AMH test - an indicator of ovarian reserve
The AMH test determines a woman's fertility level by measuring the hormone produced by the ovarian follicles. It is a key diagnostic test in the treatment of infertility and is particularly important for women over 30. The AMH hormone assesses the ovarian reserve, i.e. the number of ova capable of fertilisation. Normal values are 1-3 ng/ml for women of reproductive age, but norms change with age. A low AMH indicates reduced fertility, a high one may suggest polycystic ovary syndrome. The test is performed from venous blood, without the need to be fasting. The results help doctors choose an appropriate infertility treatment method and assess the chances of a successful IVF procedure.
Highlights:
- The AMH test assesses female fertility by measuring the hormone produced by the ovarian follicles, with a standard of 1-3 ng/ml for women of childbearing age.
- Ovarian reserve declines rapidly after the age of 30, with only 12% remaining from the initial 300-400 000 eggs.
- The test can be performed on any day of the cycle, without the need to be fasting, and the result is received after 4 working days.
- A low AMH (below 1.0 ng/ml) indicates reduced ovarian reserve, a high one (above 6 ng/ml) may signal polycystic ovary syndrome.
AMH testing - what is it?
AMH testing helps to determine a woman's fertility level. AMH is a hormone produced by the ovarian follicles. This test allows the assessment of ovarian reserve in women, and in men it allows the monitoring of androgen production or the effectiveness of testicular cancer treatment.
AMH testing is recommended primarily for women over 30 who have been trying for a child for a long time. It is also one of the tests recommended for the in vitro procedure and for diagnosing premature cessation of ovarian function. It is also worth performing during infertility treatment. The higher the AMH index, the greater the chance of success during IVF.
The role of antimüllerian hormone in female fertility
The AMH hormone is produced by the so-called preantral and antral follicles found in the ovaries. It allows the maturation process of the ovarian follicle to be assessed. Its value helps to predict the chance of conception. It is a test that is very important in determining a woman's fertility, not only during standard fertilisation, but also during the in vitro procedure.
Sometimes antimüllerian hormone is used to monitor the effectiveness of cancer treatment, such as testicular cancer in men or ovarian cancer in women.
In the treatment of infertility, the AMH hormone is also of great importance. On the basis of its concentration, it is easier to choose a treatment method, which should be individually tailored to the patient. Based on the results, the gynaecologist will be able to assess the chance of having a baby.
Normal AMH levels - performance standards
The correct standard for anti-mullerian hormone is indicative, as it depends on the age of the woman. It is assumed that a concentration between 1 ng/ml and 3.0 ng/ml is the reference value for women of reproductive age. The AMH result should be consulted with your doctor, who will interpret it correctly and order further tests if necessary.
| Standard according to age | Blood AMH norm ng/ml |
|---|---|
| 20-24 years | 1.52 - 9.95 ng/ml |
| 25-29 years | 1.20 - 9.05 ng/ml |
| 30-34 years | 0.711 - 7.59 ng/ml |
| 36-39 years | 0.405 - 6.96 ng/ml |
| 40-44 years | 0.059 - 4.44 ng/ml |
| 45-50 years | 0.01 - 1.79 ng/ml |
| PCOS | 2.41 - 17.1 ng/ml |
| IN VITRO | min. 0.7 ng/ml |
The results of the test should be interpreted by the doctor, as other factors may also influence them. However, it can be stated unequivocally that AMH levels decrease with age and that both too low and too high levels of this hormone are not desirable. During the IVF procedure, the minimum AMH level that entitles to reimbursement is 0.7 ng/ml.
| NORMA The AMH standard is an indicative value, which also depends on age. For the sake of simplicity, values between 1 ng/ml and 3.0 ng/ml are assumed to be reference values for women of reproductive age. |
What does the AMH value tell us? Interpretation of the results
Evaluation of ovarian reserve is very important for women trying to have offspring. Every woman is born with a certain supply of ova, the number of which decreases with age, which translates into a reduced chance of achieving pregnancy.
The AMH hormone test allows us to assess how much ovarian reserve remains and what the chances of conception are. The concentration of AMH hormone decreases with a woman's age until menopause, when it is so low that it may not be detectable during the test.
A woman is born with around 300-400 000 eggs ready for fertilisation. The ovarian reserve starts to decrease after the age of 20 and this process progresses slowly over the next 10 years. This is also the best fertility period for a woman and the number of ovarian cells ready for fertilisation is around 65-80 thousand.
