If you (or your partner) are thinking of getting pregnant or you are just curious about your reproductive potential, a good place to start is with an AMH test.
What is the AMH Test?
AMH stands for Anti-Müllerian Hormone and it is commonly viewed as a biomarker for ovarian reserve. The term ‘ovarian reserve’ refers to the reproductive potential in the ovaries based on the number and quality of follicles and oocytes (potential eggs) contained within.
AMH levels directly correlate with the number of small growing follicles in the ovaries and as the number of follicles decreases with age, so does the levels of AMH. Unlike most other reproductive hormones, AMH levels remain steady throughout the menstrual cycle and are not altered by oral contraceptives, making AMH a reliable biomarker.
So, by measuring your AMH levels, you can see if your ovarian reserve is as expected for your age[1].
However, it’s important to note that AMH levels only indicate the quantity of potential eggs in the ovaries; it does not give a measure of their quality and is therefore only one part of determining female fertility. Equally, low AMH levels (which points to a diminished ovarian reserve or low egg count) does not necessarily mean that you cannot conceive naturally.
If you are at all concerned about what your AMH results mean for you, please contact you GP or fertility specialist.
To understand the function of AMH in the female reproductive system, we first need to understand a bit about the development of eggs and follicles in the ovaries.
Oocyte is the term used to describe a developing egg, which differentiates into a mature egg (ovum) in response to sex hormones and gives rise to an embryo following fertilization.
A woman is born with all the oocytes she will ever have and this number decreases naturally with age. Each ‘primary’ oocyte is contained within a simple, protective sac-like structure termed a primordial follicle that is housed in the ovaries. Primary oocytes and their primordial follicles remain ‘dormant’ in the ovaries until puberty.
Each month between puberty and menopause, a small number of follicles begin a growing process that takes approximately 3 months to result in a mature follicle. This growing cycle involves several transitional phases:
Typically, only one follicle fully develops into a mature follicle each month. Within the mature follicle the oocyte can then undergo its next step in development to form a secondary oocyte. At ovulation, this secondary oocyte is released from the mature follicle and out of the ovary into the fallopian tube. The remaining growing follicles from that cycle disintegrate in a process known as follicular atresia.
Granulosa cells form the outer ring of the follicle and this cell layer increases in size as the follicle matures. AMH is produced by the granulosa cells of the secondary and early tertiary follicles. The production of AMH gradually decreases as follicles mature.
AMH is thought to limit the number of primordial follicles that can enter the growing pool, thereby prevent the premature exhaustion of follicles/oocytes[1]. It is also thought to reduce the sensitivity of growing follicles to the reproductive hormone follicle-stimulating hormone (FSH), thereby also regulating early follicle growth[2]. The decrease in AMH production by maturing follicles seems to be an important requirement for their maturation and progression to ovulation.
So, put simply, AMH acts as a type of brake on follicle development to help prevent the system from burning out too quickly.
What can AMH tell us?
1. AMH is a good biomarker of the quantitative aspect of ovarian reserve and low levels can be an indicator of diminished ovarian reserve.
2. AMH levels are routinely used to predict how well a woman is likely to respond to ovarian stimulation and what dose of hormones should be used for IVF treatment[1].
3. AMH is a focus of interest in polycystic ovary syndrome (see below).
4. AMH levels are though to predict the timing of menopause[1].
AMH levels are 2-4 times higher in women with polycystic ovary syndrome (PCOS)[1] and can be used as part of the diagnosis process. PCOS is characterised by an increase in number of follicles at all growing stages and researchers are exploring whether there is a link between AMH and the development (pathogenesis) of PCOS[2]. However, it is important to note that elevated AMH levels alone cannot effectively diagnose PCOS[3].
Diminished ovarian reserve is a condition in which the ovary loses its normal reproductive potential, compromising fertility.
Follicle-stimulating hormone is one of the gonadotrophic hormones produced by the pituitary gland (the other is luteinising hormone). In females, it acts on the ovaries to promote the maturation of follicles. In males, it acts on the testes to promote the production of sperm.
Polycystic ovary syndrome is caused by an imbalance of reproductive hormones and affects fertility through defects in the maturation and/or release of mature eggs.
If you would like to get find out more about your AMH levels, check out our Home Testing kit here
References
[1] Moolhuijsen, L., & Visser, J. A. (2020). Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function. The Journal of Clinical Endocrinology and Metabolism, 105, 3361–3373. https://doi.org/10.1210/clinem/dgaa513
[1] Durlinger AL, et al. (1999). Control of primordial follicle recruitment by anti-Mullerian hormone in the mouse ovary. Endocrinology140, 5789–96. doi:10.1210/endo.140.12.7204.
