Understanding AMH Test Results - Anti Mullerian Hormone Test


Quick Bites

  • It is important that women must understand the basics of female fertility
  • The level of AMH in the blood can help doctors estimate the number of follicles inside the ovaries
  • A typical AMH level for a fertile woman is 1.0–4.0 ng/ml
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Introduction

AMH_test_results_explained

We believe every woman must have a basic understanding of their reproductive health and fertility. Therefore, before diving into what the AMH test is?, and what your AMH test results mean? Let's understand how the female reproductive system works.

All women are born with all the eggs that they will ever have in their lifetime. The number of eggs follicles which the women have at the time of birth are approximately one to two million. As the menstruation begins, the body starts recruiting groups of ovarian follicles. These follicles have immature eggs inside them and respond to the

Follicles have the potential of responding to hormones that lead to the growth of the eggs and ovulation (release of egg from ovary). In most cases, women ovulate one egg per month, and the other eggs dissolve. If the egg does not meet sperm and gets fertilized, it is expelled along with the uterine lining during menstruation. This process gets repeated if the woman is not pregnant every month.

The average age of a woman trying to conceive is rising over the past few decades. It is due to modern women choosing to advance their education, or career, or simply living their life before growing a family. As a result, more women in their late 30s and 40s are having children than before. However, as we all know, fertility starts declining with age, and one needs to understand if they have the time to delay pregnancy, or shall they plan it soon. One such test which can help you in planning your future pregnancy is the AMH test. The Anti- Mullerian Hormone test (AMH test) indicates your ovarian reserve and how much time you have to conceive. If you know about your fertility health, you will be able to make informed decisions

The Anti-Mullerian Hormone test, abbreviated as AMH, is a laboratory test to access your egg count or ovarian reserve. AMH is a hormone that is produced by cells present in the follicles in the ovaries. Your fertility expert may recommend an AMH test to know about the number of good eggs that you have and help you plan the pregnancy accordingly.

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In this article

 

What exactly are AMH levels?

AMH plays a crucial part in developing sex organs in unborn babies. The baby starts developing reproductive organs during the beginning few weeks of pregnancy. The baby already has the genes to develop into either a female (XX genes) or male (XY genes).

If the baby has XY genes and has to develop into a male, high levels of AMH and other male hormones are made. It promotes the formation of male organs and prevents the development of female organs. If sufficient amounts of AMH are not available for hindering the development of female organs, organs of both sexes may develop.

If the unborn baby has XX genes and has to develop into a female, small amounts of Anti-Mullerian hormone is secreted. It helps in developing female reproductive organs. AMH also plays an important role in females after puberty. After puberty, the ovaries begin making AMH. Usually, the higher the number of egg cells, the higher the level of AMH except in cases of PCOD (polycystic ovarian syndrome) where the AMH level is very high.[1]

In women, the AMH level indicates fertility. This test is also used for diagnosing menstrual disorders or for monitoring a woman’s health in certain types of ovarian cancer.

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What is the AMH test used for?

The AMH test levels indicate the egg reserve in women meaning that the AMH level tells about the number of eggs available for fertilization, thereby indicating the chances of a successful pregnancy. The Anti- Mullerian hormone (AMH) is produced in the ovarian follicle. As we know, with aging, the egg count in women starts to decrease, and so does the level of AMH hormone. Hence, the AMH test can help in finding how many potential eggs are remaining, thereby indicating the chances of conception.

The importance of this test is that it can detect a woman with low AMH. This gives them a chance to do something about their fertility if they wish to grow their family. In a few cases, the AMH test is also used to:

  • Find out the cause of amenorrhea (no menstruation).[2]
  • Help in diagnosing polycystic ovary syndrome (PCOS).[2]
  • Predict the start of menopause.
  • Get to know the reason for early menopause.
  • Monitor the health of women with ovarian cancer.
Read more:Estradiol (E2) Hormone Test and its effect on fertility
 

AMH test and diagnosing infertility

Before diving deep on why your doctor might have prescribed you the AMH test and how you can read your AMH levels in your report. Let's have a quick snapshot of what your AMH level will not tell you,

The AMH test will not tell you whether you can get pregnant right away as it does not tell anything about egg quality. It indicates the ovarian reserve (number of eggs remaining) and is one of the few tests which your doctor may use to identify the cause of infertility.

