Role of Anti-mullerian Hormone in Pregnancy - One Needs to Know

Introduction:

According to the American College of Obstetricians and Gynecologists (ACOG), the AMH production is considered to be a reflection of the ovarian reserve. The ovarian reserve is visualized as a reserve of eggs. One is born with this reserve full of eggs, which gets used up in one’s lifetime. An AMH test can be used to detect the egg count. A low AMH level indicates a diminished ovarian reserve. It is due to this reason that this hormone is linked to fertility. Having a diminished ovarian reserve means that the ovarian reserve of eggs is beginning to empty out.

What Are the Various AMH Levels Based on the Age of a Woman?

When born, females have a certain number of eggs. There are about 3,00,000 to 5,00,000 eggs at the time of birth. However, this number decreases as a woman begins to age. Around menopause, a few females may have just 1,000 eggs left. AMH is measured in nanograms per milliliter (ng/mL). The following are the levels of AMH at different ages:

• 20 to 25 Years: 4.23 ng/mL.

• 26 to 30 Years: 3.48 ng/mL.

• 31 to 35 Years: 2.43 ng/mL.

• 36 to 40 Years: 1.28 ng/mL.

• 40 to 44 Years: 0.52 ng/mL.

The general ranges of AMH are as follows:

• Low: Under 1.0 ng/mL.

• Average: Between 1.0 ng/mL to 3.0 ng/mL.

• Severely Low: 0.4 ng/mL.

However, the results may slightly differ with each laboratory since different laboratories use different equipment.

What Do High and Low AMH Levels Denote?

• High AMH: Having high AMH levels indicates that the woman has a high number of eggs and has a good chance of responding to fertility treatments. High AMH levels can also indicate that the woman might be having polycystic ovarian syndrome (PCOS), which manifests as a result of hormonal imbalance. Women with PCOS may have an increased number of follicles in the growing stage, which can manufacture AMH. Still, fertility issues arise due to the inability of these eggs to form a dominant follicle and ovulate or release eggs from it. It has been found that about 10 percent of females between the ages of 15 to 44 have PCOS. In such cases, healthcare professionals may not focus on lowering the AMH levels. Usually, Metformin is prescribed by physicians to manage diabetes and insulin resistance.

• Low AMH: Low AMH levels signify that the woman has a reduced quantity of eggs. AMH hormone is released from the cells surrounding the egg in the follicle. When the number of eggs or follicles decreases with time, the AMH levels also decrease. A decrease in AMH levels can also occur due to certain medical conditions or toxic exposures like chemotherapy (treatment using drugs that contain powerful chemicals that kill the fast-growing cancer cells in the body). The American College of Obstetricians and Gynecologists (ACOG) regards AMH levels to be low if the values are less than one mg/mL.

What Is the Significance of AMH Levels in Infertility?

It is stated by the American College of Obstetricians and Gynecologists (ACOG) that about 15 percent of couples face infertility issues when trying to get pregnant. Detecting the levels of AMH can enable physicians to determine whether low egg count is contributing to infertility or if there are any other probable causes. Also, one must keep in mind that having low AMH levels does not necessarily mean that the woman is infertile. AMH is an indicator of the ovarian reserve and does not determine the ability of a woman to conceive.

AMH also aids in determining the number of potential eggs that a woman has. For instance, high AMH levels can indicate that a female may have a high ovarian reserve and many potential eggs. This signifies that the woman has a good chance of getting pregnant.

What Is the Test Done to Detect the AMH Level?

An anti-mullerian hormone test (AMH) is done to determine a woman's capacity to generate eggs. It is a type of normal blood test that can be done during the menstrual cycle or before pregnancy. One need not get prepared for an AMH test. A thin needle will be used to obtain a blood sample from a vein in the arm, and the entire process may take only a few minutes. The levels of AMH do not vary much throughout the month, unlike other reproductive hormones.

It may take a few days to receive the results. At-home AMH tests that require a finger prick are also available. Home tests may be easy and convenient to use, but it is necessary to consult a specialist to interpret the results. Fertility is a complex issue, and hence, expert consultation and evaluation are mandatory.

What Cannot Be Determined by an AMH Test?

Determining the levels of AMH is linked with determining the egg count and it is not a predictor of fertility and does not determine when one will go through menopause. Even if the AMH levels are within the normal range, the ability to get pregnant may be influenced by other factors like:

• Age, smoking, medical conditions, and so on.

• Blocked fallopian tubes, irregular ovulation, pelvic scarring, uterine abnormalities like fibroids, and endometriosis (a condition in which cells that mimic the lining of the uterus grow outside the uterus).

• Sperm count and motility.

What Are the Reasons for Testing the AMH Levels?

The reasons are as follows:

• To determine if the number of eggs that a woman has is reducing.

• To diagnose certain medical conditions that may have an impact on a woman’s ovarian reserve.

• To determine possible responses to fertility treatment. It is commonly used by physicians to assess the ovarian response in women undergoing reproductive treatment.

However, it should be kept in mind that AMH is an indicator of the ovarian reserve and does not determine the ability of a woman to conceive.

In What Ways Are High AMH Levels Important for In-Vitro Fertilization (IVF)?

High AMH levels are associated with the formation of multiple embryos in a woman’s ovaries. In the in-vitro fertilization (IVF) procedure, high levels of AMH are important due to the following reasons:

• It aids in the production of multiple eggs in a woman's ovaries, which will increase the chances of pregnancy.

• Extra embryos can be frozen for use in the future during IVF treatment.

• High AMH levels can also pose a risk of ovarian hyperstimulation syndrome (OHSS). Hence, it is necessary to choose the best ovarian stimulation rule at the appropriate time so as to reduce the risk.

• AMH can determine the number of eggs, but no changes can be made to the quality of the eggs.

High AMH levels can offer both advantages and disadvantages. Hence, it is necessary to consult a gynecologist before and after pregnancy.

Are There Any Ways to Increase the AMH Levels?

Unfortunately, there are no ways to increase the AMH levels. Though the quantity of the eggs cannot be increased, the quality of the eggs can be preserved by maintaining a healthy weight and refraining from smoking. It has been found that obesity and tobacco usage have been linked with poor egg quality. It should be kept in mind that though one has fewer eggs, if they are good ones, it will increase the chances of fertility success.

Conclusion:

Anti-mullerian hormone (AMH) levels help estimate the number of eggs or ovarian reserve that a woman has. With age, the levels of AMH tend to decline. Determining the AMH levels does not help in predicting whether a woman is infertile. Apart from estimating the ovarian reserve in a woman, AMH levels aid in diagnosing certain conditions that may have an impact on a woman’s ovarian reserve and enable the physician to evaluate possible responses to fertility treatment.