Michelle Emblenton, biochemist at inviTRA, tells us about the importance of measuring anti-mullerian hormone levels in women:
The anti-mullerian hormone is produced in women by the granulosa cells of the antral and preantral follicles in the ovaries. As such, it can be used as a measurement as to how many eggs are developing in the ovaries and therefore a measurement of a woman's ovarian reserve at that point in her life. A woman's ovarian reserve is, basically, the numbers of eggs she has. The levels of this hormone are measured to give an indication of the ovarian reserve and will often be measured in conjunction with things such as the follicle stimulating hormone, lutenizing hormone and estradiol. The levels of AMH in the bloodstream do not depend on the day of the menstrual cycle, so this test can be performed at any day within the menstrual cycle. However, since other hormones (such as FSH, LH and estradiol) are affected by the day of the menstrual cycle, the blood draw taken to study all the hormones will be the same used to study for the AMH levels and hence will be taken on the same day. The levels of AMH detected during that test give us an idea of the woman's fertility at that stage in her life when the test was taken. However, it is important to remember that different tests provide their measurements in different ways. The most commonly used units to express AMH levels are nanograms per milliliter (ng/ml). Values of over 69 ng/ml show very high levels of AMH. This shows a very good ovarian reserve. However, if IVF is going to performed and ovarian stimulation, care must be taken in order not to produce an ovarian hyperstimulation syndrome. With levels between 3 and 6 ng/ml shows a good ovarian reserve and levels between 1.2 and 3 show a normal ovarian reserve. As the levels drop, between 0.7 and 0.9 ng/ml, we have what is considered to be a normal ovarian reserve but starting to be depleted. And levels under 0.6 show a low ovarian reserve. With very low levels of AMH, perhaps under 0.3ng/ml it does show that the woman has almost depleted her source of eggs and is close to menopause. It is worth mentioning here that women with polycystic ovaries generally have higher levels of AMH, which suggests that having polycystic ovaries may delay ovarian aging. AMH levels generally decrease with age, as does the ovarian reserve. We tend to see a sharp decrease in AMH levels and ovarian reserve after the age of 36. If you are younger and have been shown to have lower AMH levels you may want to think about fertility preservation to ensure that you have a supply of eggs for future use if you intend to delay motherhood. If you have been given low levels of AMH you don't need to worry because assisted reproduction techniques can help you to become pregnant. In reality, your specialist will look at your levels of AMH in conjunction with levels of FSH and possibly an antral follicle count to assess your overall ovarian reserve. The AMH levels can be useful in assisted reproduction as there has been shown to be a relationship with AMH levels and the ovarian response in ovarian stimulation. The higher the AMH levels, generally the better response from the ovaries to the ovarian stimulation drugs used. And the lower the AMH levels, the lower response to the drugs used to stimulate the ovaries. In this case, we can use other drugs such as gonadotropins in order to stimulate the ovaries. So, basically, by knowing the levels of AMH we can better tailor the assisted reproductive treatment to your needs. In addition to AMH levels being used to show how many eggs are left in your ovarian reserve, higher AMH levels have also been shown to be related to better quality oocytes, since the developing follicles which produce better oocytes tend to express more AMH.
