首先發現到的是測量單位的不同，由於我是在澳洲做的測試，所以使用的單位和英國相同。台灣使用的單位則和美國相同，簡單來說，這兩個單位的差別是7.4。比方說美國單位1=澳洲單位7.4，以此類推。
Ovarian Fertility Potential pmol/L ng/ml
Optimal Fertility 28.6 - 48.5 4.0 - 6.8
Satisfactory Fertility 15.7 - 28.8 2.2 - 4.0
Low Fertility 2.2 - 15.7 0.3 - 2.2
Very Low / undetectable 0.0 - 2.2 0.0 - 0.3
High Level >48.5 >6.8
以此看來我的AMH值雖屬正常卻也離低值不遠，而且AMH值是會隨著年齡而下降，除非罹有多囊性卵巢則數值會增高。那不同年齡的正常AMH分別為多少呢？網路上所提供的數據標準均不同，實在很難有個＂準確＂的依據，但是我在一個英國的網站發現有一位網友做了很仔細的分析，其中引用了很多知名的研究報告，依據一份美國的研究（CHR）做出的統計為:
年齡 pmol/L ng/ml
30歲以下 14.99 以上 2.1 以上
31 - 35 12.14 以上 1.7 以上
36 - 40 7.85 以上 1.1 以上
41歲以上 3.57 以上 0.5 以上
若依這份報告提供的數字為依據的話，我的AMH值跟三十歲以下的年輕人是並駕齊驅啊，那我的經期到底去哪了啊？
但是AMH值只能作為卵巢內尚存有多少卵子的指標（卵子庫存量），並不能顯示出卵子的品質，而且AMH低也不代表做IVF的成功率不高，若是卵子品質好，一顆卵子就夠了。醫院所用的排卵劑及技術對人工受孕的成功率也有很大的關連，很多人的AMH值不高卻也能成功的取出多顆的卵子，其中一份研究更是指出有三名接受研究對象的AMH值接近無法偵測的程度卻也受孕成功，由此看來AMH值只能做為參考指數而不是決對因素。
若對那篇文章有興趣，我有附上她的連結，而原文如下：
AMH remains a fairly new test and there is still a LOT of confusion about AMH and what is "normal" and, to be honest, I don't think even the best in the medical profession have enough data yet to know what it all means. Hence I really do not think anyone should panic over the results of one test. However, a lot of less experienced doctors now place a lot of reliance on this test and will be very "doom and gloom" if yours is anything less than perfect.
The first thing anyone should find out is what scale their AMH result is on. The pmol scale has higher numbers than the ng/ml scale and the conversion factor is 7.14. Hence, if your result is 1 ng/ml that is 7.14 on the pmol/ml scale. The pmol/l scale is more commonly used in the UK and Australia but elsewhere, notably the US, the ng/ml scale is the one used.
The assay kit link (next but one link below) is the source of the "original" AMH ranges which everyone jumped on as representing the "norms". They are 2-6.8 on the ng/ml scale and 14.28 - 48.55 on the pmol/l. This is the scale which had people with AMH of say 1 (or 7.14) being told they had "low ovarian reserve". It was also the source of the statement that "optimal fertility" is about 28-48.55 pmol/l (3.92-6.8 ng/ml), while "satisfactory" fertility is 15.7-28 pmol/l (2.2-3.92) - see this link for details of this scale -http://www.tdlpathology.com/index.php?option=com_content&task=view&id=201&Itemid=73. This sample also gave a mean AMH of 4.
However, take a look at the next link which details the sample they got this from. First, the size is small (335) and ALL the women are under 38 so chances are we know they probably mostly in their 20s! (I remember reading elsewhere that a lot were college students and thus 18-23 or so but I can't find the link now!). To be fair on the assay manufacturers, they clearly never intended their results to be taken as "norms". They do point out that AMH decreases with age and that suggest labs should find their own ranges. The trouble is many have not done that and simply trot out this reference range, with no idea where it comes from.
http://www.mbl.co.jp/diagnostic/products/amh/AMH_nousho.pdf
Other research has found that in women of 37 the average AMH was 10 pmol/l (1.4ng/ml). This has 238 subjects but I don't know the numbers in age ranges. Anyway, it did find that AMH remained at about 20-25 pmol/l from age 18-29 (so satisfactory but not optimal according to the first link above!!) and then started to drop. Again, this is beginning to show lower AMH is still ok, especially for those over 30 and that even in those in their 20s, the average still looks lower than first thought. See the next link.
