AMH and AFC - How to Decipher?

When couples seek an evaluation with a fertility specialist, there can be a seemingly endless list of tests which they are required to complete. For most couples, it can be hard to decipher the significance of each of these tests. We will be exploring two of these tests that fertility specialists often use during the workup process – AMH and AFC.

What is AMH?

AMH stands for Anti-Mullerian Hormone. AMH is measured via a laboratory blood test. AMH is a hormone which is produced by the ovarian follicles. Fertility specialists use this test to estimate the number of eggs that a patient may have in her ovarian reserve. A higher AMH level predicts a higher ovarian reserve and more eggs. Conversely, a lower AMH predicts a lower egg count and a lower ovarian reserve.

What Is a Normal AMH Level?

Understandably, many patients want to know whether their AMH levels are “normal”. The general ranges of normal are as follows:

Severely low range: 0.4 ng/mL

Low range: Under 1.0 ng/mL

Average range: Between 1.0 ng/mL and 3.0 ng/mL

It is important to note that AMH levels are influenced by age. In general, AMH levels tend to rise during adolescence and peak at around 25 years of age. Thus, it is expected that AMH levels decrease over time. The estimated AMH level by age is as follows:

25 years old: 3.0 ng/mL

30 years old: 2.5 ng/mL

35 years old: 1.5 ng/mL

40 years old: 1.0 ng/mL

45 years old: 0.5 ng/mL

While most fertility patients hope for a “higher” AMH level, higher AMH levels are not always desired. Specifically, an elevated AMH level may be indicative of another issue, such as polycystic ovarian syndrome.

What is AFC?

In fertility terms, AFC stands for Antral Follicle Count. The AFC is measured via a transvaginal ultrasound. Your healthcare provider visually examines the ovaries during the ultrasound and counts the number of follicles seen. Determining the AFC helps your physician predict the number of mature follicles that you have as well as your likely response to IVF stimulation.

What is a Normal AFC?

Like the AMH, the average AFC decreases with age. The average AFC by age range has been determined as follows:

25 to 34 years of age: Average of 15 follicles

35 to 40 years of age: Average of 9 follicles

41 to 46 years of age: Average of 4 follicles

What is More Important?

Patients sometimes ask what is more important, AFC or AMH? The answer is not totally clearcut. Both AMH and AFC are predictors that physicians can use to determine fertility. However, these tests only predict and do not determine future fertility with certainty for the most part.

Additionally, fertility specialists have found that AFC and AMH levels often tend to be concordant. In other words, patients with higher AFC levels than expected often also have higher AMH levels. In situations where there AFC and AMH levels are discordant (high AFC and low AMH for example), specialists may decide to investigate further. Of note, AMH is a specific laboratory derived value, while AFC can be influenced by the skill of the ultrasound technician. It is not uncommon for patients to see differences in their AFC when evaluated by one provider versus another. If there are concerns with the accuracy of the AFC, patients may choose to request that the evaluation be repeated.

Takeaway Message:

Fertility specialists often include both AMH and AFC in a patient’s fertility workup. These tests are used to predict a patient’s ovarian reserve and likelihood to respond to treatment. AFC values can be influenced by the provider’s skill and experience, so discordant AMH and AFC values may need to be further investigated. Most importantly, AMH and AFC are tools used to paint a picture and help allow fertility specialists to plan future care.

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