ANTI MULLERIAN HORMONE (AMH)

AMH is produced by ovarian granulosa cells of the small follicles in females from the 36th week of gestation onwards until menopause when levels become undetectable.

AMH just indicates the number of eggs left in the ovary (Egg Reserve). It indicates the Quantity available, but Not the Quality of the eggs.

AMH indicates the pool of eggs left in the ovary. It does not indicate the exact number of eggs left.

High or low AMH will NOT help us to tell about the chance of achieving pregnancy.

High or low AMH will NOT tell us about the quality of the eggs, either good or poorer quality.

If the AMH value is less, couple should not waste time or not to postpone pregnancy as there will be gradual decline in the number of follicles / eggs.

Checking AMH is superior to the FSH, LH and Estradiol as a marker of ovarian reserve.

Serum AMH levels stars declining years prior to rise in FSH thus it is much more sensitive marker of ovarian reserve.

Usually AMH and number of Antral follicles in both ovaries correlate better with ovarian reserve.

AMH does not vary significantly during menstrual cycle & hence can be measured on any day of cycle.

 

CLINICAL APPLICATIONS IN INFERTILITY:To assess ovarian status, including follicle development, ovarian reserve and ovarian responsiveness, as part of evaluation for infertility and assisted reproduction protocols.

High AMH:

• High AMH is commonly seen in PCOS patients.
• Risk of ovarian hyper stimulation syndrome is high.
• Increased risk of multiple pregnancies.
• Needs frequent follow ups and scans to adjust the dose of hormonal injections.

 

LOW AMH:       

• Indicates Low egg reserve in the ovaries.
• Expect to grow less number of eggs during IVF treatment.
• Need higher dose of hormonal injections to grow the follicles / eggs.
• Need more days of hormonal injections.
• Higher chance of cancellation of IVF treatment in the middle of taking injections as follicles may not grow as usual even with higher dose.
• Less number of eggs retrieved, henceforth less number of embryos formed and less chance of extra embryos being frozen or cryopreserved.
• Women with low AMH may attain early menopause.

RANGE OF AMH VALUES:

Ovarian Fertility Potential	Levels ( ng/ml)
Very low / undetectable level	0.0-0.3
Low fertility	0.3 – 2.2
Satisfactory Fertility	2.2 – 4.0
Optimal Fertility	4.0 – 6.8
High level	>6.8