What is AMH?
- AMH, or anti-mullerian hormone is produced by granulosa cells in ovarian follicles.
- It is first made in primary follicles that advance from the primordial follicle stage. At these stages follicles are microscopic and cannot be seen by ultrasound.
- AMH production is highest in preantral and small antral stages (less than 4mm diameter) of development.
How can AMH hormone levels be a fertility test?
Since AMH is produced only in small ovarian follicles, blood levels of this substance have been used to attempt to measure the size of the pool of growing follicles in women.
- Research shows that the size of the pool of growing follicles is heavily influenced by the size of the pool of remaining primordial follicles (microscopic follicles in “deep sleep”).
- • Therefore, AMH blood levels are thought to reflect the size of the remaining egg supply – or “ovarian reserve”.
With increasing female age, the size of their pool of remaining microscopic follicles decreases. Likewise, their blood AMH levels and the number of ovarian antral follicles visible on ultrasound also decreases. Women with many small follicles, such as those with polycystic ovaries have high AMH hormone values and women that have few remaining follicles and those that are close to menopause have low anti-mullerian hormone levels.
AMH levels and pregnancy chances with in vitro fertilization
Women with higher AMH values will tend to have better response to ovarian stimulation for IVF and have more eggs retrieved. In general, having more eggs with IVF gives a higher success rate. AMH levels probably do not tell us much about egg quality.
What is a normal AMH level?
Interpretation of anti-mullerian hormone levels and chances for conception There are some problems involved with interpretation of AMH hormone levels. Because the test has not been in routine use for many years, the levels considered to be “normal” are not yet clarified and agreed on by all experts. The table below has AMH interpretation guidelines from the fertility literature and from our experience. Do not get carried away with the cutoff values shown here. For example, the difference between a 0.9 and a 1.1 ng/ml test result puts a woman in a “different box” in this table – but there is very little real difference in fertility potential. In reality, it is a continuum – and not something that categorizes well.
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