Anti-Mullerian Hormone (AMH): Tests and Effect on Fertility

The anti-Mullerian hormone (AMH) isn’t necessarily the hormone most frequently discussed or perhaps the most well-known in terms of reproductive health. But it’s really important to comprehend, particularly if you intend to have a healthy pregnancy in the future.

Measuring markers that show how many eggs you have is one of the first steps in a fertility workup. The anti-mullerian hormone levels are one of the indicators (AMH). You must be wondering what fertility information does AMH provide for you?

Let’s examine AMH in detail: including what AMH levels can and can’t tell you, what is anti mullerian hormone test, AMH levels, AMH’s relation to FSH and IVF, AMH test cost in India, and how your doctor can use the test results.

AMH: What is it?

The granulosa cells in your ovarian follicles create the hormone known as the anti-Mullerian hormone or AMH. The American College of Obstetricians and Gynecologists (ACOG) claims that the AMH you produce is an indicator of your ovarian reserve. The hormone known as the anti-mullerian hormone is secreted by the cells that support the eggs in your ovaries. Imagine a basket of eggs representing your ovarian reserve. Normally, you have a basket of eggs at birth, and you use those eggs up over the course of your lifespan. The amount of AMH generated increases with the number of eggs available.

Your egg count can be determined by an AMH test. The hormone is related to fertility since a low AMH level indicates a low egg count or a decreased ovarian reserve (DOR). To put it another way, if you have DOR, your supply of eggs is beginning to run low.

But here’s the surprising thing: Low AMH hints at DOR but is not a conclusive sign. Additionally, AMH does not indicate if the eggs in the basket are healthy. Doctors sometimes request AMH levels as “fertility tests.” However, this is problematic because AMH doesn’t provide the complete picture.

Because of this, the ACOG advises against ordering this assessment to talk to non-infertile patients about their reproductive status and prospects for future pregnancy. In fact, if you’re under 35 and haven’t been given an infertility diagnosis, testing for AMH might raise unwarranted concerns. While it’s possible that people’s AMH screening findings will lead them to decide to freeze their eggs, in-depth counseling on the underlying significance of AMH levels is necessary.

What can AMH tell you?

AMH levels are not the place to look if you’re looking for particular information regarding natural fertility. This is due to AMH’s inability to forecast natural fertility with any degree of accuracy.

AMH can, however, be used to anticipate the number of eggs you would generate as well as the amount of medicine to encourage egg production if you’re having in vitro fertilization (IVF). AMH levels do not predict the length of the gestation period or infertility in a population that is not infertile. (“non-infertile”- refers to those who are not actively attempting to conceive and have no known difficulties.)

AMH can, however, aid doctors in determining whether the ovaries are aging more quickly than they should and whether there are fewer eggs left when utilized as a part of an infertility workup. When used to create IVF protocols, AMH levels also provide the most accurate forecast of how ovarian stimulations will proceed.

Combining your chronological age, and antral follicle count (AFC) on ultrasound, and AMH is now the most accurate way to assess ovarian aging. AFC measures the number of tiny cysts on the ovary, which are thought to be eggs.

AMH, which represents the number of eggs still present in the ovary, makes AFC and AMH great tools for estimating the number of eggs you have. However, the strongest indicator of egg quality is your age. Although quantity and quality both decrease with age, age is the biggest predictor of your chances of getting pregnant.

When are AMH tests performed?

To evaluate whether an ovarian mass is a granulosa cell tumor, your doctor could do an Anti-Mullerian Hormone test. AMH levels can be used to determine whether: 

• Treatment is effective.
• The tumor has come back.

What can you infer from an AMH test?

Your remaining egg count and if your ovaries may be aging too quickly is revealed by an Anti-Mullerian Hormone test. It can show that your window of opportunity to become pregnant is smaller. Your ability to respond to injectable fertility medicines that encourage the maturation of numerous eggs in your ovaries in preparation for in vitro fertilization (IVF) may also be shown by an AMH test.

What information can’t an AMH test provide?

