Anti-Müllerian hormone – key to fertility assessment

One of the most important factors in assessing a woman’s fertility is the anti-Müllerian hormone (AMH). This marker is used to determine a woman’s ovarian reserve, which is the number of eggs she possesses at a given time. But what does it actually mean and how can AMH impact a woman’s capacity to conceive? Moreover, how does it affect fertility treatments? If you want to become pregnant and have questions regarding AMH, this article will help you make wise decisions.

What is the anti-Müllerian hormone and why is it so important?

The Anti-Müllerian hormone (AMH) is a protein present in men as well as women. However, its functions and localisation differ depending on the sex. It plays a crucial role during pregnancy, because it determines the sex of a foetus. 

For males, it is responsible for preventing the development of Müllerian ducts—the structures that later turn into a uterus and fallopian tubes. To this phenomenon it owes its peculiar name: anti-Müllerian.

Likewise, the absence of this hormone will allow the female reproductive organs to develop in the foetus. The anti-Müllerian hormone will start to manifest itself a few weeks later, when the foetus will have developed its own ovarian follicles.

When a woman reaches puberty, her ovarian follicles (where the eggs develop) start producing the anti-Müllerian hormone. The process lasts throughout the woman’s reproductive years, until menopause. 

Hence, its concentration in a woman’s blood indicates approximately the number of eggs present in the ovaries, or, in other words, indicates the state of the ovarian reserve at a given moment. Nevertheless, in order to evaluate a woman’s fertility, not only should we take into account the AMH, but also other hormones, such as the Follicle Stimulating Hormone (FSH) and the Luteinising Hormone (LH); and, among other procedures, the antral follicle count performed during a transvaginal ultrasound.

How is AMH measured and what can we deduce from its levels?

AMH levels are measured through a blood test. They can vary between women of the same age, as they depend on factors such as genetics, the patient’s lifestyle and some medical conditions. Unlike other reproductive hormones, AMH levels do not fluctuate significantly during the menstrual cycle, so they can be measured on any day of the cycle. Nevertheless, the blood test tends to be performed during the first few days of the cycle so as to be able to additionally measure the levels of other female hormones related to fertility, such as FSH and oestradiol. 

Usually, laboratories are able to provide the levels of AMH with slight variations, but the standard classification is as follows:

The correlation between the anti-Müllerian hormone and fertility treatments

The AMH is a key marker to determine what kind of strategy should be implemented in the pregnancy planning and assisted reproduction treatments. 

1. Pregnancy planning. 

Normally, the AMH levels begin to drop drastically upon reaching the age of 35, however, should you notice such a decline before this age, you can plan your pregnancy in the following ways:

– by conceiving as soon as possible, either by natural means or through assisted reproduction;

– by preserving your fertility through egg freezing if your ovarian reserve is low and you do not want to become a mother yet. Opting for either of these methods can give you the possibility to use your own eggs for fertilisation in the future, should you exhaust your ovarian reserve.

2. Adjustment of the ovarian stimulation in assisted reproduction treatments.

In a fertility treatment, the AMH levels help us, specialists, in adjusting the doses of medication for ovarian stimulation during IVF or artificial insemination.

Women with low AMH levels have to receive a very personalised ovarian stimulation, because in such instances, there is an increased probability of a low response. Nonetheless, this never means that a successful pregnancy cannot be achieved. Furthermore, you might opt for other treatments, such as an ovarian rejuvenation. This is an ovarian reactivation technique that utilises Platelet Rich Plasma (PRP). It can help to obtain more eggs and, in consequence, increase the possibility of a pregnancy.

Otherwise, for women with high AMH levels, which tends to be the case for patients suffering from PCOS, a proper control is needed in order to avoid an exaggerated ovarian response following an ovarian stimulation, as it could lead to the Ovarian Hyperstimulation Syndrome—a complication that, in severe cases, might result in hospitalisation and require additional treatment.

Effects of endometriosis on anti-Müllerian hormone levels 

It is important to keep in mind that even though endometriosis is a benign disease, if the proliferation of endometriotic tissue takes place within the ovarian tissue, it may affect the ovarian follicles. This can not only decrease the number of follicles, but also the woman’s levels of AMH, which in consequence reduces her reproductive capacity. 

Because endometriosis can spread and affect other tissues and organs, which could further lower the reproductive capacity, it is most recommended to try to achieve pregnancy as soon as possible, either by natural means or through personalised assisted reproduction treatments.

However, if you currently do not want to make such a decision and prefer to postpone it, oocyte vitrification is something to consider, because, as we mentioned above, it allows you to preserve your eggs and keeps them safe in the case of another outbreak of the disease occurring. 

Effects of PCOS on anti-Müllerian hormone levels

It has already been pointed out that patients with PCOS usually have high levels of AMH. Why is that? Because PCOS entails an increase in the number of ovarian follicles at every stage of growth. This elevated number of antral and preantral follicles, which are responsible for the anti-Müllerian production, results in the serum AMH level for women with PCOS is 2 to 4 times higher compared to the women that do not suffer from the disease.

It is important to know that this excess can trigger an exaggerated ovarian response while a patient undergoes ovarian stimulation treatments for IVF or artificial insemination and increase the risk of ovarian hyperstimulation.

In women with PCOS, when hormone stimulation is used for artificial insemination or scheduled intercourse, we must also assess the risk of multiple pregnancies if there are more than 2 or 3 mature follicles in the ovaries. Therefore, we must use very low doses of hormonal medication in these cases. Furthermore, should more follicles develop than indicated, it will be necessary to cancel the cycle and use protection if sexual intercourse takes place. This is to avoid a multiple pregnancy, as in this situation it is not possible to control exactly how many eggs are released and may be fertilised.

The importance of early and personalised diagnosis 

When AMH levels point to low ovarian reserve or elevated levels due to conditions such as PCOS, you need to make decisions as soon as possible and get help from an expert team who can advise you and offer tailored solutions. However, although the anti-Müllerian hormone provides important information about ovarian reserve, other tests and procedures are also necessary to determine a woman’s fertility status and make an accurate diagnosis. 

At Tambre, we offer a comprehensive approach, combining advanced technology and a specialised team that allows us to perform personalised assisted reproduction treatments, from targeted ovarian stimulation to egg vitrification or gamete donation, always with the aim of maximising the chances of a successful pregnancy. If you have any questions about your fertility or you are facing unusual anti-Müllerian hormone levels, our team is here to advise you and walk you through every step of the process.
If you are seeking answers regarding your fertility, at Tambre we offer a personalised diagnosis and the best options to help you achieve your dream of becoming a mother.

Contact us or call us on 91 411 61 11 to request your first consultation.

Frequently Asked Questions

Can AMH levels be improved?

There are no specific treatments to increase AMH, but certain lifestyle changes, such as a balanced diet and stress management, may help optimize ovarian health.

Does a low AMH level mean early meno