Understanding AMH Test

Women are born with approximately 2,000,000 eggs, this number will have depleted to 400,000 by puberty. From the first menstruation, a woman will lose around 1000 eggs per month, whilst one egg matures and is released by the ovary.

What is AMH?

AMH also known as Müllerian-inhibiting hormone (MIH), is a glycoprotein hormone produced by the follicles in the ovaries.

The follicles have four development stages:

AMH is produced by preantral and small antral follicles.

Antral follicles are mature ovarian follicles that hold and nourish the immature egg which will later burst through the ovary wall and travel through the fallopian tube.

As AMH is produced by the follicles, it is natural that the levels reduce with age, reaching very low levels prior to menopause.

How is it tested?

The AMH test is done through a blood sample. It can be done at any time in the menstrual cycle, as the levels are stable throughout the cycle. Normal values change with age.

For accurate assessment, AMH tests should be combined with an antral follicle count, which is a test that uses an ultrasound to count the number of small follicles within both ovaries.

Abnormal AMH: what does it mean?

A low, high or irregular AMH can be an indication of different problems:

Is AMH a good measure of ovarian reserve?

Among all ovarian reserve tests, AMH is considered the earliest and most sensitive test of ovarian reserve.

• Correlates strongly with the number of follicles, meaning high values are associated with more follicles and low values associated with less follicles.
• Has an inverse correlation with age, meaning as women get older, AMH values reduce.
• Reliably predicts ovarian response in IVF, meaning high values are associated with OHSS risk and low values to likelihood of poor response to fertility drugs.
• It is predictive of the timing of the onset of menopause, as it reduces with age.

Does it measure quantity or quality?

• Despite being a good predictor of ovarian response to stimulation in IVF, AMH is a poor predictor of nonpregnancy.
• AMH is also a poor predictor of pregnancy and live birth following ART, meaning normal values are not associated with taking a baby home.
• In a recent study, the chances of getting pregnant in any given cycle was no different for women with low and normal levels of AMH

These facts are consistent with AMH being a predictive marker of oocyte quantitybut not quality.

Is a false result possible?

AMH levels should be relatively regular in between cycles. If you have had different results in between cycles, it is worth considering if one of the results was not accurate.

Several studies have demonstrated differences between laboratory results, associated with sample stability and storage issues. This means the time between the blood sample being collected and it being analyses can affect the result. Longer periods and warm samples seem to affect AMH, giving a false result. The sample requires careful preparation and storage.

What affects AMH?

• Stress seems to reduce AMH levels.
• Hormonal disorders and medical conditions related to reproductive system also might affect AMH levels.
• Women with the history of ovarian, have a higher risk of low AMH.
• Unhealthy diet saturated with fats and processed foods reduces AMH
• Vitamin deficiency, particularly vitamin D, reduces AMH levels
• Polycystic ovary syndrome (PCOS) is associated with elevated AMH levels.
• Ovarian suppression related to oral contraceptive pills or GnRH agonist administration can decrease AMH levels.
• Caffeine, smoking and pesticides also affect AMH levels.

If you need support understanding your AMH test results or want to explore ways of improving your AMH levels, schedule a Free Fertility Consultation with our awarded Nurse Consultant and NLP Coach Andreia Trigo. It’s never too late to start your fertility support plan, why not start today? Book your appointment here.

The Enhanced Fertility Programme a unique, evidence-based programme that has been through research to improve your health for fertility. Check it out here.

About Andreia Trigo

Andreia Trigo RN BSc MSc is the founder of the Enhanced Fertility Programme, multi-awarded nurse consultant, coach, author and TEDx speaker. Combining her fourteen-year medical experience, CBT, NLP and her own eighteen-year infertility journey, she has developed unique strategies to help people undergoing similar challenges achieve their reproductive goals. The Enhanced Fertility Programme is helping people worldwide and has been awarded Best Innovation in Business 2018 and E-Business of 2018.