMH are constant and an AMH test can be performed on any day of the woman's cycle. (B)

Because AMH is produced in the small ovarian follicles, blood levels of this substance have been used to attempt to measure the size of the pool growing follicles in women. Research has shown that the size of the pool growing follicles are heavily influenced by the size of the pool of those remaining primordial follicles. Subsequently, AMH blood levels are used as a close estimate of the size of the remaining egg supply/ ovarian reserve. A Normal AMH level would be. There are some problems involved with interpretation of AMH hormone levels. Because the test has not been in routine use for many years, the levels considered to be "normal" are not yet clarified and agreed on by all experts. (B)

Ovarian Reserve Testing Methods: Anti mullerian hormone is one potential test of ovarian reserve. There are other tests that are currently used for evaluation of the remaining egg supply. None of the tests are perfect, and fertility specialists will often use a combination of tests to try to get a better estimate of the size of the remaining egg supply.( Note: Anti mullerian hormone has also been referred to (mostly in the past) as "mullerian inhibiting substance", or MIS.) (B)

As women age, the remaining microscopic follicles decreases, their blood AMH levels, and number of ovarian antral follicles visible on the ultrasound also decreases.  Women with high AMH hormone values and those that have few follicles remaining are close to menopause and have low AMH level.s Women with higher AMH levels respond better to ovarian stimulation for IVF and have more eggs retrieved. Having more eggs gives a higher success rate. (B)

For over a decade this test is responsible for inaccurate readings of women's fertility. Study from Australia told informed the public about this alarming news. However, fertility experts are saying not to panic because the Anti-Mullerian hormone test has been indeed taken off the market 3 years ago and hasn't been used since. This test has been replaced by much more accurate and updated versions. (A)

Within 'The Journal of Assisted Reproduction and Genetics' the fertility treatment organization Genea published their study of comparing the original test and protocol with the new revised test and protocol. The results showed that the original protocol underestimated fertility by an average of 68%. The Genea Study was the first to use natural conception levels to create an Anti-Mullerian reference range. (A)

RESEARCH:

The study involved 492 women whose analyzed Anti-Mullerian hormone levels showed that they were able to naturally conceive being of ages 20 to 44 years old. This group of women used the original and revised Gen II tests. The results showed and subsequently added to the existing evidence that the inaccuracies of the original test were in fact a reality. (A)

The VP of Fertility Society of Australia and professor of obstetrics and gynaecology at the University of NSW, Michael Chapman, states that, “However, I would say that Anti-Mullerian hormone test results should always be interpreted by a specialist, because it’s not a black-and-white test and should not be interpreted as such,” He assures women that the current methods of testing have been proven accurate to give stable results. Other factors are also considered beyond this test because fertility specialists will always get a few surprises of women's hormone levels here and there including their response to drugs given to them specifically for their hormone levels. (A)

CONCLUSION:

The Genea medical director, Professor Mark Bowman, strongly suggests that women, although the current tests are relatively stable with accurate readings, should always get expert input either through the pathologists and the interpretation of specialists so that the results they get does not shock or give them any unnecessary panic. (A)

LINKS:
(A)http://www.theguardian.com/society/2015/dec/18/womens-fertility-underestimated-by-68-in-highly-inaccurate-hormone-test
(B) http://www.advancedfertility.com/amh-fertility-test.htm


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