While AMH and egg count are related, neither your fertility (with or without treatments) nor the onset of menopause is predicted by AMH. Also keep in mind that, even if your AMH levels are within the normal range, other factors, may affect your ability to conceive:

• Age, health issues, smoking, etc.
• Sperm quantity and movement.
• Irregular ovulation,
• Obstructed fallopian tubes,
• Scarring in the pelvis, endometriosis, and uterine abnormalities such as fibroids.

What is a normal level of AMH?

Age has an impact on AMH levels. AMH levels in women begin to rise during adolescence and reach a high around the age of 25. Following then, levels of AMH naturally decrease.

The amount of AMH is measured by providers in nanograms per milliliter (ng/mL). Although experts disagree on the definition of average AMH levels, these are some general ranges:

Severely low: 0.4 ng/mL.

Low: Under 1.0 ng/mL.

Average: Between 1.0 ng/mL to 3.0 ng/mL.

AMH values below 1.6 ng/mL indicate that fewer eggs will be obtained with IVF. Extremely low levels are those below 0.4 ng/mL. It’s crucial to keep in mind that your results may vary significantly from test to lab because different labs use different equipment.

What AMH level is appropriate for your age?

In your 30s, 40s, and 50s, it’s typical to notice a reduced ovarian reserve because AMH levels normally decline with aging. Consider these estimations, which are on the low end of the range for each age, for real numbers:

• 3.0 ng/mL at age 25.
• 2.5 ng/mL for people over 30.
• 1.5 ng/mL for people over 35.
• 1 ng/mL at 40 years of age.
• 0.5 ng/mL at 45 years old.

AMH levels that are higher aren’t always advantageous. Some individuals with the polycystic ovarian syndrome may have high levels of AMH (PCOS).

Reasons for low AMH

Low AMH may result from a number of factors, including

• Age. Your advanced age is the main cause of your low AMH. Your ovarian reserve and AMH levels will inevitably decrease as you age.
• Your genetic composition. Your body may be losing eggs at a faster rate than the normal woman your age, which may have something to do with your DNA.
• Certain health issues. Lower ovarian reserve is possible in women who have long-term conditions like endometriosis. There may also be a role for some autoimmune diseases, such as autoimmune thyroid disease.
• Low AMH can also occasionally result from endometriosis or ovarian cyst surgery.
• Low AMH and early menopause may result from radiation or chemotherapy treatment in the past.

Can you raise your anti-mullerian hormone levels or the quality of your eggs?

As of now, there is no concrete scientific backing to support these, but a number of substances, including the antioxidant coenzyme Q-10 (CoQ1O) and DHEA, have been suggested as potential ways to increase ovarian reserve. Again, there is no data proving that taking vitamin D supplements raises AMH levels or enhances egg quality, despite some claims that there may be a correlation between adequate vitamin D levels and a higher AMH level.

The link between AMH and FSH

Your pituitary gland produces the hormone follicle stimulating hormone (FSH), which has a role in sexual function and development. FSH encourages the growth of eggs in the ovary, which raises estrogen and then progesterone.

Low ovarian reserve is typically indicated by higher FSH levels compared to lower AMH levels. Your doctor may prescribe a test to measure your FSH levels in order to establish your current ovarian reserve, much like they would with AMH.

Despite the fact that FSH can be useful, most experts concur that AMH may be a more accurate indicator of ovarian reserve because the levels are constant throughout the menstrual cycle and from cycle to cycle.

Relationship between AMH and IVF pregnancy chances

In general, there is a larger chance that a sufficient number of high-quality embryos will develop and be transferred the more eggs are stimulated and retrieved during IVF. Embryos are created when sperm fertilize eggs. In IVF, not every recovered egg will invariably result in successful fertilization.

The proportion of chromosomally defective eggs producing malformed embryos rises with a woman’s age. Therefore, the percentage of embryos will be smaller the fewer eggs that are recovered. The success of IVF is lowered by reduced AMH levels, but this is particularly pronounced in women in their late 30s and beyond.

