If my doctor tells me my cholesterol is high, I can use this information to make certain diet and exercise choices. When my shiny, high-tech watch informs me that I got four hours of sleep last night, I may choose to skip watching The Office and head to bed earlier tonight (unless it’s the Fun Run episode, in which case I always stay up).
Information is power. This applies to fertility, too. Take anti mullerian hormone (AMH), for example. When it comes to hormones (and hummus varieties), I don’t like to play favorites. But I’ve learned that AMH is one of the most important hormones included in the Modern Fertility test. AMH levels indicate ovarian reserve—a fancy way of saying the amount of eggs left in your ovaries. Let’s take a deep dive into exactly how AMH relates to big decisions like egg freezing.
You lost me at ‘ovarian reserve’
Ever been asked to guess how many M&Ms or jelly beans are in a jar? Just sub the sugar for eggs. In a 2011 study published in Fertility and Sterility, researchers actually counted the number of ovarian follicles (where eggs are housed) in 42 healthy women undergoing pelvic surgery. This would be similar to counting each M&M in the jar. While this is an accurate method, I imagine it’s pretty time consuming. In addition to counting, the scientists also measured each participant’s AMH levels. They discovered that AMH levels were proportional to the number of eggs counted in the participants’ ovaries, making AMH a marker of ovarian reserve.
My Modern Fertility report tells me my AMH levels are 2.99 ng/mL, which falls within the normal range. While falling into this range is a relief because it means I’m likely working with a good amount of healthy eggs, I’m also aware that I lose eggs each month and at a faster rate as I get older. (We’re born with a set amount of eggs and lose them each month during our cycle.) Meaning, my AMH levels and ovarian reserve will continue to drop. I’m not planning on having kids anytime soon, so I’m thinking about freezing my eggs this year.
Taking AMH one step further
In order for eggs to be frozen, they must be first be extracted or “harvested” from the ovaries. Before a harvest, injectable hormonal medications are used to stimulate the ovaries to develop multiple follicles and eggs. During a normal cycle without these excess hormones, a few ovarian follicles develop but only one egg is matured and released. With egg freezing, doctors want to harvest as many eggs as possible for freezing, so they use hormones to stimulate the ovaries. AMH levels are shown to be a strong predictor of how many eggs will be extracted during a harvest round.
This 2009 study found that, “AMH was strongly associated with oocyte (AKA egg) yield after ovarian stimulation” after observing groups of women at two fertility centers. Even though various doses of hormonal medications were used on the participants, the researchers still found AMH to be a strong predictor of egg yield. Here are the results:
Center 1 (n = 370)
AMH Levels Median # of eggs retrieved for patient in one harvest:
- Low: 5
- Normal: 10
- High: 14
Center 2 (n = 168)
AMH levels and median # of eggs retrieved for patient in one harvest:
- Low: 3
- Normal: 10
- High: 14
As you can see, for those with lower AMH levels, fewer eggs were extracted during a harvest. To put this into context, the data from the center with the larger sample size indicates that I would have somewhere between seven and 15 (the median being 10) eggs collected during a harvest, since my AMH levels fall in the normal range.
It’s also important to note that high AMH comes with risks for egg freezing. While this indicates you have a high ovarian reserve, it also puts you at a greater risk for ovarian hyperstimulation syndrome (OHSS). This potentially severe condition occurs when your ovaries are overstimulated by the hormonal medications. Symptoms include abdominal pain, shortness of breath, vomiting, and more. If your AMH levels are high, talk with your provider about adjusting your hormone medication protocol to ensure effective ovarian stimulation.
Quick recap: AMH levels not only help you and your provider make the decision on whether or not to pursue egg freezing, but they can also indicate how many eggs will be retrieved in a harvest.
What AMH has to do with starting a family
As reported by the Southern California Reproductive Center, a 2017 study in Fertility and Sterility reports that women under 35 who freeze 15 mature eggs will have a 85 percent cumulative chance of at least one live birth. In the 35 to 37 age range, freezing 20 mature eggs offers a cumulative 80 percent chance of at least one live birth. For those 38 to 40, freezing 30 mature eggs results in a cumulative 75 percent chance of at least one live birth.
Since I’m under 35, I’d want to freeze at least 15 eggs to keep my odds of a live birth at 85 percent. Based on my normal AMH levels, I know I’d probably have seven to 15 eggs extracted during a harvest to then be frozen. This means I’d need to go through anywhere from one to three harvest rounds to obtain 15 eggs. NPR reports that it costs about $10,000 for one harvest. I could end up spending $30,000 to get 15 eggs (which doesn’t include fees associated with freezing, storage, thawing, or IVF).
While this is a ton of cash, it’s actually less than what I might need to spend later in life. When I’m in my mid or late thirties, my AMH levels will likely be lower. The number of eggs extracted during a harvest will probably be lower, too. But the ideal number of eggs I’ll need to freeze in order to have a high likelihood of a live birth will be higher. I might need to undergo many harvest rounds to extract and freeze the recommended number of eggs. Essentially, mo’ harvests equals mo’ money. By freezing by eggs now, I could be saving my future self some major dough.
Who knew that a tiny, three-letter acronym can help you make big choices about life, from fertility to finances? Now, I’m definitely not here to tell you to freeze your eggs if your AMH levels are low. You’re the expert in you. Modern Fertility is a simply a tool that’s helping me think through these major decisions. When you track and understand your body over the course of your reproductive lifecycle, you can team up with your provider to make choices that align with your unique personal goals, whether it’s choosing to start a family earlier, freeze your eggs, pursue IVF, or take whatever action necessary to create the life you want.
What’s more empowering than that?
- Hansen, Karl et al. “Correlation of Ovarian Reserve Tests With Histologically Determined Primordial Follicle Number.” Fertility and Sterility 95.1 (2001): 170-175. Fertility and Sterility. Web. 24 April 2018.
- “How Many Eggs Should I Freeze?”
- Nelson, Scott et al. “Anti-Mullerian Hormone-Based Approach to Controlled Ovarian Stimulation for Assisted Conception.” Human Reproduction 24.2 (2009): 867-875. Oxford Academic.Web. 24 April 2018.
- “Ovarian Hyperstimulation Syndrome”
- “Women Can Freeze Their Eggs for the Future, but at a Cost.”