Ne mesurez pas l’hormone antimullérienne (AMH) pour prédire la fécondité des femmes.

Résumé libre de l'article publié dans Fertility & Sterility par Dominique de Ziegler (board scientifique de la Maison de la Fertilité), Sean Soktean et Paul Pirtea

L’hormone antimüllérienne (AMH) est souvent présentée comme un “test de fertilité”, mais c’est une idée fausse. Si elle reflète la quantité de follicules présents dans les ovaires, elle ne dit rien sur la qualité des ovocytes ni sur les chances réelles de tomber enceinte naturellement. De nombreuses études montrent qu’une femme avec un taux d’AMH bas peut tout à fait concevoir sans aide. Utiliser ce test chez des femmes sans problème de fertilité risque surtout de créer du stress inutile. L’AMH doit rester un outil médical réservé à la prise en charge en PMA, pas un indicateur de “fertilité future”.

Texte Original en Anglais :

"Do not measure antimullerian hormone to predict women’s fecundity"

Antimüllerian hormone (AMH) is produced by the granulosa cells surrounding oocytes in small developing follicles. The number of AMH-producing follicles largely exceeds that of antral follicles, which cease AMH production. Antimüllerian hormone levels generally correlate with the antral follicle count at any given time. Both parameters reflect the number of ovarian follicles susceptible to respond to ovarian stimulation (OS) with exogenous gonadotropins, as used in assisted reproductive technologies (ART). It is widely accepted that AMH testing aids in managing OS in ART by identifying women likely to respond either poorly or excessively thus allowing for adjusting treatment (1).

The ability to predict the number of follicles responding to OS has introduced the concept of ovarian reserve. As AMH levels and antral follicle count decline with age—mirroring the decline in fecundity—it has been mistakenly assumed that ovarian reserve reflects a women’s fecundity. The simultaneous age-related decline in oocyte quantity and quality has led to the false belief that the two are inherently linked. In reality, their parallel decline is due to a common confounder: age. Although age affects both oocyte quality and quantity, these two effects are independent. For instance, if oocyte quantity is reduced because of an age-independent factor such as ovarian surgery, oocyte quality remains unaffected, which has been well documented in the literature.

Some have proposed that ovarian reserve can predict women’s fecundity. On the basis of this false assumption, recommendations have been made to measure AMH in young women to foretell the chances of future fecundity and predict the age-related decline in fertility. As described later, this conclusion is fundamentally incorrect. Using routine AMH testing is inappropriate and prone to foster unwarranted anxiety about infertility in women with low AMH levels.

Over 18 years ago, we first reported live pregnancies in women whose AMH levels were undetectable and had been advised to undergo donor-egg ART (2). Moreover, in a study published over 10 years ago, we looked at AMH levels in women who had discontinued oral contraception to conceive (3). As expected, we observed an age-related decrease in AMH concentrations. However, our data showed no correlation between AMH levels and effective time to pregnancy, which ranged from 1 to 15 months (3). The findings of Streuli et al. (3) demonstrated that AMH levels do not influence fecundity, as expressed by the time to spontaneous conception . This was the first landmark study arguing against AMH testing in women without infertility for the purpose of predicting natural conception potential (3).

Since then, our results have been confirmed by Zarek et al. (4). These investigators reported that lower and higher AMH values are not associated with the chances of natural conception in a cohort of women with a history of one or two prior losses (4). Zarek et al. (4) reiterated that their data do not support routine AMH testing for preconception counseling in young women and predict their fecundity . Extending these findings, more recent data from Galati et al. (5) confirmed that ovarian reserve markers and notably AMH levels are unrelated to natural conception . The investigators conclude that doctors and patients should be aware of this to avoid inappropriate counseling of women on the basis of AMH levels and propose undue clinical decisions (5).

Despite this evidence, many clinics and fertility centers and specialists continue to offer AMH testing as a fertility assessment tool, likely driven by financial incentives. This indeed offers sizable financial returns for the care providers and may lead women to undertake expensive infertility treatments that are not necessary. France, for example, envisions to recommend universal AMH screening for women, taking the risk of creating unjustified anguish and stress to women who may not even be infertile. As said above, routine AMH measurement for fertility assessment is inefficient and unjustified. Similar proposals in the State of Illinois have met opposition from fertility experts (Eve Feinberg, personal communication). This misuse of AMH testing is reminiscent of the now-debunked recommendation to routinely measure CA-125 for ovarian cancer screening. In 2011, the American College of Obstetricians and Gynecologists, in collaboration with the Society of Gynecologic Oncologists, issued a committee opinion stating that current evidence does not support the use of CA-125 for routine screening in asymptomatic, average-risk women. Likewise, we strongly recommend here to not offer routine AMH testing for fertility assessment and advising women not to undergo such testing. This aligns with guidelines put forth by the American College of Obstetricians and Gynecologists and the American Society of Reproductive Medicine, which state that ovarian reserve testing should not be used for screening in asymptomatic women. Likewise, in the United Kingdom, the National Institute for Health and Care Excellence states: “Do not use AMH levels as a predictor of the likelihood of natural conception.” It further supports that AMH does not reliably predict natural fertility or the chances of conception without treatment.

In summary, the routine measurement of AMH in young women for counseling them about their fecundity is fundamentally flawed. This practice, still too often recommended and undertaken, may lead to unnecessary and unfounded fears in women whose AMH is low. Reproductive doctors and women alike should know that routine AMH dosage for fertility counseling provides false information and should be absolutely discouraged. Let this be a call to action to raise awareness within both the public and the obstetrics and gynecology communities about the limitations of AMH testing and to end this misguided practice.

L’étude complète est disponible en anglais ici :

https://www.fertstert.org/article/S0015-0282(25)00598-9/fulltext