AMH (Anti-Mullerian Hormone)

Anti-Mullerian Hormone (AMH) is secreted by Sertoli cells in the testes in males, contributing to the normal development of the reproductive organs in the early stages and continues to be secreted throughout life. In females, it begins to be secreted by granulosa cells in the ovaries after birth, increases during the reproductive years, and decreases towards menopause to levels that are almost undetectable.

AMH plays a crucial role in tissue development and differentiation during fetal development. In male fetuses, it facilitates the regression of the Mullerian duct, which forms the fallopian tubes and upper vagina, contributing to the formation of male genital organs. Additionally, it regulates spermatogenesis, which is the production of sperm. In females, it is involved in the regulation of folliculogenesis, determining which eggs will develop.

What is the AMH test?

The Anti-Mullerian Hormone (AMH) test is a blood test used to measure ovarian reserve in women. AMH, found in both men and women, is secreted in females from birth and continues to be secreted until menopause. Its levels drop to undetectable levels with menopause.

AMH, a hormone secreted by granulosa cells surrounding small growing eggs in women, plays a crucial role in determining which eggs will develop. It is a significant test providing information about ovarian reserve as it is secreted by small cells not visible even with ultrasound. The level of AMH is directly related to the number of eggs in the ovaries.

In the context of in vitro fertilization (IVF) treatments, AMH serves as a crucial indicator of response to treatment. It guides us in determining the hormone levels to be used before treatment. Patients are informed that in cases of low AMH levels, a limited number of eggs may be collected.

How is the AMH test performed?

The AMH test, like other hormone tests, is performed by analyzing blood. It is a blood test taken from a vein. The AMH test can be done at any point in the menstrual cycle, and there is no need for the patient to be in a specific phase of the cycle, unlike other tests.

Why is the AMH test requested?

The most common use of the AMH test is to determine ovarian reserve in women, making it a crucial marker in contemporary fertility assessments.
It is a test requested for investigating and monitoring granulosa cell tumors (ovarian cancer).
Used in in vitro fertilization (IVF) treatments to assess the risk of poor response or hyperstimulation (OHSS).
Employed in the differential diagnosis of patients with genital anomalies.
Applied in detecting menopause.
Recommended for diagnosing Polycystic Ovary Syndrome (PCOS).

What are the normal values for the AMH test?

During puberty, it ranges between 1.5-4 ng/ml and decreases with age, reaching undetectable levels with menopause. Your doctor must evaluate your AMH value, and it provides information about the number of eggs in your ovaries. It is important to consider each patient individually and apply personalized treatment.

High (AMH > 4 ng/ml)
Normal (AMH 1.5-4 ng/ml)
Low (AMH < 1.5 ng/ml)
Very Low (AMH < 0.5 ng/ml)

What are the key differences between the FSH and AMH tests?

FSH is secreted by the pituitary gland in the brain, while AMH is directly secreted by granulosa cells in the ovaries.
FSH can be measured in specific phases of the menstrual cycle, whereas AMH can be measured at any point in the cycle.
FSH levels vary significantly during menstrual cycles and in menopausal periods, while AMH levels remain stable.
AMH is not affected by birth control pills.
AMH is a direct test indicating ovarian reserve in women.
Fasting or non-fasting does not affect AMH test results.

How is the AMH test interpreted?

The AMH result should be evaluated by your doctor after considering all examination and test findings discussed during a consultation.

It's crucial to remember that the AMH value provides information about the number of eggs in your ovaries, not the quality of the eggs. In cases of very low AMH values, it is important not to panic immediately. Even with a low number of eggs, quality eggs can develop, leading to a successful pregnancy. Patients with low AMH values should carefully consider their remaining time and, if they desire to have children, it is advisable to act promptly.

Patients with high AMH values are informed about the potential risk of developing Ovarian Hyperstimulation Syndrome (OHSS) during IVF treatment, and the treatment process is managed accordingly.

Treatment for Low AMH:

While men can produce sperm daily, women are born with a finite ovarian reserve. Since AMH reflects the number of eggs in the ovaries, and women cannot produce new eggs, treatment to increase AMH is not possible. If patients with low AMH values wish to have children, it is recommended that they act promptly.