After the age of 30, this decline is faster, and after the age of 35, the dynamics accelerate even more and getting pregnant is more difficult. After the menopause, fertilisation by natural means is no longer possible. In women after the age of 30, the number of remaining eggs ready for fertilisation is about 12% of the total with which she was born.
Over the course of a woman's lifetime, the ovaries will release around 500 mature ova ready for fertilisation. When this number runs out, the ovaries stop producing oestrogen and menopause occurs. It is estimated that the average age of menopause in women from developed countries is about 51 years. In assessing ovarian reserve, it is important to have the opinion of a doctor who will look at the patient individually.
Low AMH
A low AMH level indicates a reduced ovarian reserve, i.e. a low number of ovarian follicles containing an egg cell. An AMH value of less than 1.0 ng/ml is an indication to consult a clinic specialising in infertility treatment for the diagnosis of premature ovarian extinction.
High AMH
A high level of the anti-Müllerian hormone (above 6 ng/ml) may indicate the so-called Polycystic Ovary Syndrome (PCOS), which manifests itself by the production of too many immature Graff's follicles, which disturbs the hormonal balance of a woman's organism. The causes of PCOS are attributed to insulin resistance, as well as excessive excretion of luteinising hormone (LH) and folliculotropic hormone (FSH) by the pituitary gland. People with polycystic ovary syndrome are usually also burdened with hirsutism (excessive body hair) and obesity.
| The AMH result should be consulted with a specialist, who may order further tests needed for further treatment. |
Do anti-Müllerian hormone concentrations change with age?
A woman's age plays a very important role in planning a pregnancy. Many gynaecologists recommend that the decision to have offspring should be made around 20-25 years of age, when the chances of having a child are greatest. The AMH hormone helps to assess the level of fertility in women. As we age, the norm of the hormone changes. As the years go by, the number of ovarian follicles ready for fertilisation decreases. After the age of 35 it can be difficult to get pregnant. At this time, there are approximately 5% eggs left for a woman to be born with, which is about 15,000-16,000. The norms for a 40-year-old woman are very low. After this age, the number of ova is only 9,000, and after the age of 45, less than 3,000. The decrease in this number is a normal process of ageing. It is important to bear in mind that, in addition to age, their number is affected by smoking, medication taken or ovarian operations performed.
| AGE | RESIDUAL OVARIAN RESERVE |
|---|---|
| birth | 100% |
| adolescence | 50% |
| 25 years | 22% |
| 30 years | 12% |
| 35 years | 5% |
| 40 years | 3% |
| 45 years | 1% |
As a woman enters puberty, she has about half the number of egg cells that can be fertilised. Up to the age of 30, the decline is slow, while later on it accelerates greatly.
When to perform the test?
The AMH concentration helps to determine how many ova a woman has. A sufficient number of them allows a woman to get pregnant, while too low a number may indicate premature cessation of ovarian function or impending menopause.
This test is recommended for women who have been trying for a child for a long time without results. It is important information for gynaecologists who specialise in treating infertility. On the basis of the results, they are able to select the appropriate treatment to enable the patient to have a child.
An adequate AMF concentration increases the success rate of the IVF procedure. The higher the AMF index, the greater the chance of fertilisation. This means that the woman has an adequate number of healthy ova that can be fertilised in vitro.
In women
The test is most often performed in infertility clinics, as the indications are most often for women who are trying to have offspring. Antimüllerian hormone determination can be performed on any day of the cycle.
In men
It is worth remembering that AMH is also tested in men. It is most often carried out when verifying the effectiveness of treatment for testicular cancer and also to check for a return of the disease. In younger boys, AMH can be determined before puberty. It is performed to assess the function of the testicular tissue. Suspected congenital abnormalities of the male reproductive system may also be an indication.
How do I prepare for the AMH test?
The popularity of the Mirena IUD is due to at least several issues. Few people know when to test their hormones.
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The AMH determination can be performed at any time of day.
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It is not necessary to be fasting.
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The hormone is also in the same concentration throughout the menstrual cycle.
However, it is important to remember that this is not a routine test, so it is important to find the right facility before performing it. At Invimed, we perform this test because it is important during infertility treatment.
The result of the analysis is not affected by the use of contraceptive pills or hormone therapy. The woman can eat and drink normally before the test.
What is the course of the study?
The concentration of anti-Müllerian hormone is determined in the patient's blood serum. After disinfecting the elbow area, a small amount of blood is drawn with a disposable needle.
As after other collections, hold the gauze pad at the injection site for about 5 minutes. Keep your hand down to prevent bruising.
The blood draw is performed by a qualified nurse. It is a painless test that does not require prolonged convalescence and you can return to your daily routine immediately afterwards. It usually takes a few minutes, so it can even be performed during a clinic visit.
