Each woman is born with a specific pool of egg cells. As you get older and with each subsequent menstruation, this number decreases. From about 23.-25 years of age, there are fewer and fewer ova and their quality becomes poorer. This process accelerates after the age of 35 until menopause, when a woman is no longer fertile. To assess fertility potential, an AMH test is performed. With this knowledge, it is possible to estimate the time a woman has left to become a mother.

AMH hormone in women and men

Although the hormone AMH is usually associated with women, it is also found in men.

Antimüllerian hormone is produced by germ cells already during fetal life. It is responsible for sex determination and plays a key role in the development of the external and internal sex organs. In boys, the level of AMH increases from around 8 weeks of fetal life and decreases significantly at puberty. In girls, on the other hand, the increase in AMH occurs from birth, decreases at reproductive age and disappears at menopause.

Testing the level of antimüllerian hormone in women is an important marker of fertility potential. It assesses the number and quality of ovarian follicles that can develop into fertilisation-capable ova. The test is also used to diagnose polycystic ovary syndrome or premature menopause. It is also routinely performed prior to an IVF approach.

For men, AMH level testing is much less common; it is performed when necessary in boys before puberty to assess testicular function.

AMH test

The AHM test is well known to patients of infertility clinics. It is one of the first, basic diagnostic tests for fertility problems.

The test itself is relatively simple and safe. It is performed by drawing venous blood from the hand. The test can be performed on any day of the cycle and there is no need to be fasting. The result is not affected by contraception, for example. The InviMed clinic receives the results within four working days.

The test is performed in laboratories equipped with specialised equipment, most often in infertility clinics.

AMH standards

General laboratory AMH standards are:

a result above 3.0 ng/ml - a high level, may indicate polycystic ovary syndrome;
result above 1.0 ng/ml - normal value;
a result of less than 1.0 ng/ml - low level, may indicate premature cessation of ovarian function.

It is worth noting that ovarian reserve never has a constant value, it depends on, among other things, a woman's age. The older she is, the lower her AMH level will be. It is estimated that the value of this hormone decreases by 5% per year. Therefore, you should always consult the result with your doctor.

In men, the result should be between 2.15 and 10.10 ng/ml

AMH too low

Too low a level of ovarian reserve may indicate premature ovarian failure (POF). This is the termination of ovarian function before the age that is considered typical for the onset of menopause. According to statistics, this is 51 years for the average Polish woman.

Patients who suffer from premature ovarian extinction observe in themselves the complaints that we usually associate with the menopause. These include the gradual disappearance of menstruation (it is irregular, scanty), sudden hot flashes, so-called night sweats, and mood swings. It is estimated that the problem of premature menopause affects about 1 in 100 women between the ages of 30 and 40, and 1 in 1 000 women who have yet to reach their 30th birthday.

Ovarian dysfunction and ovarian extinction can be genetically determined, can follow oncological treatment, the passage of certain infectious diseases. Environmental factors also play an important role, including cigarette smoking, which has been shown to significantly reduce AMH levels.

Although the diagnosis of the condition is usually difficult to accept, especially for women who are in their childbearing years, even with low AMH the dream of being a mum is possible. With an individualised assessment of the problem and planning of appropriate treatment, many women manage to get pregnant. One of the more effective methods will be the use of in vitro fertilisation.

AMH too high

Also, too high AMH can make it difficult to get pregnant. An elevated test result (above 6 ng/ml) can be a sign of polycystic ovary syndrome (PCOS). However, this is not the rule; sometimes a woman has an elevated result "by nature". Therefore, a doctor should be consulted to order an in-depth diagnosis.

PCOS is a condition that now affects up to 10% women of reproductive age. It involves the ovaries producing too many follicles, which interferes with ovulation and is characterised by the occurrence of non-ovulatory cycles. In addition, there is an overproduction of male sex hormones in the female body, which disrupts the hormonal balance throughout the body. The disease is diagnosed on the basis of the so-called Rotterdam criteria. These are oligoovulation (rare ovulation) or absence of ovulation, hyperandrogenism, and the presence of polycystic ovaries on ultrasound examination. PCOS is diagnosed in the presence of two of these three criteria.

Usually PCOS manifests itself with menstrual disorders, acne and excessive body hair (symptoms of androgenisation), obesity - especially in the abdominal region - and sometimes psychological disorders (depression, anxiety). Women with PCOS usually have difficulty getting pregnant. Fortunately, also in this case, medicine knows methods that effectively open the way to motherhood for patients. With advanced PCOS, in vitro fertilisation is recommended. It is not worth waiting for treatment, as the symptoms of the disease can get worse with age.

Higher AMH concentrations give a greater chance of obtaining the desired number of ova capable of fertilisation than in women with a low determination of the hormone.

AMH result and in vitro

An AMH determination is performed on each patient prior to the approach to extracorporeal insemination. On the basis of the result, the doctor can select an appropriate stimulation protocol prior to oocyte retrieval. The AMH value allows him to predict, for example, a poor response to stimulation and to select appropriate medication. The hormone concentration also helps to estimate the number and quality of the oocytes obtained.

In patients diagnosed with PCOS, the doctor pays particular attention to the course of stimulation because of the increased risk of ovarian hyperstimulation, i.e. the body producing too many follicles. Such a situation can endanger the health and even the life of the woman.

It is worth mentioning, however, that hormonal stimulation does not reduce ovarian reserve, as follicles are used which would have atrophied anyway in the given cycle (if it were natural).

Substantive consultation: Dr Kinga Ziółkowska, MD - Specialist gynaecologist-obstetrician