Improving the diagnosis and management of infertility in women

Understanding the impact of testing for Anti-Müllerian Hormone (AMH)

2014.09.15-elecsys-amh

The desire to have children comes naturally to many couples, and becoming pregnant might be an easy thing to do. However, after two years of trying, some couples experience the opposite. Approximately 10 percent of all women of childbearing age are infertile, and another 25 percent will experience this situation once in their lifetime. Age is one major parameter when estimating the probability of conception. The quantity and quality of eggs declines in the mid-30s, and this process accelerates as women approach their 40th birthday.

Being infertile doesn’t mean that couples are completely unable to have children, but their chances are reduced if they try to conceive naturally. The chance of conceiving in women aged 35 and older is roughly half that of women aged 25 and younger. Common causes of infertility may also originate from diseases or defects of the reproductive organs, but in 12 percent of the cases the cause is unknown.1,2 Unexplained infertility means that a medical problem may be causing the unwished-for childlessness, but physicians are unable to identify it. For example, the more nebulous factors of stress, smoking and obesity may be a reason as it can affect ovulation.

Infertility tends not just to be a problem in either the woman or man alone; in many cases it stems from both. Experts estimate that around 50 million couples worldwide cannot conceive at all, and in general roughly 10 percent are unable to have children the natural way.3

There is no cut-off point as such when a couple finally has to accept infertility, and a diagnosis of this kind does not necessarily mean a couple is doomed to childlessness. Approximately three out of four women can fall pregnant successfully with the help of medical treatment.

Regardless of the reason, couples ride a roller coaster of emotions, as the psychological impact of presumable infertility may escalate to a true challenge. For the many of them, in vitro fertilization remains the only option. However, couples who are seeking for chances of in vitro fertilization shouldn’t act rushly. It is needed to weigh a number of factors including costs during the course of treatment and a reliable evaluation of the likelihood for conception.

Testing for Anti-Müllerian Hormone levels can help assess ovarian reserve level and adds prognostic value in determining the right course of treatment, as recent studies show that basal AMH levels are associated with ovarian response in patients who undergo in vitro fertilisation.4

In summer 2014, Roche announced its collaboration with Ferring Pharmaceuticals, with a view to combine the AMH test with one of Ferring’s gonadotrophin treatment options. Ferring’s human cell line derived follicle-stimulating hormone, currently in phase III development in combination with the AMH test,could potentially help enable healthcare professionals to improve infertility treatment by delivering a personalised dose.

What is Anti-Müllerian Hormone?
Anti-Müllerian Hormone (AMH) is produced in the small ovarian follicles of women and limits the formation of primary follicles by inhibiting excessive follicular recruitment by FSH. Measuring blood levels of this protein helps healthcare professionals assess the ovarian reserve levels of women and by doing so aids in tailoring the right course of treatment to maximize the changes of conceiving a baby . It may also be of value in identifying women with polycystic ovarian syndrome, a hormonal disorder and a cause of infertility. Testing for AMH is not the only procedure of this kind as doctors can always perform additional examinations such as ultrasound, as well as testing for other hormones such as estradiol and FSH, a hormone which helps control the menstrual cycle.



References

1) ASRM. Quick facts about infertility. Available at: http://www.asrm.org/detail.aspx?id=2322 (Last accessed June 2014).

2) CDC. National Survey of Family Growth (2006–2010). Available at: http://www.cdc.gov/nchs/data/nhsr/nhsr051.pdf (Last accessed June 2014)

3) Maya N. Mascarenhas et al. (2012): National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys; DOI: 10.1371/journal.pmed.1001356

4) Himabindu Y, Sriharibabu M, Gopinathan K, Satish U, Louis TF, Gopinath P. J Hum Reprod Sci. 2013 Jan;6(1):27-31. doi: 10.4103/0974-1208.112377