Anti-Müllerian Hormone (AMH): The female fertility hormone (what is it, values and its meaning)
What is the AMH Anti-Müllerian Hormone?
AMH, or Anti-Müllerian Hormone, is a hormone that is not often heard of, except during fertility treatments.
Gynecologists specialized in human reproduction are obsessed with it and require its measurement already in the initial assessment of a woman’s fertility, but why is that?
Because AMH is a hormone that can be measured in the blood and that allows us fertility specialists to estimate your “ovarian reserve“, or the number of egg cells you still have at your disposal to try and get pregnant.
In fact, the Anti-Müllerian Hormone, is produced by the cells that make up the ovarian follicles, which, if you remember from my article regarding the ovaries, are the “houses” where our egg cells live and grow in the ovaries.
More specifically, the Anti-Müllerian Hormone production is made by the “granulosa cells” of the very small primary ovarian follicles.
How is the AMH anti-Müllerian hormone measured?
Dosing the anti-Müllerian hormone value is simple, and only requires a blood sample.
AMH is the acronym for Anti Mullerian Hormone, and this is the name that is most often found in the blood test reports.
Unlike other hormones such as FSH or prolactin, there is no need to test your AMH levels on a specific day of your menstrual cycle or at a specific time of the day, and also fasting is not required.
In fact, the values of AMH do not vary greatly intracycle (that is during the menstrual cycle) or intercycle (that is between one menstrual cycle and the next).
AMH remains stable over time and makes the repetition of its measurement unnecessary before 6 months have passed from the last test.
This means you can go and get your blood test to measure your AMH levels whenever you want!
The AMH value will be very different depending on the unit of measurement used by the laboratory.
For this reason, it is essential to always consider which units the measurement number is followed by (for example ng/ml or pmol/l).
Why is this so important? Because, just to make it simple, 1 ng/mL corresponds to about 7 pmol/l.
Therefore an AMH of 4 will have a very different meaning idepending if the measurement is in ng/ml (which would indicate a very high ovarian reserve) or pmol/l (which would indicate a poor ovarian reserve).
What is the purpose of measuring the AMH Anti Mullerian Hormone?
The anti-Müllerian hormone is used to provide your fertility doctor with an estimate of the quantity of oocytes still present in your ovaries.
It is not an indicator of oocyte quality nor an indicator of the probability of pregnancy.
AMH is furthermore a good indicator of how your ovaries could respond to an ovarian stimulation treatment.
In case of an assisted reproduction treatment, it must always be measured to guide the choice of treatment protocol and the dosage of the medication to be used.
AMH: what it is NOT
As mentioned, your AMH level is only able to give us an estimate of how many oocytes are still available to you, but it does not provide us with any information on your egg quality.
Of course, quantity is relevant, but quality is actually the most important parameter when it comes to your chance of getting pregnant.
Interpretation of values
The same AMH value in different women of different ages, for example, will have a totally different meaning.
AMH: its meaning in practice
Your ovaries are your fertility banks, storing all your egg cells.
Your egg cells or oocytes can either be of good quality (golden eggs) or poor quality (white eggs).
Over the years more and more good quality eggs will become poor quality eggs.
let’s examine 2 women with the same AMH value, but different ages.
You will see that the meaning of the AMH value for our 2 friends is going to be totally different!
Sarah is 28 and Julie is 39, both have the same AMH value: 2 ng/ml.
The number of egg cells that can be retrieved in an ovarian stimulation treatment will be comparable for the two women.
To make this example simple, let’s pretend that the number of retrieved oocytes is 10 for both friends.
So, the quantity of eggs retrieved is the same, but when we focus on the quality of these retrieved egg cells, we will discover that
- in Sarah’s case about 8 eggs out of 10 will be of good quality,
- while in Julie’s case only 4 out of 10 eggs will be of good quality
This example should not be taken literally. It should help you understand how important age is in determining the success of conception both with traditional sex and with assisted fertilization techniques.
AMH Anti Mullerian Hormone and pregnancy
Only one good quality egg is required to achieve a pregnancy that leads to the birth of a healthy baby.
A lower AMH value than the average value expected in your age group could lead to your doctor's recommendation to perform an ovarian stimulation treatment in order to preserve your fertility potential in the years to come.
To date, there are no tests able to analyze the quality of eggs, which we know decreases with age for all of us girls.
The AMH value should therefore always be critically evaluated in relationship to the age of the woman, because oocyte quality mostly depends on the age.
The “goodness” of the oocytes can only be investigated once the assisted fertilization treatment has been performed:
AMH: why is it called ANTI Mullerian hormone?
In reality, the anti-Müllerian hormone is not an exclusively female hormone.
Its name comes from the role it plays in the development of the male reproductive system!
In fact, at the beginning of the intrauterine life development, all human beings have 2 types of structures:
- Müller’s ducts and
- Wolff’s ducts,
Regardless of their chromosomal sex (XX female or XY male).
On the other hand, in female embryos the Müller’s ducts will not be opposed by the action of the anti-Müllerian hormone and will allow the development of
- the uterus,
- the fallopian tubes,
- the vagina.
If we stop and think about it for a moment, until the 12th week of pregnancy we are all the same, male and female, so, even from a scientific point of view ... gender-based hatred makes absolutely no sense!
AMH: All you need to know
The anti-Müllerian hormone value will begin to decrease more rapidly starting more or less from age 35 reaching zero at the onset of menopause.
Always remember that AMH is the bank statement of your ovaries!
