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Times of India
19 April 2010
By Ishan Srivastava
Chennai, India

Keeping Tabs on a Woman's Biological Clock: Doctors Diffe on Merits of Test
You can’t turn back the clock, but you can keep track of how fast or slowly it’s ticking. Women can now determine how long they can delay child–bearing by keeping track of their AMH levels.

Anti–mullerian hormone levels are a good indicator of the ovarian reserve (size of the remaining egg supply) in women. AMH levels decrease with age, thereby providing a fairly good way to keep tabs on the biological clock.

“AMH is a test for ovarian reserves. The state of fertility, however, depends on a host of other factors, all of which must be taken into account before arriving at a final decision,“ says Dr Jayashree Gajaraj, obstetrician and gynaecologist. “The AMH test shouldn’t be the only factor considered when taking the decision to delay child bearing,“ she says.

AMH is produced by the egg follicle that the ovaries grow. The test is based on the idea that levels of AMH in the blood are consistent through the month, and hence, could be an indicator of a woman’s ovarian function and if she is still fertile and how many eggs she has left in her ovaries.

A number of women opt to take this test as it is considered fairly accurate and it is easy to take. The test can be done at any time of the month unlike other ovarian reserve tests such as the follicle stimulating hormone test, which must be done on day two or day three of the menstrual cycle.

Doctors, though, are wary about recommending it in isolation. Gynaecologist and obstetrician Dr Priya Selvaraj said, &ldaquo;No test currently can give a 100% view of the fertility. A lot of other factors need to be considered, including the clinical history, and state and history of menstrual cycles.“ She says that a combination of tests is required to reach the correct conclusion. &lduo;In fact, an ultrasound scan is the first thing I would do. AMH as a standalone test is not something I would recommend,“ she 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 by 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 menstural cycle respectively

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