Anti-Müllerian Hormone (AMH)

Anti-Müllerian Hormone (AMH) - Assessment of Ovarian Reserve

The Center for Laboratory Medicine presents the first fully automated test, offering clinical reliability and laboratory efficiency for the assessment of ovarian reserve.

This test quantifies AMH levels in women with low ovarian reserve,⁶ with the convenience of being able to be performed at any time during the menstrual cycle.²

To take the test, simply visit one of the Germano de Sousa Group’s collection points.

On this page, you can find all the information regarding the Anti-Müllerian Hormone (AMH) test.

Infertility

A Reality in Portugal

It is estimated that between 266,088 and 292,996 women (couples)
will experience infertility at some point in their ^lives1

… and that between 116,630 and 121,059 women
are of reproductive age1

IN PORTUGAL, THE LIFETIME PREVALENCE OF INFERTILITY RANGES BETWEEN 9 AND 10%¹

It may result from one or a combination of factors 2^{, 3}

FACTORS CONTRIBUTING TO INFERTILITY2^{, 3}

1. JL Silva Carvalho; A Santos. (2009). Afrodite Study, Characterization of Infertility in Portugal, Community-Based Study. 2. ASRM. Quick facts about infertility. Available at: http://www.asrm.org/detail.aspx?id=2322 (Last accessed June 2014). 3. CDC. National Survey of Family Growth (2006–2010). Available at: http://www.cdc.gov/nchs/data/nhsr/nhsr051.pdf (Last accessed June 2014). 4. Tsepelidis S et al. Hum Reprod 2007;22:1837-1840. 5. Jirge PR. J Hum Reprod Sci 2011;4:108-113. 6. Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2012;98:1407-1415. 7. Hansen KR et al. Fertil Steril 2011;95:170-175. 8. Broekmans FJ et al. Fertil Steril 2010;94:1044-1051. 9. Iliodromiti S, Nelson SM. Biomark Med 2013;7:147-158. 10. Dewailly D et al. Hum Reprod Update 2014;20:370-385. 11. van Disseldorp J et al. Hum Reprod 2010;25:221-227.

Markers of Ovarian Reserve

An important clinical need

BIOMARKERS—FSH AND ESTRADIOL

Intra- and inter-menstrual cycle variability; assessment on day 3 and day 4
Normal levels do not rule out diminished ovarian reserve 5^{, 7}
Low sensitivity and clinical reliability

B ANTHRAL FOLLICLE COUNT (AFC)

Inter-menstrual cycle variability—assessment on days 2–4 6^{, 8}
Inter- and intra-operator/laboratory variability—difficulty in ensuring standardized results ^{8, 9}

FCA is strongly correlated with the number of primordial follicles 7

C ANTI-MÜLLERIAN HORMONE (AMH)

SERUM AMH LEVELS REFLECT THE TOTAL NUMBER OF GROWING FOLLICLES10

Serum AMH levels remain stable throughout the menstrual cycle and can be measured on any ^{day4, 11}

Assessment of ovarian reserve

An important choice

PRIMORDIAL FOLLICLE RESERVE FROM CONCEPTION TO MENOPAUSE

RESERVA DE FOLÍCULOS PRIMORDIAIS DESDE A CONCEÇÃO À MENOPAUSA

Ovarian reserve declines with age1^{, 2}
Two women of the same age may differ by a factor of 100 in the size of their ovarian reserve³^{, ⁴}
The depletion of primordial follicles marks the onset of menopause4

Infertility increases with age

COMPLEX AND TIME-CONSUMING PROCESSES

EXAMPLE OF THE JOURNEY FOR COUPLES

1. de Bruin JP, teVelde ER. Female reproductive aging: Concepts and consequences. In: Tulandi T, Gosden RG, editors. Preservation of Fertility. London, UK: Taylor and Francis; 2004. p. 3. 2. Jirge PR. J Hum Reprod Sci 2011;4:108–113. 3. Grynnerup AG et al. Curr Opin Obstet Gynecol 2014;26:162–167. 4. Wallace WH, Kelsey TW. PLoS ONE 2010;5:e8772. 5. Iliodromiti S, Nelson SM. Biomark Med 2013;7:147-158.

Clinical reliability and laboratory efficiency

First fully automated test

1 High Sensitivity

Innovative technology: Electrochemiluminescence

Test principle: Sandwich

Elevada Sensibilidade

(uses two monoclonal antibodies, one labeled with biotin and the other with ruthenium)

Wide measurement range with lower limit of detection: 0.01–23.0 ng/mL⁶^{, ⁷}

Allows for the quantification of AMH in women with low ovarian reserve 6

2 Clinically consistent with antral follicle count1

		Low	Normal	Elevated
		CFA 0–7	CFA 8–15	CFA > 15	n
Low	AMH ≤ 0.681 ng/mL	63.2%	32.4%	4.4%	68
Normal	0.681 ng/mL < AMH ≤ 2.27 ng/mL	12.0%	56.9%	31.1%	167
High	AMH > 2.27 ng/mL	1.4%	24.1%	74.5%	216
	n	66	169	216	451

3 Age-specific reference ranges3

	N	5th percentile ng/mL	10th percentile ng/mL	Median percentile ng/mL	90th percentile ng/mL	95th percentile ng/mL
Healthy women (years)
20–24	115	1.66	1.88	3.97	7.29	9.49
25–29	142	1.18	1.83	3.34	7.53	9.16
30–34	110	0.672	0.946	2.76	6.70	7.55
35–39	57*	-	0.777	2.05	5.24	-
40–44	41*	-	0.097	1.06	2.96	-
45–50	28*	-	0.046	0.223	2.06	-
Women with PCOS **
	149	2.41	3.12	6.81	12.6	12.6

* Due to the smaller number of women in these age groups, the extreme percentiles were not calculated³

** According to the diagnostic criteria for PCOS revised by the Rotterdam
Consensus4 PCOS - Polycystic ovary syndrome.

Better Clinical Decisions

4 Shorter wait time

Allowing results to be delivered on the day of the appointment for better management of expectations.

Faster clinical decisions

1. Anti-Müllerian Hormone. Elecsys and cobas analyzers package insert 2014. 2. van Tilborg TC et al. BMC Women’s Health 2012;18;12:29. 3. Anti-Müllerian Hormone. Elecsys and cobas analyzers package insert 2014. 4. Rotterdam ESHRE/

Women’s Health

The Germano de Sousa Group has dedicated an extensive portfolio of tests to Women’s Health:

Fertility	Pregnancy Risk	Thyroid Panel	Bone Markers
hCG+β	AFP	Anti-Tg	P1NP
hCG	hCG+β	Anti-TPO	β Crosslaps
Estradiol	hCG	Anti-TSHR	Osteocalcin
Testosterone	Free β-hCG	Calcitonin	PTH
Progesterone	PAPP-A	FT3	Total Vitamin D
LH	PIGF	FT4
FSH	sFit-1	T3	STI
Prolactin	Rubella	T4	Chlamydia t.
SHBG	Toxoplasmosis	Thyroglobulin	Neisseria g.
DHEA-S	Cytomegalovirus	TSH	Treponema p.
AMH	Blood Glucose +PTGO	T-Uptake	Mycoplasma g.
	HVS		Trichomonas
	HIV
	HBV		HPV
	HCV		Genotyping
	HAV		Subtyping 16 and 18
	HTLV I and II		E6 and E7 Genes
	Group B Streptococcus		Cervical Cytology

If you have any questions, please contact us.
We'll be happy to help.

CLINICAL PATHOLOGY LABORATORY

EMAIL

Phone 212 693 530*

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