AMH test will not be able to identify problems like uterine fibroids, blocked fallopian tubes, or other issues that might be preventing your pregnancy. In such cases, your doctors may recommend additional tests and ultrasounds.

Having said that, the AMH test does give an indication of the number of egg follicles remaining in the woman's body, which will help you plan your pregnancy accordingly. AMH is made only in small ovarian follicles. And so, blood levels of this substance are used to measure the pool of growing follicles in women. Researchers have discovered that the number of growing follicles is largely influenced by the number of remaining primordial follicles (tiny follicles in deep sleep). Therefore, by undergoing the AMH blood test, your fertility specialist will be able to determine the size of your ovarian reserve.[3]

With age, the number of primordial follicles decreases and so does the blood AMH levels. It is usually thought that the higher the AMH level the better is the female fertility, however, in conditions like PCOD have a higher AMH value than normal. Women that have fewer follicles remaining or those that are close to menopause have a low AMH level. Your doctor by looking at your AMH levels will be able to identify if your infertility issue is related to low ovarian reserve or not.

Is it a good idea to get an AMH test done?

It is important that women are educated about their fertility. This in turn empowers them to make the right decisions about their health. One part of this education about fertility is knowing about their ovarian reserve at a given point in time.

AMH test is a very reliable and very popular test among couples who want to defer the pregnancy for some time. It is a small blood test where the healthcare provider will draw a blood sample from your vein in the arm to collect a small amount of blood. This usually takes less than five minutes. There is no risk or very little risk of getting an AMH test. You may find bruising or slight pain around the area where the needle was put, but this goes away quickly.[4]

AMH test results can help women in determining if they want to do something about their fertility now. Do not forget that AMH tests determine your ovarian reserve now. They do not predict how rapidly the ovarian reserve may decline in the future.

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Understanding your AMH test result and AMH levels

We have formed a table below to help you interpret AMH test results. You can check your AMH level below as per your AMH test result. Do note that not all current commercial attempts of AMH testing give equivalent results, therefore, you must review the AMH test results with your fertility specialist and the table below should only act as a reference guide.

Women with 0.9 and women with 1.0 ng/ml test results are put in different boxes in this table. But in reality, there is very hardly any or very little difference in their fertility potential. It is a continuous sequence that cannot be well categorized.[5]

AMH Blood Level (ng/ml)

Fertility Interpretation

Less than 0.3

Very Low Fertility

0.4 – 0.9

Low Fertility

1.0 - 3.0

Normal Fertility

More than 3.0

Low fertility

(often an indicator of PCOS / PCOD)


Fertility options for women with various AMH levels

Whatever the results may be, you always have some options for solving your infertility issues with modern fertility treatments. Let's see what you can do to improve your chances of pregnancy as per your AMH levels.

Low

Even if a woman has a low ovarian reserve, she can still have children using her eggs. Your doctor may prescribe fertility medication to stimulate egg growth and will retrieve your eggs for In Vitro Fertilization(IVF). You can also cryopreserve or freeze your eggs for use in future IVF cycles.

Normal

If your AMH level falls under the normal range, it is a good sign. However, just because your AMH level is normal, does not mean that it will stay the same in the future, or that you can conceive easily. Even with normal AMH levels, you may have trouble conceiving due to either poor egg quality or other medical issues like uterine lining issues, fibroids, or others. In such cases, your fertility doctor may prescribe you additional tests to diagnose the cause of infertility and devise the treatment plan accordingly.

High

Higher levels of AMH means that you may have better chances of conception or that you have more time for trying to get pregnant. It may also mean that you have polycystic ovary syndrome (PCOS).

Read more:Importance of Testosterone Hormone Test in Fertility
 

AMH levels and chances of conceiving with in-vitro fertilization (IVF)

Women who have a high AMH value respond better to ovarian stimulation for IVF as more eggs can be retrieved. Women with lower AMH produce a lower number of eggs and have a lower antral follicle count.

Your doctor makes a decision about the dosage of stimulation injection based on AMH level. That is why it is an important test before starting with IVF. Women with high or normal AMH level will require low dosage of stimulation injections. This is because they respond better to ovarian stimulation and so the doctor will be able to retrieve a good number of eggs to fertilise.

