17 September 2018

What is the role of anti-Müllerian hormone in female fertility and infertility?

By the Editorial Comitee IVI Blog


Anti-Müllerian hormone (AMH hormone) is one of the naturally occurring hormones in the female body that can give an indication of fertility potential. In this article we look at the implications of this for both fertility and infertility and how an AMH test can give a helpful pointer to both clinicians and patients who may have any concerns on these topics. You may have heard about high FSH low AMH success stories and we will unpack the meaning of these concepts. We also set out what an AMH blood test involves and how long for AMH test results your waiting time may be, what low AMH can mean for your prospects of becoming a parent and some of the facts and myths about how to increase AMH naturally.

Finally we tell you a little about ourselves, how we may be able to offer help to patients with low AMH levels, and what you can expect when you visit an IVI clinic.


What is AMH and what is its role in female fertility?

Anti-Müllerian hormone is a substance which developing egg sacs (ovarian follicles) secrete, and its levels are detectable by the simple means of an AMH blood test. The higher the number of eggs remaining in the ovaries, the higher the level of AMH which will show in the bloodstream. Therefore, a low level is considered to be a sign of a low ovarian reserve, i.e. few remaining follicles. This would be normal for a woman who is approaching menopause. By the same token, a woman who has polycystic ovarian syndrome, characterised by the presence of many small ovarian follicles, would normally be expected to show high levels of AMH.

In this way AMH plasma levels reflect the continuous growth of small follicles, and so reflect the size of the remaining follicle pool, thus representing a useful marker of ovarian reserve. Anti-Müllerian hormone is particularly useful as an endocrine marker for assessing the age-related decline of the ovarian pool and consequently its ability to predict future reproductive lifespan. It is particularly useful, although not a complete diagnostic solution, since an AMH test can be carried out at any time of the monthly cycle, and even if the woman concerned is taking oral contraceptives.

Often the waiting time for the results of other types of hormonal tests may include the wait for the right point in your monthly cycle for the test to be carried out, and so with AMH this is not an issue. So how long for AMH test results is just a matter of a few days at any time of the month.


What is the role of low AMH in infertility?

If you, or you and your partner are aiming to start a family and you have any concerns about the possibility of declining fertility, either because of your age or for any other reason, it would be helpful to have an AMH test. We have noted that this is a good indicator of the remaining reserve of egg follicles in the body. However, if your AMH blood test shows you have low AMH levels, this is not tantamount to a diagnosis of infertility, only of a decline in the level of fertility. The results at this stage do not tell us anything about the quality of the remaining egg follicles. Factors other than age can also affect the ovarian reserve and, in the case of younger women, a low ovarian reserve may not indicate poor oocyte quality.


What other tests can help determine the ovarian reserve?

The AMH test is only one of the ways to determine ovarian reserve. Other hormones which play their part in determining fertility or lack of it include:

  • Follicle-stimulating hormone (FSH) which acts on the ovarian follicles by regulating the menstrual cycle and stimulating egg cell production.
  • Luteinizing hormone (LH) controls follicle maturation. An increase in LH level acts as the signal for the ovary to release an egg cell. The LH test allows ovulation to be assessed and can determine whether a woman has reached menopause.
  • Estradiol is the most important of the oestrogens. The test for this hormone (sometimes also known as E2) allows ovary function to be assessed. The test must be carried out between days 3 and 5 of the menstrual cycle.

In addition to the AMH measurement, testing the level of these hormones helps clinicians to evaluate a woman’s level of fertility and the likelihood of natural conception. Another very important function of AMH testing is that it is an important indicator of the potential effectiveness of assisted fertility treatment. This is because it provides an assessment of the likely ovarian response to hormone treatment.


What exactly are low levels of AMH and how are they measured

The level of AMH is expected to drop with age until it becomes undetectable at menopause. In this context, very low AMH is usually thought to be an AMH below 1.05 ng/ml, and undetectably low AMH levels are calculated as below 0.16 ng/ml. A low level of FSH (follicle stimulating hormone) can be an additional indicator of a problem with the quantity of a woman’s eggs.

If you have browsed any of the fertility information available on the web, you no doubt have come across some high FSH low AMH success stories and naturally many of these are encouraging and raise hopes for anyone also hoping for reproductive success. Frequently these reports are combined with advice on how to increase AMH naturally and encouraging ovarian health through diet, herbs, supplements and increased circulation to the reproductive system. However, these methods have not been scientifically proven. While there is no doubt that maintaining a healthy lifestyle including diet and exercise is good for overall health and therefore in general good for optimum fertility, reports on how to increase AMH naturally, as well as the various high FSH low AMH success stories should be approached with a degree of healthy scepticism.


What help is available from IVI for women with low AMH hormone levels?

IVI is the largest assisted reproduction group in the world, and our experience of offering the best techniques in assisted reproduction spans over 27 years. Thanks to our services, more than 160,000 babies have so far been born. When you visit one of our clinics you will find yourself in a welcoming environment where the patient experience and needs are put at the heart of all clinical developments. We focus on turning our patients’ dreams of becoming parents into reality and in doing so, we always follow the consistently high standards that apply throughout our IVI clinics globally. This is the level of professional commitment and expertise that you can rely on.

In the case of low AMH hormone levels, first you could be offered an AMH and FSH test to see how well your ovaries might respond to fertility drugs. This can help your clinical adviser to judge whether IVF is the best treatment. Providing your clinical consultant at IVI considers there is an adequate AMH level for IVF, in vitro fertilisation could well be the treatment recommended. Alternatively, if the AMH levels and thus the ovarian reserve are so low that this type of treatment is unlikely to succeed, your clinician may advise you to consider the use of egg donation. Especially for women with an extremely low ovarian reserve, and if multiple rounds of IVF have not been successful, egg donation could be the best option for achieving pregnancy.

If the treatment that is most suitable in your own particular case is IVF, it could take place either through the very well-established conventional IVF, which consists of placing the eggs in contact with sperm in a petri dish or alternatively through ICSI (Intracytoplasmic sperm injection). This consists of microinjection of the sperm directly into the mature egg with the help of a pipette. You can find out more about IVF and ICSI on our YouTube video channel. If on the other hand the optimum assisted reproduction technique in your unique circumstances is egg donation, you can find out more and get some of your questions answered with this article about egg donation on our website. You should of course also feel free to read up on our range of treatments and get up-to-date details on our methods and clinical results on our website.

If this article or your perusal of the information on our website has raised any queries that you would like to discuss with one of our advisers, do get in touch. When you feel ready to make your first appointment at IVI to discuss how we may be able to help you on your journey to becoming a parent, go ahead. You can call us on Freephone 08 000 850 035 from the UK or on +34 960 451 185 from other countries. Alternatively, complete our online contact form and one of our advisers will get back to you straight away.



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