Anti-Müllerian Hormone (AMH) Blood Test

AMH is a protein used to measure a woman's ovarian reserve. It reflects where she is in her reproductive lifespan or how close she is to menopause.
AMH is produced by granulosa (follicular) cells in a woman's ovary. Granulosa cells surround follicles which are small sacs containing immature eggs. These cells play a role in the development of follicles and the maturation of eggs, during a woman's reproductive years. AMH also plays a key role in gender development during the first 8 weeks of an embryo's development in utero.

At the beginning of each menstrual cycle, 5-7 primary follicles begin to develop from a pool of primordial follicles in a woman's ovaries. This growth is caused by rising levels of FSH (Follicle Stimulating Hormone) in the blood. These follicles compete with each other for dominance, as only one will develop fully and release a mature egg from the ovary. AMH is produced by cells surrounding these growing follicles.

Every woman is born with all her eggs, albeit immature, already in her ovaries. These eggs are created earlier on during fetal development (weeks 18–22 post-conception). However, after creation their development is halted such that they become suspended at an immature stage, during a delicate stage of cell division. These immature eggs only become active again once a woman reaches puberty, at which point one will mature and be released each month in response to rising levels of FSH. Some few eggs will remain in this dormant immature state for up to 50 years until menopause.

Every woman is born with a different ovarian reserve, and the rate of decline of the primordial follicle pool throughout her reproductive life, will also vary.
Research indicates women can be born with between 35,000 and 2.5 million primordial follicles per ovary (Wallace and Kelsey, 2010). With only an average of 450 ovulatory monthly cycles in a typical female reproductive lifespan, the majority of follicles will degenerate over time.
Primordial follicles are more abundant in the ovary than primary follicles, but they have fewer granulosa cells which means that they contribute less to serum AMH concentrations. Pre-antral and early antral stage growing follicles are responsible for the majority of AMH expression but AMH production declines when a follicle grows beyond 8mm in diameter.

    Advantages of Measuring AMH Levels
  • The advantage of measuring AMH is that throughout a menstral cycle, AMH levels remain consistent. This makes AMH a more reliable test, not constrained to measurement on specific days of the menstrual cycle like FSH and progesterone.
  • The AMH test is useful in assessing conditions such as polycystic ovary syndrome and premature ovarian failure.
  • A decrease in AMH signifying approaching menopause can be seen five years before a difference can be detected in the levels of FSH or Inhibin B.
  • In clinical practice, AMH measurement may be useful in the prediction of poor response to fertility medication and cycle cancellation. It can also indicate a potential for hyper-response and ovarian hyperstimulation syndrome (La Marca et al., 2010).
  • How Do I Interpret Results?

    AMH results can be confusing as there are two ways of measuring AMH levels. The United States will usually interpret results in ng/ml while in Ireland we are leaning more toward pmol/l. The difference is a multiple of 7.14.
    That means AMH = 1ng/ml is equal to 7.14pmol/l.

    The AMH normal range will also change depending on your age.
    I've included a graph below in which you can see your age along the x-axis. Take a ruler and follow a line up to see if your AMH value (pmol/l) falls within the green, orange or red category according to your age. Green indicates a healthy ovarian reserve and the solid black line is the average value for women of a specfic age.

You can also use the following table to interpret AMH results. This table contains broad reference ranges for 'Ovarian Fertility Potential'.

Ovarian Fertility Potential pmol/l ng/ml
Optimal Fertility 28.6 - 48.5 4.0 - 6.8
Satisfactory Fertility 15.7 - 28.6 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
Higher Levels, that can be associated with PCOS > 48.5 > 6.8

A Recent Clinical Study
A study linking AMH levels and IVF treatment success was performed by Swedish researchers who tracked 892 women undergoing 1,230 IVF treatments at the Carl von Linné Clinic in Uppsala between 2008-2011. The study found that women with high AMH levels were 2.5 times more likely to have a successful IVF cycle than women of a similar age with low levels of the hormone. This study was the first to demonstrate that AMH levels are directly connected to birth and pregnancy rates. Researchers claimed AMH levels reveal important information about the quality as well as the quantity of eggs remaining in a woman's ovaries. They claimed women who have high AMH levels are likely to have a high proportion of eggs capable of developing into healthy embryos.
Women with AMH levels above 2.94 ng/ml had the highest birth rates. When AMH levels surpassed 5 ng/ml the effects became comparable. There was 53 IVF cycles where woman had AMH levels below 0.2 ng/ml and these resulted in only 18 embryo transfers and the birth of three children (Broer et al., 2011).

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