AMH Test – Anti-Müllerian Hormone, Ovarian Reserve & Fertility Explained

Overview

The AMH (Anti-Mullerian Hormone) Test is a blood test that measures the level of AMH in your body.
AMH is a hormone produced by small growing follicles in the ovaries and is considered one of the most reliable markers of a woman’s ovarian reserve — meaning the number of eggs remaining in the ovaries.

In simple words, AMH gives doctors an idea of how many eggs are left and how the ovaries might respond to fertility treatments such as IVF (In Vitro Fertilization).

This test is commonly used for:

• Fertility evaluation in women
• Predicting menopause timing
• Assessing Polycystic Ovary Syndrome (PCOS)
• Monitoring ovarian function during fertility or cancer treatments

What is AMH (Anti-Mullerian Hormone)?

AMH is a protein hormone made by granulosa cells that surround each developing egg in the ovaries.
AMH levels naturally change throughout a woman’s life — high during reproductive years and very low or undetectable after menopause.

In men, AMH is produced by the testes during fetal development and plays a role in the formation of the male reproductive system.
However, in adults, AMH testing is mainly used for female reproductive health.

Where is AMH Produced in the Body?

• In Females: AMH is produced by the granulosa cells of small ovarian follicles (called pre-antral and early antral follicles). These are immature eggs that have not yet matured for ovulation.
• In Males (fetal stage): AMH is produced by the testes, which helps in the normal development of male reproductive organs by suppressing the Müllerian ducts (structures that form the uterus and fallopian tubes in females).

Once adulthood is reached, AMH levels are most relevant in females, as they reflect the remaining egg count and help assess fertility potential.

Main Functions and Importance

While AMH itself doesn’t affect fertility directly, it provides vital information about a woman’s reproductive health.

Key Functions and Clinical Importance:

• Indicates Ovarian Reserve: Shows how many eggs are available — though it doesn’t measure egg quality.
• Helps Predict Response to IVF: Higher AMH usually means a better response to fertility medication, while low AMH may mean fewer eggs retrieved.
• Assists in Diagnosing PCOS: Women with PCOS often have high AMH levels due to multiple small follicles.
• Monitors Ovarian Health: Used to assess ovarian function in women undergoing chemotherapy, radiation, or surgery.
• In Young Girls: Helps evaluate ovarian development or detect absence of ovaries.
• In Boys: Can help detect Persistent Müllerian Duct Syndrome (PMDS) or testicular function problems.

Causes of Low AMH Levels

Low AMH means that the ovarian reserve (egg count) is decreasing.
This is a natural part of aging, but it can also result from other medical or environmental factors.

Common Causes:

• Natural aging process (especially after age 35)
• Primary ovarian insufficiency (POI)
• Early menopause
• After chemotherapy or radiation therapy
• Genetic disorders (e.g., Turner syndrome)
• Surgical removal of ovaries
• Chronic stress or lifestyle factors affecting egg reserve

Symptoms of Low AMH Levels

Low AMH doesn’t cause symptoms by itself — it’s an indicator, not a disease.
However, it often appears along with symptoms of reduced fertility or early menopause:

• Difficulty conceiving (infertility)
• Irregular or absent menstrual periods
• Hot flashes, night sweats, or mood swings
• Poor response to fertility medications
• Family history of early menopause

If AMH is low and a woman is trying to conceive, doctors may discuss fertility preservation, such as egg freezing or early IVF.

Causes of High AMH Levels

High AMH levels indicate a greater number of small follicles, which can happen naturally or due to certain conditions.

Common Causes:

• Polycystic Ovary Syndrome (PCOS) – the most common reason for high AMH
• Granulosa cell tumors (a rare type of ovarian tumor that produces hormones)
• Delayed puberty or hormonal imbalance
• Persistent Müllerian Duct Syndrome (in boys)

Symptoms of High AMH Levels

High AMH itself doesn’t cause problems, but it often indicates underlying conditions such as PCOS or ovarian tumors.

Common Signs:

• Irregular or missed periods
• Acne or oily skin
• Excessive hair growth (face, chest, or abdomen)
• Difficulty getting pregnant
• Enlarged ovaries (seen on ultrasound)
• Rarely, symptoms of hormone-producing ovarian tumors (abdominal pain, bloating)

Reference Ranges (Normal AMH Levels)

⚠️ Note: Reference ranges may vary slightly depending on the lab and testing method.
AMH levels naturally decline with age, starting around age 30–35.

Sample Type

• Sample Type: Blood sample (serum)
• Tube Type: Plain (Red top or Serum Separator Tube)
• Fasting: Not required
• Test Time: Can be done any day of the menstrual cycle, as AMH levels remain relatively stable throughout.

Why the AMH Test is Important

The AMH test helps in several key clinical situations:

1. Fertility Evaluation: Determines if a woman has a good ovarian reserve before IVF or pregnancy planning.
2. PCOS Diagnosis: Confirms hormonal imbalance and follicle count correlation.
3. Cancer or Surgery Monitoring: Tracks ovarian recovery after medical treatments.
4. Menopause Prediction: Helps estimate when menopause may begin.
5. Gender Development Disorders: Useful in pediatric and male hormone evaluations.

Test Preparation

• No fasting or special diet needed.
• Continue regular medications unless told otherwise.
• Inform your doctor if you are on birth control pills or hormone therapy, as they can slightly affect results.
• Can be done any day of the menstrual cycle.

When to Consult a Doctor

You should discuss AMH testing with your doctor if you:

• Have difficulty getting pregnant
• Have irregular or no periods
• Are planning IVF or egg freezing
• Have a family history of early menopause
• Have symptoms of PCOS (irregular cycles, acne, excess hair)
• Are about to start chemotherapy or radiation therapy

Important Word Explanations

• Ovarian Reserve: The total number of eggs left in a woman’s ovaries.
• Follicles: Small fluid-filled sacs in the ovaries that contain immature eggs.
• Granulosa Cells: Cells that surround the egg and produce AMH.
• IVF (In Vitro Fertilization): Fertility treatment that retrieves eggs and fertilizes them outside the body.
• PCOS: Hormonal disorder causing irregular periods and multiple ovarian cysts.

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