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Anti Mullerian Hormone (AMH)

Reproductive
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Anti-Müllerian Hormone (AMH) is a hormone secreted by granulosa cells of ovarian follicles. It reflects the ovarian reserve, or the remaining egg supply in a woman’s ovaries

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Anti Mullerian Hormone (AMH) - Comprehensive Test Guide

  • Why is it done?
    • Measures ovarian reserve and the number of egg-producing follicles in women to assess reproductive potential and fertility status
    • Evaluates fertility in women planning pregnancy or undergoing assisted reproductive techniques such as in vitro fertilization (IVF)
    • Predicts age-related decline in fertility and evaluates diminished ovarian reserve (DOR)
    • Diagnoses or monitors polycystic ovary syndrome (PCOS) in women with irregular cycles or infertility
    • Assesses ovarian function and detects premature ovarian failure (POF) or primary ovarian insufficiency (POI)
    • Performed typically during the early follicular phase (days 3-5) of the menstrual cycle for optimal accuracy
    • May be ordered in women over age 35 seeking fertility consultation, experiencing unexplained infertility, or with family history of early menopause
  • Normal Range
    • General Normal Range: 1.0 - 3.0 ng/mL (or 7 - 21 pmol/L in SI units)
    • Reference ranges may vary by laboratory:
    • Normal/Good Ovarian Reserve: 1.5 - 4.0 ng/mL indicates adequate egg supply for fertility purposes
    • Low AMH: <1.0 ng/mL indicates diminished ovarian reserve; suggests reduced number of viable eggs and lower fertility potential
    • Very Low AMH: <0.3 ng/mL indicates severely diminished or very poor ovarian reserve
    • High AMH: >4.0 ng/mL may suggest PCOS, higher ovarian reserve, or potentially increased risk of ovarian hyperstimulation during fertility treatment
    • Units of Measurement: ng/mL (nanograms per milliliter) or pmol/L (picomoles per liter)
  • Interpretation
    • Low AMH Levels (<1.0 ng/mL):
    • Indicates reduced number of remaining follicles and declining ovarian function; associated with advanced reproductive age or premature ovarian aging
    • May result in fewer eggs retrieved during IVF cycles and reduced fertilization rates; does not necessarily indicate inability to conceive naturally
    • Requires reassessment as AMH can fluctuate; elevated FSH levels often accompany low AMH confirming ovarian reserve decline
    • Normal AMH Levels (1.5-4.0 ng/mL):
    • Suggests adequate ovarian reserve with reasonable number of follicles available; favorable prognosis for fertility treatments and natural conception
    • Correlates with age-appropriate ovarian function; indicates potential for good egg retrieval during IVF procedures
    • High AMH Levels (>4.0 ng/mL):
    • Indicates higher than average number of follicles; often associated with PCOS diagnosis when combined with other clinical findings
    • Associated with increased risk of ovarian hyperstimulation syndrome (OHSS) during fertility treatment; may require adjusted stimulation protocols
    • May suggest younger ovarian age; positive indicator for quantity of eggs but does not reflect egg quality
    • Factors Affecting AMH Results:
    • Age is the most significant factor; AMH naturally decreases with advancing reproductive age
    • Hormonal contraceptives may suppress AMH levels; oral contraceptives can lower values by 20-30%
    • Smoking, body mass index (BMI), and insulin resistance can negatively impact AMH levels
    • Previous ovarian surgery or chemotherapy can permanently reduce AMH levels by damaging ovarian tissue
    • Cycle day and timing of blood draw; some variation occurs throughout menstrual cycle though AMH is relatively stable compared to FSH
    • Laboratory variations and different assay methods can produce different reference ranges; results should be interpreted using the specific lab's reference values
  • Associated Organs
    • Primary Organ System:
    • Reproductive system, specifically the ovaries which produce AMH from granulosa cells in developing follicles
    • Pituitary gland and hypothalamus which regulate FSH secretion that stimulates follicle development and subsequent AMH production
    • Medical Conditions Associated with Abnormal Results:
    • Polycystic Ovary Syndrome (PCOS) - elevated AMH due to numerous small follicles with increased granulosa cell population
    • Diminished Ovarian Reserve (DOR) - low AMH indicating accelerated age-related decline in egg quantity
