This document summarizes a journal reading on the evaluation of female fertility using antimüllerian hormone (AMH) and ovarian reserve testing. It discusses how AMH levels can help characterize menstrual cycles, diagnose conditions like polycystic ovary syndrome, predict ovarian response to fertility treatments, and provide counseling on expected outcomes. The document includes figures and discusses strategies for diagnosing and managing infertility using AMH testing and other clinical markers of ovarian reserve.

1. Journal Reading
Evaluation of Female Fertility—AMH
and Ovarian Reserve Testing
Presenter:
Moderator:
Assesor:
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SRIWIJAYA UNIVERSITY / DR. MOHAMMAD HOESIN
GENERAL HOSPITAL PALEMBANG
2023

2. 2

3. INTRODUCTION
3
Infertility
Aneuploidy
Ovarian
Reserve
Antimullerian
hormone
(AMH)

4. 4
Figure 1. Live birth per transfer based on age (Society for Assisted
Reproductive Technology) comparing autologous eggs to donor eggs

5. 5
Figure 2. Percentage of live birth declines with increasing age

6. 6
Figure 3. The occurrence of aneuploidy in human: lessons from the
cytogenetic studies of human oocytes.

7. 7
Figure 4. Individual markers of serumantimüllerian hormone (AMH) across ages

8. Materials and Methods
8
PubMed search was conducted to find recent literature
on measurements and use of serum AMH as a marker
of ovarian reserve and in treatment of infertility.

9. DISCUSSION
Strategies for Diagnosis, Management and Treatment
9
Initial Evaluation of
the Infertile Couple
Couples should begin an evaluation if
they have not conceived after 1
year of active attempts.
Vaginal intercourse, history,
and life style

10. DISCUSSION
10
Symptoms of hypothyroidism, hyperprolactinemia,
hypoestrogenism, or hyperandrogenism.
The first approach to an infertile woman is to characterize the menstrual
Approach to the Subfertile/Infertile Woman
Women undergoing active fertility management, particularly ovarian
stimulation, should have an evaluation of ovarian reserve by serum
AMH and/or ultrasound-guided AFC

11. How to Use Antimüllerian Hormone in
Clinical Management
11
AMH is a predictor of
response to stimulation (IVF
cycle) but does not correlate
with pregnancy success.
Assisted reproductive technology
AMH is used to counsel
regarding the expected
number of oocytes at retrieval,
and to help determine specific
stimulation protocol and
required dosing

12. Ovulatory Dysfunction
12
The 2 most common causes of anovulation are
polycystic ovary syndrome (PCOS):
Irregular cycles, hyperandrogenism, and polycystic-appearing ovaries; and
hypogonadotropic hypogonadism, which can be genetic, functional, or due to
hypothyroidism or hyperprolactinemia
For women with PCOS, screening should exclude dyslipidemia, fatty
liver, and/or impaired glucose tolerance/ diabetes that may require
further assessment, treatment, and/or weight loss before conception.

13. Focus on high
antimüllerian hormone
13
Increasingly a role for AMH in the
pathophysiology of PCOS has been
identified. AMH reduces the progression
of developing follicles into
the recruitable pool.
Polycystic ovary syndrome.
PCOS is the most common
endocrine disorder of
reproductive-aged women.

14. Focus on low
antimüllerian Hormone
14
In cases of severe diminished
ovarian reserve and primary ovarian
insufficiency (POI), AMH levels may
be quite low.
Primary ovarian
insufficiency,
hypogonadotropic
hypogonadism.
Case of hypogonadotropic
hypogonadism, AMH may be falsely
suppressed inaccurately suggesting
poor stimulation capacity

15. 15
Figure 5. Relationship betweenantimüllerian hormone (AMH) and
duration of human menopausal gonadotropin (hMG) over 2 cycles.

16. CONCLUSION
16
Assessment of ovarian reserve is critical in the evaluation of an infertile woman.
AMH and AFC both assess the functional ovarian reserve: the capacity for
response to stimulation and the reproductive window
Women with high AMH, and PCOS, are best treated with weight reduction. If this
fails to induce ovulation and/or the individual is older, ovulation induction with
letrozole is indicated.
Women with low AMH and hypogonadotropic hypogonadism should have the
underlying cause corrected if possible: hyperprolactinemia, hypothyroidism, low
body weight, or excessive exercise. The ideal therapy with primary
hypogonadotropic hypogonadism or functional hypothalamic amenorrhea is to
replace the missing hormone with pulsatile GnRH.

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