Can AMH Tests Really Offer Insight into your Biological Clock?
Celmatix’s Dr. Karen Hunter Cohn Shares New Research on Fertility Biomarkers
When it comes to women’s fertility, few concepts loom quite as large as the proverbial ‘biological clock.’ But each woman is unique, and understanding when your own fertility will decline can be tricky. One test that’s long been offered by doctors to gain insight into a woman’s egg reserve is anti-Müllerian hormone, or AMH. In the past few years this test has become increasingly popular, even making its way into new direct-to-consumer testing services, but in 2017, a study was published that cast doubt on the effectiveness of AMH testing as a way of predicting future fertility.
So how useful is an AMH test? We sat down with Karen Hunter Cohn, PhD, the Director of Translational Science at Celmatix, to discuss some new research from the Celmatix team that sheds light on this complex issue.
Celmatix: What did this study examine, and what did it find?
Dr. Cohn: Biomarkers such as anti-Müllerian hormone (AMH), basal antral follicle count (BAFC), and day three follicle-stimulating hormone (FSH) represent a woman’s remaining egg reserve and are predictive of likely outcomes of infertility treatment. There has been some recent controversy about how well these biomarkers predict reproductive potential in women of unknown fertility status.
A recent study¹ found that in women without a history of infertility, biomarkers associated with decreased ovarian reserve, including AMH, were not predictive of reduced fertility. However, given the increased utilization of these tests in women trying to understand their fertility potential, we wanted to investigate this question further. To do this, we studied the outcomes of a population of 2,270 women who were between ages 30–45 and had sought fertility treatment because they did not have a male partner, not because of a history of infertility. This group included single women and women in same-sex relationships who were using donor insemination (DIUI) without the use of any stimulation medications.
When we looked at this group of women, we saw that biomarkers for decreased ovarian reserve, (low AMH, low BAFC, or elevated Day 3 FSH) were associated with lower probabilities of ongoing pregnancy after controlling for age.
Biomarkers suggestive of decreased ovarian reserve are associated with reduced fecundability, or ability to become pregnant, in women seeking DIUI. As these women are representative of women in the general population, this indicates that these biomarkers can provide insight into fecundability, independent of age.
Celmatix: How do these findings differ from previous research on AMH? What do you think accounts for these differences?
Dr. Cohn: As I noted above, a previous study had shown that AMH did not predict infertility. This was done in a different setting — women who were trying to conceive without assistance. In our study of women being treated at a fertility center, it is possible that the close monitoring of ovulation for timing of the insemination led us to see the reduction in pregnancy rates with decreased AMH levels and other ovarian reserve biomarkers. Another possible reason is that our dataset contained a larger sample size, allowing us to better see differences between these groups.
Celmatix: What do these findings mean for women? What about their doctors?
Dr. Cohn: There is an increasing trend in the U.S. that women delay childbearing until their thirties or forties, and ovarian reserve testing is appealing for these women to evaluate their reproductive potential.
Our study shows that ovarian reserve biomarkers are not only informative for infertile patients, but can also provide valuable information for women in their 30s and 40s who proactively seek to understand their reproductive potential.
While decreased ovarian reserve biomarkers cannot diagnose a woman with infertility, they offer an additional piece of information that women and their physicians can discuss in the context of her entire medical history and family goals.
Celmatix: Some have questioned the utility of proactive fertility tests that leverage AMH lately. What could this study mean for the future of fertility testing?
Dr. Cohn: Our study shows that these markers are one piece of information that can be used to understand reproductive potential, but are not a definitive/diagnostic test for fecundability. They should be used as part of a larger discussion about other fertility risk factors such as family history and genetics, exposures such as smoking, body-mass index (BMI), and future goals.
Celmatix: What further research is needed/What’s next?
Dr. Cohn: Given the different results seen between our study and previous studies, and the increasing use of these biomarkers in women who haven’t been diagnosed with infertility, but want to learn more about their fertility potential proactively, further studies are needed.
However, what is clear from our studies and others is that a single marker like AMH is not sufficient to fully capture a woman’s biological clock.
Additional research is necessary to help identify more biomarkers, and uncover subclinical factors such as genetic risk factors, that will allow women to truly understand their current fertility potential, and provide insight into what their future fertility looks like.
Karen Hunter Cohn, PhD, is Director of Translational Science at Celmatix. To view opportunities to join Celmatix’s research team, visit www.celmatix.com/careers.
¹Steiner et al, “Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Reproductive Age Women,” Journal of the American Medical Association, 2017 Oct 10; 318(14): 1367–1376.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5744252/)