[2] Durlinger AL, et al. (2001). Anti-Mullerian hormone attenuates the effects of FSH on follicle development in the mouse ovary. Endocrinology 142, 4891–9. doi:10.1210/endo.142.11.8486.
[1] S. L. Broer, et al. (2011). Anti-Müllerian Hormone Predicts Menopause: A Long-Term Follow-Up Study in Normoovulatory Women. The Journal of Clinical Endocrinology & Metabolism, 96, 2532–2539.
https://doi.org/10.1210/jc.2010-2776
[1] Gomez R, Schorsch M, Hahn T, Henke A, Hoffmann I, Seufert R, Skala C. (2016). The influence of AMH on IVF success. Arch Gynecol Obstet. 293, 667-673. doi: 10.1007/s00404-015-3901-0
[1] Wiweko, Budi et al. (2014) Anti-mullerian hormone as a diagnostic and prognostic tool for PCOS patients. Journal of Assisted Reproduction and Genetics 31, 1311-1316. doi:10.1007/s10815-014-0300-6
[2] Dewailly D., Barbotin A.L., Dumont A., Catteau-Jonard S., Robin G. (2020) Role of Anti-Müllerian Hormone in the Pathogenesis of Polycystic Ovary Syndrome. Front Endocrinol. 2020 11, 641.
doi: 10.3389/fendo.2020.00641.
[3] Saxena, U. et al. (2018). Role of AMH as Diagnostic Tool for Polycystic Ovarian Syndrome. Journal of Obstetrics and Gynaecology of India 68, 117-122. doi:10.1007/s13224-017-1066-4
AMH stands for Anti-Müllerian Hormone and it is commonly viewed as a biomarker for ovarian reserve. The term ‘ovarian reserve’ refers to the reproductive potential in the ovaries based on the number and quality of follicles and oocytes (potential eggs) contained within.
Folate and folic acid are terms that are often used interchangeably to describe the essential water-soluble vitamin, vitamin B9. Folate is the natural form of this vitamin found in food, whereas folic acid is the synthetic form that is added to fortified foods or is found in supplements.
If you (or your partner) are thinking of getting pregnant or you are just curious about your reproductive potential, a good place to start is with an AMH test.
AMH stands for Anti-Müllerian Hormone and it is commonly viewed as a biomarker for ovarian reserve. The term ‘ovarian reserve’ refers to the reproductive potential in the ovaries based on the number and quality of follicles and oocytes (potential eggs) contained within.
AMH levels directly correlate with the number of small growing follicles in the ovaries and as the number of follicles decreases with age, so does the levels of AMH. Unlike most other reproductive hormones, AMH levels remain steady throughout the menstrual cycle and are not altered by oral contraceptives, making AMH a reliable biomarker.
So, by measuring your AMH levels, you can see if your ovarian reserve is as expected for your age[1].
However, it’s important to note that AMH levels only indicate the quantity of potential eggs in the ovaries; it does not give a measure of their quality and is therefore only one part of determining female fertility. Equally, low AMH levels (which points to a diminished ovarian reserve or low egg count) does not necessarily mean that you cannot conceive naturally.
If you are at all concerned about what your AMH results mean for you, please contact you GP or fertility specialist.
To understand the function of AMH in the female reproductive system, we first need to understand a bit about the development of eggs and follicles in the ovaries.
Oocyte is the term used to describe a developing egg, which differentiates into a mature egg (ovum) in response to sex hormones and gives rise to an embryo following fertilization.
A woman is born with all the oocytes she will ever have and this number decreases naturally with age. Each ‘primary’ oocyte is contained within a simple, protective sac-like structure termed a primordial follicle that is housed in the ovaries. Primary oocytes and their primordial follicles remain ‘dormant’ in the ovaries until puberty.
Each month between puberty and menopause, a small number of follicles begin a growing process that takes approximately 3 months to result in a mature follicle. This growing cycle involves several transitional phases:
Typically, only one follicle fully develops into a mature follicle each month. Within the mature follicle the oocyte can then undergo its next step in development to form a secondary oocyte. At ovulation, this secondary oocyte is released from the mature follicle and out of the ovary into the fallopian tube. The remaining growing follicles from that cycle disintegrate in a process known as follicular atresia.
Granulosa cells form the outer ring of the follicle and this cell layer increases in size as the follicle matures. AMH is produced by the granulosa cells of the secondary and early tertiary follicles. The production of AMH gradually decreases as follicles mature.