You typically have more eggs, and better eggs, in your 20s and early 30s. You typically have fewer eggs, and fewer healthy eggs, in your later 30s and beyond. In contrast, a young woman with few eggs (low AMH) should nevertheless have a larger percentage of golden eggs and, as a result, have a better IVF outcome (more high-quality eggs recovered) than an older woman. While it is possible for an older individual to still be able to produce a number of eggs by luck, a significant proportion of those eggs will have lost their “good & healthy egg status” due to increased age and may not consequently grow into healthy embryos. Reduced AMH levels (1) are related to

• retrieval yield of eggs is decreased
• greater chance of cycle cancellation (your IVF cycle being stopped and your eggs not being recovered)
• more aberrant fertilization at higher rates

Is there a way to treat AMH-related infertility?

There are, sadly, no effective techniques to raise your AMH levels. You can attempt to preserve egg quality by quitting smoking and maintaining a healthy weight as prescribed by your doctor, even though you cannot raise your egg counts (quantity). Lower egg quality has been linked to both obesity and cigarette smoking. Keep in mind that even if you have fewer eggs, you can still have quality ones, which will boost your chances of having a successful pregnancy.

What else might AMH levels reveal?

AMH levels may aid your doctor in diagnosing other diseases including polycystic ovarian syndrome and menopause in addition to estimating your egg count. One of the most prevalent hormonal illnesses in women is PCOS. However, despite the fact that many people with PCOS have elevated AMH levels, medical societies (such as the ACOG) have not agreed to utilize AMH levels as a diagnostic indicator for PCOS.

The research on how AMH levels affect menopause timing has produced inconsistent results, according to the ACOG. Some research suggests that AMH can be utilized as a broad indicator but not as a precise time frame. According to a recent study, measuring your AMH could help doctors predict when you will have your last period. 

Although some individuals think that AMH levels can predict a baby’s gender, there is no proof that AMH has any bearing on a baby’s gender. Different levels of AMH are produced during pregnancy by male and female fetuses.

AMH Test Cost

In India, an AMH test cost ranges from Rs 900 to Rs 3000. Some laboratories may charge an additional Rs 100 to Rs 150 for home sample collection. However, the cost of the test will vary depending on the city and the hospital or diagnostic center.

The AMH test cost varies on the option your healthcare provider suggests. The price varies according to the city and the lab. Here is a table to give an idea about the approximate pricing range for some cities in India.

FAQs

• How is an Anti-Mullerian Hormone test conducted?

A tiny needle will be used by the phlebotomist to draw some blood from a vein in your arm. Then, into a test tube or vial, a small amount of blood will be collected once the needle has been placed onto your arm. The needle may somewhat hurt and pinch a little when it enters and exits your body. This is typically done only in a few minutes.

• Will there be anything I need to do to get ready for the AMH blood test?

An AMH blood test doesn’t require any additional preparation on your part. It is much like any other blood test.

• Does the AMH blood test involve any risks?

The risks associated with getting a blood test are significantly low. You might have some minor discomfort or some light bruising where the needle was pricked, however, most side effects are short-term.

• Do I schedule my AMH test to coincide with my period?

AMH tests are available at any time during the menstrual cycle. AMH fluctuates very little over the course of the month, in contrast to other reproductive hormones.

• Is pregnancy still possible with low AMH?

Yes. Low AMH level women frequently conceive spontaneously. It’s only one of several numbers your doctor will examine as part of a reproductive workup.

• Can’t I conduct an at-home AMH blood test?

An Anti-Mullerian Hormone test is simple to purchase offline or online. A finger prick is often required for at-home AMH tests. Even while home tests are practical, it’s essential to consult a specialist to assist you in understanding the results. Because it is a complicated subject, fertility has to be thoroughly examined by professionals.

Conclusion

Your ovarian reserve, or the quantity of eggs you have at the time of testing, is determined in part by your AMH levels. These levels decrease with aging. An AMH test may be requested by doctors as a diagnostic aid to help initiate a discussion regarding fertility. Your doctor can suggest a blood test to assess AMH and other markers like follicle-stimulating hormone (FSH) and estradiol at your preconception checkup. That will help paint a picture of a woman’s fertility combined with other elements. AMH levels alone cannot predict infertility, so keep in mind that these, together with other fertility tests, won’t always tell the whole story. Talk to your doctor if you have any worries, and if you’re having trouble conceiving, make a plan to work with a reproductive endocrinologist and a fertility expert.