Anti-Müllerian hormone (AMH) is a hormone produced primarily by the granulosa cells of ovarian follicles in women. It plays a key role in the development of the female reproductive organs and in the regulation of ovarian function. How to explain a high or low rate?
What is the role of anti-Müllerian hormone?
Anti-Müllerian hormone (AMH) is a hormone produced primarily by the granulosa cells of the ovarian follicles in women. “She plays a key role in the development of female reproductive organs and in the regulation of ovarian function“, explains Dr Céline Musset, gynecologist. men also produce AMH, but in them it is produced by Sertoli cells in the testes. “AMH has an inhibitory effect on the development of the Müllerian ducts, which are the precursors of the female internal reproductive organs, such as the uterus, fallopian tubes and vagina. By inhibiting the development of these structures, AMH contributes to the formation of the external female genitalias“. AMH is used as a marker of ovarian reserve, i.e. the quantity of eggs remaining in a woman’s ovaries. “The quality of the oocytes being linked to the age of the woman and not to her ovarian reserve. AMH levels naturally decline with age until menopause. AMH is sometimes incorrectly used as a fertility marker, but it does not predict the chances of spontaneous pregnancy“. On the other hand, it allows to assess the chances of pregnancy in ART techniques and allows you to adapt the dosage of stimulation treatments and plan ART treatments.
What is the normal level of anti-Müllerian hormone?
Normal levels of anti-Müllerian hormone (AMH) can vary depending on the laboratory and the specific measurement methods used. “Generally, AMH levels are expresseds in nanograms per milliliter (ng/mL) of blood“, continues the gynecologist.
► The normal levels in women of childbearing age (20 to 40 years): approximately 1 to 4 ng/mL.
► AMH levels tend to decrease naturally with age. “Postmenopausal women typically have very low AMH levels, often below 0.1 ng/mL. However, menopause is not diagnosed by the AMH dosage, but by the estradiol and FSH levels.
“It is often associated with carrying out a count of antral follicles by pelvic ultrasound, which corresponds to the number of small ovarian follicles less than 10 mm on each ovary, in order to best assess the ovarian reserve.” “The dosage of AMH under hormonal contraception can be artificially lowered, reversibly”. This must be taken into account when interpreting the results. “It is recommended evaluate results in conjunction with other hormonal assays such as FSH, LH, prolactin and estradiol“. These studies should be carried out between the third and fifth day after the start of menstruation, because during this period hormones are in a basal state and therefore can be compared according to reference values. “In men, AMH is not measured in routine practice, even for PMA or infertile men.
AMH testing is typically performed in the context of female fertility or assisted reproduction planning, but it can also be used to assess certain medical conditions. “The AMH dosage is done by blood test, possible at any time of the menstrual cycle, on medical prescription“, confirms the doctor. The results are usually available after a few days. “It is important to note that AMH testing only provides an indication of ovarian reserve at any given time. It does not predict future fertility or the ability to conceive.”
What does a low AMH level mean?
A low AMH level can indicate several things, depending on the context and the person’s situation. However, in general, a low AMH level is often associated with reduced ovarian reserve. “This means that the amount of eggs remaining in the ovaries is less than normal for the person’s agewhich may have implications for fertility and pregnancy planning”, specifies our interlocutor. A low AMH level can also be associated with early ovarian insufficiency (IOD). “This means that the woman could reach menopause earlier than average, which may impact her ability to conceive naturally.” When the AMH level becomes very low, associated with a prolonged cessation of periods and an increase in FSH levels measured several months apart, it may be a premature ovarian failure (IOP), for which one can resort to egg donation in the event of a desire to become pregnant.
What does a high AMH level mean?
A high AMH level can also have several meanings depending on the context and situation of the person. A high AMH level may indicate a greater ovarian reserve than normal. This means that there are potentially more eggs present in the ovaries than average for the person’s age. “THE polycystic ovarian syndrome (PCOS) is a common hormonal condition in women, characterized by the presence of multiple ovarian follicles evoking “microcysts” on ultrasound, frequently associated with menstrual irregularities (often long cycles or absence of periods), as well as hyper androgenism (increase in blood testosterone, acne, hyperhair), concludes Dr Musset. Women with PCOS often have elevated AMH levels due to the presence of large numbers of ovarian follicles blocked in an immature stage.”
Women with high AMH levels may have more intense ovarian response to fertility treatments, such as ovarian stimulation for in vitro fertilization (IVF). This means that a large number of eggs can be stimulated and harvested during these procedures, which can increase the chances of success.
Thanks to Dr Céline Musset, gynecologist at the Belharra Clinic (Ramsay Santé) in Bayonne.