    • Premature Ovarian Failure (POF) / Primary Ovarian Insufficiency (POI) - very low or undetectable AMH in women under 40 with menstrual irregularity
    • Unexplained Infertility - low AMH may explain infertility in women with normal menstrual cycles
    • Ovarian Cancer - may be associated with altered AMH levels; used as potential tumor marker in some cases
    • Turner Syndrome - extremely low AMH due to reduced number of primordial follicles
    • Autoimmune oophoritis - inflammatory condition affecting ovaries with potential impact on AMH production
    • Potential Complications and Risks Associated with Abnormal Results:
    • Low AMH - reduced fertility potential, lower pregnancy rates with assisted reproductive technology, need for more aggressive stimulation protocols
    • High AMH in PCOS - increased risk of ovarian hyperstimulation syndrome during fertility treatment, higher chance of ectopic pregnancy, metabolic abnormalities
    • Psychological impact of low AMH results including anxiety about fertility and reproductive timing
    • POI/POF diagnosis implications for quality of life, increased cardiovascular and bone health risks requiring long-term management
  • Follow-up Tests
    • Recommended Additional Tests Based on AMH Results:
    • Follicle Stimulating Hormone (FSH) - measured on cycle day 3; elevated FSH with low AMH confirms diminished ovarian reserve; FSH >10 mIU/mL suggests poor prognosis
    • Luteinizing Hormone (LH) - assess pituitary function and LH:FSH ratio; elevated ratio may suggest PCOS
    • Estradiol (E2) - measured with FSH to rule out false-low FSH readings and accurately assess ovarian reserve
    • Inhibin B - provides additional marker of ovarian reserve; particularly useful in early follicular phase assessment
    • Testosterone and Free Androgen Index - if PCOS suspected to evaluate hyperandrogenism
    • Thyroid Function Tests (TSH, Free T4) - autoimmune thyroid disease can affect ovarian function; common in POI
    • Prolactin levels - elevated prolactin can suppress ovarian function and FSH secretion
    • Transvaginal Ultrasound - visualizes ovaries and antral follicle count (AFC); correlates with AMH for ovarian reserve assessment
    • Semen Analysis - if infertility evaluation; assess male factor contribution to couple's fertility status
    • Hysterosalpingography (HSG) or Diagnostic Laparoscopy - evaluate tubal patency and pelvic pathology if structural issues suspected
    • Monitoring Frequency:
    • Baseline assessment typically performed once; results relatively stable over months to years
    • Repeat testing may be warranted after 1-2 years to assess decline trajectory in women with low AMH or DOR
    • If undergoing fertility treatment, may retest to assess response and plan subsequent treatment cycles
    • POI/POF patients require ongoing monitoring of ovarian function, metabolic parameters, and cardiovascular risk annually
  • Fasting Required?
    • Fasting: No - fasting is not required for AMH testing
    • AMH levels are not affected by food intake or meal timing; test can be performed at any time of day
    • Special Timing Considerations:
    • Ideally performed during early follicular phase (cycle days 3-5) for consistency and comparability with baseline values, though AMH is relatively stable throughout cycle
    • If patient is on oral contraceptives, should ideally wait 2-3 months after discontinuation for more accurate assessment, as hormonal contraceptives suppress AMH
    • Medications to Avoid:
    • No specific medications need to be held prior to testing; however, hormonal contraceptives (birth control pills, patches, injections) can lower AMH levels
    • If possible, discontinue hormonal contraceptives 2-3 months before testing for most accurate reserve assessment
    • Other medications do not significantly affect AMH levels; continue all regular medications unless otherwise directed by provider
    • Other Patient Preparation Requirements:
    • Minimal preparation needed; standard blood draw procedure with no special positioning or restrictions required
    • Wear loose, comfortable clothing to facilitate blood draw access; bring insurance card and photo identification
    • Inform phlebotomist if prone to fainting or have difficulty with blood draws; can remain seated or lie down during procedure
    • Drink adequate fluids day of testing to improve vein visibility; mild dehydration can make blood draws more difficult
    • Can resume normal activities immediately after blood draw; no activity restrictions

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