In women, the anti-müllerian hormone (AMH) is secreted by special cells in the ovary called “follicles”, which are fluid pockets containing the oocytes that are released at ovulation, after the first menstrual period.

 

The number of follicles contained in the ovaries will continue to decrease throughout a woman’s life. In fact, the stock of follicles, which is approximately 7 million in the 7th month of intrauterine life, will be almost halved after birth, and then will gradually decrease with an acceleration of follicular loss from the age of 35 onwards in a physiological manner. However, there is great variability in the rate of decline of the follicular stock from one woman to another…

 

The synthesis and release of AMH begin a few days before the birth of the female fetus (around the 36th week of pregnancy), increases to reach a peak at puberty, then reaches a plateau between the ages of 20 and 25, and finally decreases progressively until the menopause, when the stock of follicles is completely exhausted.

 

The AMH test, considered today as one of the best biological markers of the primordial follicle stock in the ovary and therefore of the ovarian reserve, is a source of many questions and sometimes of concern when the result is considered too low.

When is AMH testing indicated in women?

AMH testing is mainly indicated in the context of infertility if your doctor is considering proposing a medically assisted reproduction (MAP) technique. Indeed, as its level is a very good marker of the pool of follicles that can be selected during ovarian stimulation protocols, your doctor will be able to determine whether or not it is possible to carry out a MAP. This will also enable him to adapt treatments (doses, etc.) to optimize stimulation in patients at risk of poor response or, conversely, to limit the risk of ovarian hyperstimulation syndrome. Although AMH is therefore a good marker of your chances of responding to ovarian stimulation in AMP, this marker does not reflect oocyte quality and therefore does not allow the chances of a live birth to be assessed after AMP management.

 

The AMH assay can also be used to assess ovarian reserve in women who are not trying to conceive immediately, but in whom fertility preservation is proposed, for example in the case of cancer requiring the administration of a toxic treatment for the ovaries (such as chemotherapy) or before ovarian surgery in the context of an organic cyst (endometrium or other).

 

On the other hand, this biological marker is in no way a predictive factor for spontaneous fertility or after simple stimulation, which means that even if your AMH level is low, your chances of conceiving a baby naturally still exist!

 

This test should not be done just “to see” for the purpose of advising non-infertile women on their future fertility or to predict their time to conception.

 

The AMH test is not part of the diagnostic criteria for polycystic ovary syndrome (PCOS). However, it may be useful in an adolescent or a patient in whom accurate pelvic ultrasound (vaginal) is not possible. If PCOS is suspected, an elevated AMH level will be an additional argument for making this diagnosis.

 

Finally, AMH should not be prescribed in practice to predict the age of menopause even though AMH is considered to have the best predictive value in this context.

LUNA helps you:

The Fertility Pathway allows you to assess your fertility potential according to your age for information purposes, and to track your fertility period according to your menstrual cycle. You can also record your temperature readings within LUNA.

How is the AMH test performed?

The test is performed by a simple blood test which can be taken at any time during the cycle as the variations in AMH levels during the menstrual cycle are not significant.

 

The test can also be carried out in a woman taking hormonal contraception. It is therefore not necessary to stop taking hormonal contraception for the test.

 

Developed in the 2000s, AMH testing techniques have evolved in recent years. Initially performed using manual assay techniques, since 2014 AMH blood levels have been measured using automated assay techniques, allowing for better reproducibility and less variation between different laboratories.

 

This test is not reimbursed by the French Social Security.

How to interpret the result of an AMH test?

Interpretation of the AMH result should be cautious and should take into account the overall clinical context of the woman, including the reason for taking the sample and the woman’s age. Other factors may also influence the AMH level, such as the use of hormonal contraception (a decrease of about 20% which is reversible on discontinuation), smoking and non-Caucasian ethnicity.

 

The result of the assay cannot be analyzed on its own. Its interpretation requires the concomitant evaluation of other parameters of ovarian reserve and in particular the count of antral follicles by pelvic ultrasound because there is a very good correlation between the number of follicles visible on ultrasound at the beginning of the cycle and the AMH level.

 

The results of AMH levels should also be interpreted in relation to FSH and estradiol levels measured at the beginning of the cycle.

 

Finally, there are some pitfalls in interpreting the result which may be related either to the use of old assay kits or to errors in the interpretation of the unit as the result may be given either in ng/ml or in pmol/l (1 ng/ml = 7.13 pmol/l).

LUNA helps you:

With your LUNA Evaluation and LUNA and Me, identify and analyze your pain profile. Evaluate and visualize their evolution regularly thanks to curves and graphs, and find all the advice from LUNA to take care of yourself and gain ground on the disease!


Conclusion

It is only after all these parameters have been analyzed that your doctor will be able to explain the true value of your AMH level and suggest the strategy best suited to your situation.



Co-authored and scientifically validated by Dr Lorraine Maitrot-Mantelet,

Gynaecologist in the Department of Obstetrics and Gynaecology II and Reproductive Medicine at the Hôpital Cochin, Paris.


Read also: LUNA Explains: Ovarian Reserve and Fertility