http://www.ingentaconnect.com/content/bsc/ajo/2005/00000045/00000001/art00006;jsessionid=o9h2pdwmbk56.alice?format=print
This next study was small (only 20) but the mean age was 26 and the mean AMH was 2.4 ng/ml - this again suggests that even in young women typical AMH levels may not be as high as first suggested. The study also specifically notes that two women aged 33 and 35 had much lower AMH results (1.2 and 0.39) than the rest. Note that this study was not in infertility populations - just individuals with normal hormones in all other respects, normal menstrual cycle, BMI etc. See the link below.
http://humrep.oxfordjournals.org/cgi/content/full/dem101v1
The next one was bascially showing that ladies with PCOS have higher AMH which declines more slowly than in control groups, but look at the control stats. Again, it's only a small number (41) but the study looked at the decline in AMH over time and consisted of 2 visits. The mean age at visit 1 was 29.9 and the mean AMH was then 2.1 ng/ml (written as ug/l here but it is the same). At visit 2 the mean age was 32.9 and the mean AMH was 1.3ng/ml. So these "control" ladies would have, on average, had low ovarian reserve by their second visit according to the first stats. Even in their first visit, they are only just "satisfactory" on average!! See below link.
http://humrep.oxfordjournals.org/cgi/content/full/19/9/2036
Repromedix is a bis US lab and was the original supplier of the "mail order" AMH test to women in the US wanting to see how much time they had!! It was marketed as the "plan ahead" test or something similar. Personally I think it is very misleading to suggest a blood test can possibly tell anyone how much "time" they have left!! But, moving on from that, Repromedix will have got a lot of data from having supplied this. Take a look at what they consider normal!! It's right down - bascially from 0.7-3.5 on the ng/ml scale, which is 5-25 on the pmol/l scale is to them "normal" with 0.3-0.7ng/ml (2.14-5 pmol/l) being "borderline low" and 3.5-5 ng/ml (25-35.7 pmol/l) being "borderline high". This has shifted the goalposts considerably!!! In this regard, the Glasgow Centre from Reproductive Medicine and some other clinics now regard 5-15pmol/l as normal and 15 and above as high. This fits in with the Repromedix scale. I think this demonstrates how experience of AMH ranges (not just reading a supposed "norm" off a sheet with no understanding of its source) is all important.
http://www.repromedix.com/pdf/AMHbL17CF181.pdf
More recently, CHR in New York has introduced "age specific" AMH levels. As I noted above, the scale that much of the UK uses is dervied from a very young sample population so women over 35 are judged on a wholly inapplicable scale. Plus, research clearly suggests AMH declines with age and yet most women are still fertile at 40 so a certain amount of lowering must be entirely normal. If you see the link you will note that for women under 30 the level should, according to CHR, be 2.1ng/ml or more (14.99 pmol/l or more); for women 31-35 the level should be 1.7 ng/ml or more (12.14 pmol/l or more); for women 36-40 the level should be 1.1 ng/ml or more (7.85 pmol/l or more) and for women 41 or more the level should be 0.5 ng/ml of more (3.57 pmol/l or more).
http://www.centerforhumanreprod.com/about_newsletter.html
This link is from the advanced fertility centre in Chicago and, as you can see, they regard AMH of 0.7-3 ng/ml as being normal (although 0.7-0.9 is low normal). Plus, it is only below 0.3 ng/ml that they regard AMH as very low (about 2 pmol/l). This site also makes it clear that AMH probably does not reflect egg quality.
http://www.advancedfertility.com/amh-fertility-test.htm
This lab from Germany regards 1-5 ng/ml as normal and 0.8-1 as redisidual. However it regards below 0.4 as "menopausal" which we know cannot possibly be correct since loads of women with lower AMH that that have got pregnant!!
http://www.labmed.de/en/uploads/labmed_letters/amh-engl.pdf
Personally, I think the main message is that it is all too up in the air for anyone to base too much on this one test!! The goalposts are clearly moving and plenty of clinics are surprised all the time. Plus the scales in America seem consistently lower than those in Europe so that a lot of women who are told they are "low" here would be fine there, which is ridiculous!
My last link is from a Swiss clinic warning that AMH use has its limits and advising of natural pregnancies in 2 women with completely undetectable AMH!!
http://www.ncbi.nlm.nih.gov/pubmed/17562340
Note also that in 2009 on the poor responder thread there were 3 pregnancies in ladies with AMH of 0.1ng/ml. One of these was straight after an IVF cycle in which no eggs were collected and another was in a lady who had not seen AF for a few months.
資料來源: http://www.fertilityfriends.co.uk/forum/index.php?topic=268441.0
我也准备做IVF了，医生说我的AMH值好低，不能等了，当时听了差点落泪。还好医生说还有希望。回来搜AMH值相关信息，结果看到你的博客。谢谢你的信息!:)
回覆刪除不客氣, 希望你的好孕早點到!
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