Every woman is born with a lifetime supply of eggs and these decrease in both quality and quantity with age. Starting at the first menstrual cycle, their body recruits a group of follicles that have the potential to respond to hormones, grow and ovulate. Anti-Mullerian Hormone is a hormone that is secreted by cells in developing egg sacs or follicles. As AMH does not change during the menstrual cycle, the blood sample can be taken at any time of the month.
What is Anti-Mullerian Hormone (AMH)?
Generally, every woman becomes completely infertile after they hit menopause. Women must identify and gauge their ovarian reserve if they ever plan to have a baby. Anti-Mullerian Hormone test is a blood test that is used to analyze a woman’s ovarian reserve and diagnose problems such as polycystic ovarian disease (PCOD), early menopause, or low ovarian reserve. This test gives insight on the remaining quantity of eggs, duration of fertility, but no concrete information about the quality of eggs. When the AMH is low it may indicate low ovarian reserve and when it is high it suggests a bright future fertility probability.
This test is proved to be a good evaluator of a woman’s ovarian reserve. And AMH gives accurate results when it is done in conjunction with the antral follicle count or AFC test. The AFC test evaluates the quantity and quality of eggs.
AMH test uses
Often this test is used to check a woman’s ability to produce eggs that can be fertilized for pregnancy. A woman’s ovaries make thousands of eggs during the childbearing years. And these number declines as a woman gets older. The levels of AMH can reveal how many potential egg cells a woman has left, which is known as the ovarian reserve. When the ovarian reserve is high, she may have a better chance of getting pregnant. And when the ovarian reserve is low women will have trouble getting pregnant.
AMH tests may also be used to:
- Determine whether a woman has entered menopause. Usually, menopause starts when a woman is around 50 years old.
- Learn the reason for early menopause.
- Find out the reason for amenorrhea (lack of menstruation).
- Diagnose polycystic ovary syndrome (PCOS) a hormonal disorder that causes female infertility and the inability to get pregnant.
- Women who will be undergoing assisted reproduction procedures like in vitro fertilization (IVF).
- Observe women who have certain types of ovarian cancer.
- Examine infants with genitals that are not identified as male/female.
Who needs an AMH test?
AMH test can be useful in the following situation:
- Any woman who is facing difficulty getting pregnant
- If you are considering IVF or any other fertility treatments
- If you are being treated for ovarian cancer (test can help show if your treatment is working)
- When an infant has ambiguous genitalia (or when a male child’s testicles are not descended properly)
- If a female begins to develop the characteristics of male
- When you would like to conceive in the future
- When you would like to understand more about the current ovarian reserve
A woman with symptoms of PCOS may also require an AMH test. Symptoms may include:
- Menstrual disorders
- Excess body and facial hair growth
- Abnormal uterine bleeding
- Acanthosis nigricans
- Acne
- Decreased breast size
- Enlarged ovaries
- Weight gain or obesity
- Skin tags in the armpits or neck
What happens during an AMH test?
There are no preparations for an AMH test. A health care professional or a lab technician will use a small needle to take a blood sample from a vein in the arm. And the needle will be inserted to collect a small amount of blood into a test tube. After drawing blood, the lab technician will cover the area with a bandage to stop any bleeding. Usually, this test takes less than five minutes.
Risk of this test
There is very little risk in this test. It is common for people to have slight pain or bruise at the spot where the needle was inserted. However, these symptoms go away quickly.
What do the results mean?
High AMH levels may indicate:
- A higher the number of remaining ovarian follicles (eggs)
- A higher likelihood of a positive response to IVF
- Polycystic ovary syndrome (PCOS)
Low AMH levels may indicate:
- A progression to menopause
- Trouble in getting pregnant
- Lower likelihood of positive response to IVF
- Ovarian hyperstimulation syndrome (OHSS)
- A low number & quality of eggs (low ovarian reserve)
- Premature ovarian failure
If a woman trying to get pregnant, the results can help show what her chances are for conceiving. And it can also help decide when to try to get pregnant. And the low level is normal among young girls and women after menopause. Additionally, if you are being treated for ovarian cancer, the test can show whether the treatment is working.
In infants, a low level of AMH may mean a genetic or hormonal problem causing genitals that are not male or female. When AMH levels are normal, it indicated that the baby has working testicles, but they are not in the right location. This can be treated with surgery or hormone therapy.
Normal AMH level
The test hasn’t been in routine use for many years, so the levels considered to be normal are not yet clarified and agreed on by all experts.
Do not get carried away with the values shown here. For instance, the difference between a 0.9 and a 1.1 ng/ml test result puts a woman in a different box in this table. However, there is very little real difference in fertility potential.
| High | Over 4.0 ng/ml |
| Normal | 1.5 – 4.0 ng/ml |
| Low normal range | 1.0 – 1.5 ng/ml |
| Low | 0.5 – 1.0 ng/ml |
| Very low | Less than 0.5 ng/ml |
The above table has AMH interpretation guidelines from the fertility literature and the experience of the advanced fertility center.
Treatment for AMH-related fertility
There are no proven ways to increase the AMH levels. But one cannot increase the egg numbers (quantity). You can work to preserve egg quality by maintaining a healthy weight (as determined by your doctor) and by not smoking. Both obesity and tobacco use have been associated with lower egg quality.
