Understanding AMH

Fertility & Conception
Key Points

  • AMH is a glycoprotein hormone produced by the follicles in the ovaries.
  • AMH test is a predictor of egg quantity but not quality.
  • AMH values will naturally decrease with age.

What is AMH?

AMH stands for anti Müllerian hormone, also known as Müllerian-inhibiting hormone (MIH), is a glycoprotein hormone produced by the follicles in the ovaries. The follicles have four development stages: primordial, primary, preantral and antral.

AMH is produced by preantral and small antral follicles. Antral follicles are mature ovarian follicles that hold and nourish the immature egg which will later burst through the ovary wall and travel through the fallopian tube. As AMH is produced by the follicles, it is natural that the levels reduce with age, reaching very low levels prior to menopause.

How is it tested?

The AMH test is done through a blood sample. It can be done at any time in the menstrual cycle, as the levels are stable throughout the cycle. Normal values change with age.
For accurate assessment, AMH tests should be combined with an antral follicle count, which is a test that uses an ultrasound to count the number of small follicles within both ovaries. Values AMH A low, high or irregular AMH can be an indication of different problems: Abnormal AMH

Understanding your AMH values

The table below shows different values of AMH (on the left) and the age (at the bottom). You can see the average value (black line) and the different percentiles (dotted lines. You can cross your value with your age, to see how far your values are from average to other women of the same age.
You can also notice the colours green, yellow and red and the likely number of eggs you might egg when undergoing ovarian stimulation. AMH Percentile

Is AMH a good measure of Ovarian Reserve?

Among all ovarian reserve tests, AMH is considered the earliest and most sensitive test of ovarian reserve.
  • Correlates strongly with the number of follicles, meaning high values are associated with more follicles and low values associated with less follicles.
  • Has an inverse correlation with age, meaning as women get older, AMH values reduce.
  • Reliably predicts ovarian response in IVF, meaning high values are associated with OHSS risk and low values to likelihood of poor response to fertility drugs.
  • It is predictive of the timing of the onset of menopause, as it reduces with age.

Does it measure quantity or quality?

Despite being a good predictor of ovarian response to stimulation in IVF, AMH is a poor predictor of nonpregnancy.
AMH is also a poor predictor of pregnancy and live birth following ART, meaning normal values are not associated with taking a baby home.

In a recent study, the chances of getting pregnant in any given cycle was no different for women with low and normal levels of AMH.

These facts are consistent with AMH being a predictive marker of egg quantity but not quality.

Is a False Result possible?

AMH levels should be relatively regular in between cycles. If you have had different results in between cycles, it is worth considering if one of the results was not accurate.
Several studies have demonstrated differences between laboratory results, associated with sample stability and storage issues. This means the time between the blood sample being collected and it being analyses can affect the result. Longer periods and warm samples seem to affect AMH, giving a false result. The sample requires careful preparation and storage.

What affects AMH levels?

  • Stress seems to reduce AMH levels.
  • Hormonal disorders and medical conditions related to reproductive system also might affect AMH levels.
  • AMH values will naturally decrease with age.
  • Women with the history of ovarian failure, have a higher risk of low AMH.
  • Unhealthy diet saturated with fats and processed foods reduces AMH.
  • Vitamin deficiency, particularly vitamin D, reduces AMH levels.
  • Polycystic ovary syndrome (PCOS) is associated with elevated AMH levels.
  • Ovarian suppression related to oral contraceptive pills or GnRH agonist administration can decrease AMH levels.
  • Caffeine, smoking and pesticides also affect AMH levels.
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