Infertility is defined as not being able to get pregnant even after one year or longer of unprotected sex.

Women with infertility should consider consulting a reproductive endocrinologist—a doctor who specializes in managing infertility. A reproductive endocrinologist can also help women who have a recurrent pregnancy loss, defined as having two or more spontaneous miscarriages.

What can cause infertility in women?

Conditions affecting the ovaries, fallopian tube, or uterus can contribute to female infertility. 

Some of the major conditions include:

• Disruption of ovarian function (presence or absence of ovulation and effects of ovarian “age”)
• Fallopian tube obstruction (whether fallopian tubes are open, blocked, or swollen)
• Physical characteristics of the uterus

Female fertility is known to decline with:

• Age - Fertility declines with age primarily because egg quality declines over time. In addition, older women have fewer eggs left. Aging also increases a woman’s chances of miscarriage and of having a child with a genetic abnormality.
• Smoking
• Excessive alcohol use
• People with overweight or obesity or underweight
• Extreme weight gain or loss
• Excessive physical or emotional stress that results in amenorrhea (absent periods)

How is infertility treated?

Infertility can be treated with medicine, surgery, intrauterine insemination, or assisted reproductive technology.

Medications help with hormones and ovulation and are sometimes combined with minor surgical procedures. Assisted Reproductive Technology (ART) includes several kinds of procedures that can help you have a baby. 

Two of the most common fertility treatments are:

• intrauterine insemination (IUI) – wherein healthy sperm is collected and inserted directly into your uterus when you’re ovulating.
• in vitro fertilization (IVF) – the process by which eggs are taken from your ovaries and fertilized by sperm in a lab, where they develop into embryos. Then a doctor puts the embryos into your uterus.

AMH Test and its significance in infertility treatment

Women have a limited supply of eggs for their whole lives. Once the eggs are exhausted, there is no chance of conceiving naturally thereafter. Also, women generally become completely infertile after they have hit menopause. It is, therefore, important for women to identify and gauge their ovarian reserve if they ever plan to have a baby.

Anti-Mullerian Hormone (AMH) is a protein hormone made by the cells lining the follicles (sacs that hold the eggs).  Low levels of AMH indicate low ovarian reserve, while optimal levels of AMH (4.00 – 6.80) suggest a bright future fertility probability.

AMH is made in the reproductive tissues of both males and females. The role of AMH and whether levels are normal will depend on your age and gender.

An AMH test measures the amount of anti-mullerian hormone (AMH) in your blood. Though both men and women produce AMH, healthcare providers frequently use the test in women, mainly to provide a snapshot of a woman’s reproductive health.

Anti-Mullerian Hormone (AMH) test is a simple blood test that helps to analyse a woman's ovarian reserve and diagnose problems such as PCOD, early menopause, or low ovarian reserve.

This test gives insight into the remaining quantity of eggs and the duration of fertility.

The AMH test is a good indicator of a woman's ovarian reserve mainly because AMH levels are generally stable and are not affected by the menstrual cycle, pregnancy, or oral contraception. For this reason, the AMH test can be drawn at any time throughout the month.

When Do You Need an AMH Test?

The AMH test is helpful when:

• You are not conceiving for over six months    
• You are contemplating IVF or other fertility treatments since low AMH levels suggest a poor response to IVF
• You want to understand your current chances of getting pregnant

Conclusion

An AMH test checks a woman's ability to produce eggs that can be fertilized for pregnancy. AMH levels show how many potential egg cells are remaining in a woman, which is also known as the ovarian reserve.

If the ovarian reserve is high, there’s a better chance of getting pregnant. This also indicates that a woman may also be able to wait months or years before trying to get pregnant. 

On the other hand, if the ovarian reserve is low, it indicates that a woman will have trouble getting pregnant, and should not delay very long before trying to have a baby.

Thus, AMH testing plays a vital role in determining what your chances are of conceiving a baby. If you are already seeing a fertility specialist, your doctor may use the test to predict whether you will respond well to treatment, such as in vitro fertilization (IVF).

An optimal level of AMH is 4.00ng/ml – 6.80ng/ml.