However, when a woman’s ovarian reserve is so low and she has reached the early stages of menopause, fertility treatments cannot help her by using her own eggs. In such cases, donor eggs can be used and the woman can carry the pregnancy herself.

Egg quality is probably not affected by AMH levels. But having a large number of eggs during egg retrieval gives a better opportunity for more eggs to fertilize and develop into embryos. However, more eggs do not always mean more embryos too. The quality of the egg plays an important role in the fertilization process and the development of embryos. The ultimate goal of this process is to have at least one healthy embryo for transferring into the uterus.[7]

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AMH levels and chances of pregnancy with In-Vitro Fertilization (IVF)

Women who have a high AMH value respond better to ovarian stimulation for IVF as more eggs can be retrieved. Women with lower AMH produce a lower number of eggs and have a lower antral follicle count.

Your doctor makes a decision about the dosage of stimulation injection based on AMH level. That is why it is an important test before starting with IVF. Women with high or normal AMH level will require low dosage of stimulation injections. This is because they respond better to ovarian stimulation and so the doctor will be able to retrieve a good number of eggs to fertilise.

However, when a woman’s ovarian reserve is so low and she has reached the early stages of menopause, fertility treatments cannot help her by using her own eggs. In such cases, donor eggs can be used and the woman can carry the pregnancy herself.

Egg quality is probably not affected by AMH levels. But having a large number of eggs during egg retrieval gives a better opportunity for more eggs to fertilize and develop into embryos. However, more eggs do not always mean more embryos too. The quality of the egg plays an important role in the fertilization process and the development of embryos. The ultimate goal of this process is to have at least one healthy embryo for transferring into the uterus.[6]

Read more:Progesterone Test and Its Importance in Female Fertility
 

Can you increase your AMH levels?

If your ovarian reserve is low you will get low AMH test results but this does not mean that you won't be able to conceive naturally.

Unfortunately, there is no proven way that helps in increasing AMH levels, but some research has shown that DHEA (Dehydroepiandrosterone) supplements and vitamin D may help[7]. Don’t take any supplements without consulting the consultation of doctors.

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Conclusion

When it comes to your reproductive capability, AMH is key. AMH is known to be the best predictor for ovarian reserve, but that does not mean it can say whether you are fertile or not. There are various reasons because of which knowing your AMH levels can be useful. Finding out things about your body lets you prepare for your life and live it the way you want to.

However, your AMH levels alone won’t help you in deciding your next steps will be. You and your doctor can come up with a course of action taking the AMH and other test results along with your health history into consideration.

Thankfully, conceiving is not completely dependent on AMH level alone. No AMH levels guarantee pregnancy also, there is no AMH level below which you cannot conceive. It is advised to check with your doctor to know what is best for you, taking all factors into account.

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references

List of ReferencesHide

1 .

medlineplus.gov. “Anti-Müllerian Hormone Test”. medlineplus.gov, 30 July 2020

3 .

Anna Garcia-Alix Grynnerup, Anette Lindhard, et al. “The role of anti-Müllerian hormone in female fertility and infertility - an overview” Acta Obstet Gynecol Scand. 2012 Nov;91(11):1252-60, PMID: 22646322

4 .

nhlbi.nih.gov. “Blood Tests”. nhlbi.nih.gov, 30 July 2020.

5 .

Dr. Mary Birdsall. “AMH - Understanding the results - Dr Mary Birdsall”. fertilityassociates.co.nz, 20 February 2018.

6 .

Alberto Revelli, Valentina Biasoni, et al. “IVF results in patients with very low serum AMH are significantly affected by chronological age”. Published online 2016 Feb 18, PMID: 26888025.

7 .

Alberto Revelli, Valentina Biasoni, et al. “IVF results in patients with very low serum AMH are significantly affected by chronological age”. Published online 2016 Feb 18, PMID: 26888025.

8 .

Mazen R. Fouany and Fady I. Sharara. “Is there a role for DHEA supplementation in women with diminished ovarian reserve?”. Published online 2013 Jun 5, PMID: 23737215.

Last updated on: : 28 Sep 2020

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