Endocrinology

Anti-Mullerian Hormone (AMH)

Optimal Result: 5.5 - 37.4 pmol/L, or 0.77 - 5.24 ng/mL.

Anti-Müllerian hormone (AMH) plasma levels reflect the continuous non-cyclic growth of small follicles, thereby mirroring the size of the resting primordial follicle pool and thus acting as a useful marker of ovarian reserve. Anti-Müllerian hormone seems to be the best endocrine marker for assessing the age-related decline of the ovarian pool in healthy women; thus, it has a potential ability to predict future reproductive lifespan. The most established role for AMH measurements is before in vitro fertilization is initiated, because AMH can be predictive of the ovarian response, namely poor and hyper-responses. However, recent research has also highlighted the use of AMH in a variety of ovarian pathological conditions, including polycystic ovary syndrome, granulosa cell tumors and premature ovarian failure. A new commercial enzyme-linked immunosorbent assay for measuring AMH levels has been developed, making results from different studies more comparable. Nevertheless, widespread clinical application awaits an international standard for AMH, so that results using future assays can be reliably compared.

What does it mean if your Anti-Mullerian Hormone (AMH) result is too low?

Anti-Müllerian Hormone (AMH) naturally decreases with age as the ovarian reserve is depleted, and women in their 40s frequently have low AMH results. AMH levels are considered ‘satisfactory’ if they are above 21.98 pmol/l, although age and other circumstances have to be taken into account in order to make the most accurate assessment.

Low levels of AMH mean you may have fewer eggs available.

A low level can mean you may have trouble getting pregnant. It can also mean that you are starting menopause. A low level of AMH is normal in young girls and in women after menopause.

AMH levels are determined by the number of developing follicles in your ovaries. The most important determining factor in the number of follicles is age, as ovarian reserve diminishes over time. Ovarian reserve begins to decline in the mid to late 30s, and AMH (and hence ovarian reserve) levels tend to be low in women in their 40s.

Age is not always a factor in low AMH however. Some women continue to have high AMH levels into their 40s, while others have declining AMH levels in their 20s or 30s. This can be due to environmental factors such as cancer treatment, or down to inherited genetic causes. It is important to find out the age of menopause in your family because this is often a good guide to the rate of your own fertility decline.

Whilst there are no obvious obvious symptoms of low AMH, some women notice a reduction or absence of periods. Getting an AMH blood test is the best way of assessing what your AMH levels are.

Low AMH is not a cause of infertility, but it is an indication of a decreased egg reserve. When there are fewer developing eggs in the ovaries, the chance of a mature and healthy egg being released and fertilised decreases. In age-related low AMH, the quality of the eggs may also be affected, as eggs accumulate mutations over time. This may mean that the chances of abnormal fertilisation and miscarriage are increased.

What does it mean if your Anti-Mullerian Hormone (AMH) result is too high?

AMH or anti-mullerian hormone is a laboratory test that OBGYN and fertility doctors may use to assess a woman’s ovarian reserve or egg count. AMH is a hormone produced by cells from the small follicles in a woman’s ovaries and is used as a marker of oocyte quantity.

Higher AMH values (greater than 1 ng/mL) usually signify that a woman has a normal ovarian reserve and lower numbers (less than 1 ng/mL) may indicate a woman with a low or diminished ovarian reserve (DOR).

We know that a woman’s fertility declines as she ages so typically we see AMH values also start to decline as women age. The value of this test is that a woman with a low AMH can choose to do something about her fertility now if she desires a family for the future.

High levels may mean you may have more eggs available and will respond better to treatment.

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