AMH Levels and Ovarian Reserve in Endometriosis

Clinical Utility of AMH Assessment

The American College of Obstetricians and Gynecologists recommends measuring AMH levels in all reproductive-age women with diagnosed or suspected endometriosis to establish baseline ovarian reserve, as AMH correlates well with antral follicle count and is superior to age, basal FSH, estradiol, and inhibin B for assessing ovarian reserve in healthy women 1
AMH does not vary significantly by menstrual cycle day and is not affected by exogenous estrogen or progesterone use, making it a reliable marker for ovarian reserve 1
The American Society for Reproductive Medicine suggests that very low AMH levels (<0.7 ng/ml) indicate incipient ovarian insufficiency and represent the best endocrine marker for age-related decline in ovarian reserve 3

Women with severely low AMH (<0.7 ng/ml) face 91% increased odds of miscarriage, and in women ≥35 years, low AMH confers 85% increased miscarriage risk 3
The American Society for Reproductive Medicine recommends that women with AMH <1 ng/ml should pursue fertility evaluation and attempts promptly 3

The American College of Obstetricians and Gynecologists recommends interpreting AMH values in context of age, BMI, and endometriosis phenotype, and considering non-excisional approaches over cystectomy when fertility preservation is paramount 1, 2
Fertility preservation options, such as oocyte cryopreservation, should be discussed before any planned endometrioma surgery, especially in women with low baseline AMH 1