Where to perform the AMH test?
The AMH level determination can be performed at any of our clinics located in Warsaw, Wrocław, Poznań, Katowice or Gdynia. Depending on the location where the blood is to be drawn, different hours of operation of the collection centre may apply.
AMH result is obtained after 4 working days, so it is important to do the test early enough so that the doctor can read and interpret the result at the next visit.
The price of the test may vary from one centre to another, but the cost is around PLN 200. Evaluation of ovarian reserve is important to determine the next steps in infertility treatment.
Frequently asked questions - FAQ
Dietary supplements do not affect the AMH test result. Unlike some hormone tests, AMH levels remain stable regardless of vitamin or mineral intake.
AMH only provides information about ovarian reserve, but not about egg quality or hormonal function. Therefore, it is usually performed together with FSH, LH or oestradiol to get a complete picture of fertility.
Yes, different laboratories may use different assay methods and units. Therefore, always compare the result with the standards given by the specific laboratory and not with general tables.
After the age of 35, it is a good idea to check AMH every 12-18 months if pregnancy is planned. In women over 40, it may be necessary to check every 6-12 months due to a more rapid decline in ovarian reserve.
Chronic stress can indirectly affect ovarian function, but has no direct effect on the result of a single AMH test. Stress does not change the concentration of the hormone in the short term.
An ovarian reserve test does not require a referral from a doctor, but it should be remembered that it is only recommended in specific cases. In our clinic, it is part of the infertility treatment and the doctors usually order it for their patients. It is also possible to have an AMH determination free of charge on the National Health Fund. In this case, a referral is necessary, which can only be issued by a gynaecologist or a doctor specialising in infertility treatment.
The waiting time for results can vary. The antimullerian hormone determination is best performed at an infertility clinic, such as Invimed. This is a place that specialises in performing this type of test. There is usually a wait of about 14 days for AMH results, whereas by choosing to have it performed at our clinic, you will receive the result after 4 working days. By providing such a short period of time, the appropriate treatment can be started sooner and the chances of getting pregnant can be increased. If you have the test performed at the National Health Service, you will first have to wait for an appointment with the referral specialist, and then you will often need to make an appointment for this test. The wait for the result may also be longer than in private facilities.
When receiving test results, pay particular attention to the unit in which they are given. It is recommended that the results are interpreted by the specialist who ordered the test. If the AMH concentration is given in pmol/l, the appropriate conversion should be used: pmol/L = ng/mL x 7.14. Before checking the pmol/l standard, it should be adjusted to the standards that apply. By doing this yourself, you can easily make a mistake, so it is advisable to leave it to the specialists.
As is well known, AMH levels decrease with age. The test should be performed before IVF stimulation to determine the response to stimulation and the chances of getting pregnant. Sometimes it is necessary to repeat the test, but only if the result is borderline or the patient is older than 37 years. It is not necessary to determine the hormone every cycle. The test can be repeated after 6 months. It is also important to note that it is not recommended to carry out this test during stimulation with the hormone FSH, as it can artificially lower the result.
A drop in AMH levels is the rule and affects every woman. Many postpone the decision to have children, which is not always a good idea. The concentration of this hormone cannot be raised, but research is constantly being carried out to increase the ovarian reserve in women. If you want to get pregnant, you should take into account that this may become increasingly difficult as you get older. The AMH concentration may not increase in any way, so one has to reckon with a longer and more difficult attempt to have a child. You should discuss your ovarian reserve with your gynaecologist, who can order tests to help assess it. In the case of an elevated AMH level, it is worth extending the diagnosis, if only for polycystic ovarian syndrome.
- Laudanski, P. (ed.). (2022). Gynaecological endocrinology and infertility. Part 1. In the office of the specialist physician. Gynaecology and obstetrics. PZWL Wydawnictwo Lekarskie. ISBN: 978-8320062748.
- Krawczyńska, M., & Słowińska-Srzednicka, J. (2016). Application of antimüllerian hormone (AMH) concentration determinations in the diagnosis of endocrine diseases. Progress of Medical Sciences, 29(12), 921-928.
- Laudanski, P. (ed.). (2022). Infertility. In the office of a specialist physician. PZWL Wydawnictwo Lekarskie.
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The medical information presented should be considered as general guidelines and does not replace the individual judgement of the doctor regarding the medical management of each patient. The doctor, after a thorough examination of the patient's condition, determines the extent and frequency of diagnostic tests and/or therapeutic procedures, taking into account specific medical indications. All medical decisions are made in full consultation with the patient.
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