Times of India
14 April 2010
Mumbai, India

New Test Touted As Best Indicator Of A Woman’s Egg Reserves
It’s a number that women who want to have a baby should perhaps know: Her AMH score that can tell how far she can delay childbirth. In an age when late motherhood is more the norm than an exception, medical advances have brought forth a simple blood test that could indicate whether or not a woman should be worried about her ticking biological clock.

Some doctors feel that the blood test to determine the Anti–Mullerian Hormone (AMH) levels could just be the best indicator of a woman’s egg reserves. “If a woman is over 32 and wants to postpone childbearing, she should get this test done,” says infertility specialist Dr Aniruddha Malpani. “If her score is low, she may want to re–think her priorities. If it’s normal, she can postpone childbearing but repeat the test every year,” he adds. In other words, if her AMH level drops over consecutive years she should pay attention to her biological clock.

Twenty–nine–year–old Kranti Shah (name changed) confesses she hasn’t heard about the AMH test. “But it sounds like an easy way to settle a worrisome issue,” she says. Ovarian reserve is a measure of a women’s fertility. While tests have been available in the past as well to indicate this, doctors say that the AMH levels are by far the most accurate (see box). “The AMH test is good. It has been available in India for a year now,” says infertility expert Dr Hrishikesh Pai, who heads the Mumbai Obstetrics Gynaecological Society. The test is also being marketed across the world as an indicator of fertility.

He regularly recommends it to women who come to him for infertility treatment. “It serves as an excellent marker to decide whether a woman should be given stronger stimulation for egg production or not,” he says, adding it is a good prognostic tool to indicate whether the infertility treatment will work or not.

But can it be used as a screening tool for women who want to decide when to get pregnant? Dr Pai is not so sure. “It is the best test to indicate ovarian reserve, but it is not a 100% marker on fertility. I wouldn’t recommend it as a stand – alone test,” he says. Gynaecologist Dr Duru Shah says she would recommend the AMH test to woman in her 30s who is concerned about delaying motherhood. “But I would ask her to do three other tests as well. She should undergo two blood tests – FSH (follicle stimulate test) and E2 (estradiol or sex hormone levels) – and an ultrasound scan. Only then will she get the perfect picture about her fertility,” says Dr Shah.

But Dr Malpani points out that the AMH test has another plus point. “It can be done any time of the month while the other tests have to be done on specific days of the woman’s monthly period,” he says.

Auto–Mullerian Hormone Test
The Auto–Mullerian Hormone (AMH) test is a blood test that can be done any time of the month. It costs roughly around Rs 1,500 and is done only at a few laboratories
PROS: The AMH test is used to evaluate fertility potential and ovarian response in women undergoing infertility treatment. Its USP is that women, especially in their ’30s, can use it to monitor their biological clock

The Auto–Mullerian Hormone is directly produced by the ovarian follicles. Its levels thus correlate to the number of follicles–these are enclosures for developing the ova–present in the ovary. Tests have shown that women with lower AMH score have lower antral follicular counts and thus produce a lower number of oocytes compared with women with higher levels

• Results: Healthy women, below 38 years old, with normal follicular status at Day 3 of the menstrual cycle, have AMH levels of 2.0 6.8 ng/ml (14.28 48.55 pmol/L).
• Caution: As this is a relatively new test, some doctors remain sceptical. They say that the AMH test should be done along with two other blood tests – the FSH value (follicle–stimulating hormone) and the Estradiol (a measure of the sex hormone or level of the major estrogen) as well as an ultrasound scan done on the third and sixth day of their menustral cycle respectively.