AMH is thought to limit the number of primordial follicles that can enter the growing pool, thereby prevent the premature exhaustion of follicles/oocytes[1]. It is also thought to reduce the sensitivity of growing follicles to the reproductive hormone follicle-stimulating hormone (FSH), thereby also regulating early follicle growth[2]. The decrease in AMH production by maturing follicles seems to be an important requirement for their maturation and progression to ovulation.
So, put simply, AMH acts as a type of brake on follicle development to help prevent the system from burning out too quickly.
1. AMH is a good biomarker of the quantitative aspect of ovarian reserve and low levels can be an indicator of diminished ovarian reserve.
2. AMH levels are routinely used to predict how well a woman is likely to respond to ovarian stimulation and what dose of hormones should be used for IVF treatment[1].
3. AMH is a focus of interest in polycystic ovary syndrome (see below).
4. AMH levels are though to predict the timing of menopause[1].
AMH levels are 2-4 times higher in women with polycystic ovary syndrome (PCOS)[1] and can be used as part of the diagnosis process. PCOS is characterised by an increase in number of follicles at all growing stages and researchers are exploring whether there is a link between AMH and the development (pathogenesis) of PCOS[2]. However, it is important to note that elevated AMH levels alone cannot effectively diagnose PCOS[3].
Diminished ovarian reserve is a condition in which the ovary loses its normal reproductive potential, compromising fertility.
Follicle-stimulating hormone is one of the gonadotrophic hormones produced by the pituitary gland (the other is luteinising hormone). In females, it acts on the ovaries to promote the maturation of follicles. In males, it acts on the testes to promote the production of sperm.
Polycystic ovary syndrome is caused by an imbalance of reproductive hormones and affects fertility through defects in the maturation and/or release of mature eggs.
If you would like to get find out more about your AMH levels, check out our Home Testing kit here
References
[1] Moolhuijsen, L., & Visser, J. A. (2020). Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function. The Journal of Clinical Endocrinology and Metabolism, 105, 3361–3373. https://doi.org/10.1210/clinem/dgaa513
[1] Durlinger AL, et al. (1999). Control of primordial follicle recruitment by anti-Mullerian hormone in the mouse ovary. Endocrinology140, 5789–96. doi:10.1210/endo.140.12.7204.
[2] Durlinger AL, et al. (2001). Anti-Mullerian hormone attenuates the effects of FSH on follicle development in the mouse ovary. Endocrinology 142, 4891–9. doi:10.1210/endo.142.11.8486.
[1] S. L. Broer, et al. (2011). Anti-Müllerian Hormone Predicts Menopause: A Long-Term Follow-Up Study in Normoovulatory Women. The Journal of Clinical Endocrinology & Metabolism, 96, 2532–2539.
https://doi.org/10.1210/jc.2010-2776
[1] Gomez R, Schorsch M, Hahn T, Henke A, Hoffmann I, Seufert R, Skala C. (2016). The influence of AMH on IVF success. Arch Gynecol Obstet. 293, 667-673. doi: 10.1007/s00404-015-3901-0
[1] Wiweko, Budi et al. (2014) Anti-mullerian hormone as a diagnostic and prognostic tool for PCOS patients. Journal of Assisted Reproduction and Genetics 31, 1311-1316. doi:10.1007/s10815-014-0300-6
[2] Dewailly D., Barbotin A.L., Dumont A., Catteau-Jonard S., Robin G. (2020) Role of Anti-Müllerian Hormone in the Pathogenesis of Polycystic Ovary Syndrome. Front Endocrinol. 2020 11, 641.
doi: 10.3389/fendo.2020.00641.
[3] Saxena, U. et al. (2018). Role of AMH as Diagnostic Tool for Polycystic Ovarian Syndrome. Journal of Obstetrics and Gynaecology of India 68, 117-122. doi:10.1007/s13224-017-1066-4
Olive gained her PhD in Trinity College Dublin in Immunology. She has enjoyed a varied career including working as an immunologist, researcher, science communicator and Chief Editor for leading scientific journal, Nature Reviews Immunology. Olive has now set up her own business in sustainable forestry management but still maintains her passion for science and education through her articles with Hibernian Health Check.
AMH stands for Anti-Müllerian Hormone and it is commonly viewed as a biomarker for ovarian reserve. The term ‘ovarian reserve’ refers to the reproductive potential in the ovaries based on the number and quality of follicles and oocytes (potential eggs) contained within.
Folate and folic acid are terms that are often used interchangeably to describe the essential water-soluble vitamin, vitamin B9. Folate is the natural form of this vitamin found in food, whereas folic acid is the synthetic form that is added to fortified foods or is found in supplements.
