AMH: Predictor of Oocyte Quality and Fertilization Success

Words by Preeti Bista
Ms. Bista, a senior reproductive biologist and certified clinical embryologist, is among Nepal’s first few experts in assisted reproductive technology. With advanced degrees from UC Merced, IVIRMA, and ongoing PhD work at the University of Valencia, she directs labs at Nepal International Fertility and Laparoscopic Center (NIFLC Maya IVF) and Angel Fertility Clinic. Known for her dedication to training future professionals, Preeti’s work has supported countless couples in achieving parenthood, and she remains committed to advancing reproductive technologies

In the realm of assisted reproductive technologies (ART), understanding ovarian reserve and tailoring fertility treatments to individual profiles is paramount. Anti-Müllerian Hormone (AMH), a glycoprotein produced by ovarian granulosa cells, has emerged as a robust marker of ovarian reserve and a critical tool in ART. While initially valued for predicting the quantity of retrievable oocytes during IVF, recent research reveals that AMH also offers insights into oocyte quality and fertilization rates. This article explores AMH’s crucial role, supported by a range of recent studies highlighting its significance in improving clinical outcomes in ART.

AMH and Its Role in Ovarian Reserve Assessment
AMH levels, unlike those of other ovarian reserve markers such as Follicle Stimulating Hormone (FSH) or estradiol, remain stable throughout the menstrual cycle. This stability makes AMH particularly valuable for assessing ovarian reserve at any point in the cycle, providing a clearer picture of egg quantity. AMH levels are independent of hormonal fluctuations, offering consistent insights for clinicians planning fertility treatments. Its discovery in the 1940s led to its eventual widespread use in ART, where it has since replaced less reliable markers, streamlining fertility assessments and enabling more precise, individualized ART protocols.

AMH in Tailoring ART Protocols
AMH is now recognized as instrumental in predicting ovarian response to stimulation, helping clinicians anticipate how many eggs a patient may produce during IVF. A higher AMH level generally signals a greater ovarian reserve, allowing embryologists and fertility specialists to adjust hormone stimulation for optimal outcomes.
The value of AMH in ART extends beyond mere numbers. According to Papanikolaou et al. (2021), a meta-analysis covering data from multiple randomized controlled trials (RCTs) involving approximately 12,000 women, AMH significantly correlates with cumulative live birth rates. Women with AMH levels above 2.5 ng/mL had markedly higher live birth rates than those with lower levels, cementing AMH’s role as a potent predictor of IVF success.

AMH’s Predictive Strength for Oocyte Quality and Embryo Development
While AMH is primarily a marker of oocyte quantity, its potential role in predicting oocyte quality has garnered interest, especially as multiple studies support this link. This association holds significant implications for clinical embryologists, as oocyte quality directly impacts fertilization success and embryo viability. The studies outlined below provide compelling evidence for AMH’s predictive value in oocyte quality:

Gleicher et al. (2013) explored AMH’s correlation with embryo quality in women aged 35 and older. This cohort study, involving 1,000 IVF patients, revealed that higher AMH levels correlated with better embryo quality and higher fertilization rates in older women. This study’s findings demonstrate that AMH’s influence extends beyond quantity, making it a valuable indicator of embryo quality even in older patients, traditionally considered to have lower fertility potential. Similarly, Iliodromiti et al. (2015) conducted a prospective study of 2,000 IVF patients to examine the association between AMH, oocyte quality, and IVF success rates. Findings indicated that higher AMH levels were linked not only to higher egg retrieval numbers but also to superior embryo quality, higher fertilization rates, and improved pregnancy rates. This study underscores AMH as a dual-purpose marker that can guide both the quantity and quality aspects of ovarian reserve assessment, enhancing success rates in IVF. Furthermore,Grynberg et al. (2021) provided further evidence by analyzing data from 1,300 IVF patients. Higher AMH levels were shown to be positively correlated with oocyte maturation, improved embryo quality, and increased fertilization rates. These findings suggest that AMH serves as a potent marker not just for follicular quantity but also for the quality of oocytes, reaffirming its role in predicting successful embryo development. These findings emphasize AMH’s value as a comprehensive indicator of fertility potential across age groups, as its benefits are evident not only in older patients but also in younger women undergoing IVF.

Nyboe Andersen et al. (2020) performed a multicenter study of 2,500 women, finding that elevated AMH levels correlated with better-quality embryos and higher fertilization rates across diverse populations. The study’s robust sample size lends credibility to the idea that AMH can serve as a reliable marker for quality as well as quantity, reaffirming its broad utility in ART and IVF protocols. These study’s findings indicate that AMH, by reflecting both oocyte and embryo quality, is a strong predictor of success across ART cycles, making it an indispensable tool in fertility treatment. Lensen et al. (2022) on the other hand, examined women over 40 to assess the predictive power of AMH for oocyte quality and IVF success. Among the 600 participants, those with higher AMH levels had improved oocyte maturity, better-quality embryos, and higher fertilization rates. This study illustrates that even in advanced age, AMH levels serve as a useful predictor of oocyte quality, supporting its relevance across varying fertility profiles.

AMH and Live Birth Rates: Strengthening the Case for AMH in ART
The ultimate goal of ART is live birth, and studies show that AMH is highly predictive of this outcome. The prospective cohort study by Huirne et al. (2023), which involved 1,500 women undergoing IVF, found a moderate positive correlation between AMH levels and cumulative live birth rates across multiple IVF cycles. This evidence supports the value of AMH as a tool to optimize treatment protocols, particularly for patients with varied responses to ovarian stimulation. Additionally, Zhang et al. (2024) demonstrated a link between AMH levels, oocyte quality, and IVF success, noting that higher AMH correlated with improved fertilization rates and enhanced chances of pregnancy.

AMH as a Comprehensive Marker in ART
Collectively, these studies highlight AMH’s unparalleled strength in ART. More than just a marker of ovarian reserve, AMH predicts not only the number of oocytes but also their quality and fertilization potential, making it invaluable for clinicians. For clinical embryologists, AMH offers critical insights that enhance the customization of fertility treatments, improving the chances of successful outcomes in IVF cycles. When combined with other markers, such as antral follicle count (AFC), AMH gives a fuller, more reliable picture of both ovarian quantity and quality.

In a field where precision and individualized care are essential, AMH stands out as a versatile, evidence-based biomarker. Its ability to reliably indicate ovarian reserve, assess oocyte quality, and predict successful fertilization outcomes positions AMH as a central tool in ART, contributing significantly to patient-specific treatment and overall success in fertility care.

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