Anti-Müllerian hormone • How high is the egg reserve?

The anti-Müllerian hormone (AMH) is a central assessment criterion for reproductive medicine: as a laboratory parameter, the AMH value is used to identify fertility disorders in women and to control hormonal fertility treatments. But is the value also meaningful for finding out how the biological clock is ticking?

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What is Anti-Müllerian Hormone?

The anti-Müllerian hormone (AMH) already plays an important role in the development of the unborn child in the womb because it influences gender differentiation. By the eighth week of pregnancy, the anti-Müllerian hormone causes the Müllerian ducts to recede in male fetuses. Female fetuses do not produce AMH, so the mullerian ducts can develop into the uterus, fallopian tubes and parts of the vagina.

Only with sexual maturity does the hormone also form in the female sex. In adult women, the anti-Müllerian hormone is produced in the granulosa cells. These are special cells in the ovarian follicles of the ovaries.

At birth, every woman has a certain number of follicles (egg sacs). The egg cells can later mature in them. With increasing age, their number decreases at an individual rate until menopause finally begins. After sexual maturity, the anti-Müllerian hormone allows conclusions to be drawn about the number of oocytes present in the ovaries: the higher the value, the more fertilizable oocytes can still mature.

AMH test: how is the value determined?

The anti-Müllerian hormone is determined via a blood test. As a rule, the level fluctuates only slightly during the cycle, which is why the examination can be carried out at any time. However, some studies have shown that cycle-dependent fluctuations can exist, especially in younger women. The individual procedure should therefore be discussed with the gynecological practice or with the fertility clinic.

AMH and the desire to have children: when is the value determined?

The anti-Müllerian hormone is of great importance in the diagnosis of fertility disorders. The AMH value provides information about the so-called ovarian functional reserve. This is the egg reserve: that is, the number of mature follicles in the ovary that can develop into an egg capable of being fertilized.

The AMH value says nothing about the quality of these egg cells. Other factors such as the age of the woman and the duration of the unfulfilled desire to have children are therefore also taken into account for the diagnosis. In addition, further examinations are usually carried out – these include ultrasound and the determination of the hormone FSH.

The AMH value is also important during ongoing fertility treatment: it helps to adjust stimulation therapy individually and to assess the risk of overstimulation of the ovaries.

What AMH levels are normal?

The following AMH values ​​are considered as reference values ​​for guidance, but they can vary between laboratories and methods. The interpretation of the anti-Müllerian hormone values ​​should always be left to the medical staff: they must be considered individually in the respective context.

Anti-Müllerian hormone levels:

  • Normal value in a sexually mature woman: 1-10 µg/l
  • Eingeschränkte ovarielle Restfunktion: ca. 0.4-1µg/l
  • Ab der Menopause: < 0,4 µg/l

Anti-Müllerian hormone too low

There are several factors that can affect anti-Müllerian hormone. This includes, among other things, the use of hormonal contraceptives: Here the value can be around 30 percent lower. From around the age of 30, the anti-Müllerian hormone level drops naturally. During the menopause, the hormone is hardly detectable.

Regarding fertility, a low anti-Müllerian hormone level is an early biomarker to detect a declining egg count. However, a low value does not automatically mean that the patient cannot become pregnant per se.

If the egg cell reserve has decreased significantly at a very early stage, premature ovarian insufficiency (POI) may be present. A possible reason for this premature menopause before the age of 40 could be chemotherapy for cancer treatment, for example.

Anti-Müllerian hormone too high

Very high AMH levels are not automatically associated with increased fertility. Conspicuous results should therefore always be clarified by a doctor. For example, an AMH level that is too high can indicate polycystic ovary syndrome (PCOS). This is a hormonal disorder in women that can be associated with reduced fertility.

AMH value as a fertility test?

Since the concentration of the anti-Müllerian hormone decreases with age, its determination is also offered as a fertility test. The aim of such a test is to find out how much time a woman has left to fulfill her desire to have children.

Whether general screening makes sense from a certain age is a matter of controversy. Due to a lack of data, it is not possible to clearly derive from the level of the value how long the function of the ovaries will be maintained. In addition, this value is not the only decisive factor for the occurrence of a spontaneous pregnancy.

The AMH is therefore not necessarily suitable as an indicator of fertility for women who do not currently wish to have children or who have menstrual disorders and is therefore not recommended without reservation as a fertility check. On the contrary, the knowledge of a low AMH value could even have a negative effect: if the value is interpreted as pathological by the woman concerned, although there is no acute problem with the desire to have children.

Can the AMH value be improved?

A low AMH value does not mean that the affected woman can no longer become pregnant. As long as the menopause has not yet occurred, there is also the possibility of pregnancy. If pregnancy does not occur naturally, gynecological advice should be sought first. In this way, all factors can be taken into account and appropriate treatment can be initiated depending on the cause.

So far, there is not enough data to recommend a specific means of increasing the AMH level. The influence of vitamin D or DHEA (a steroid hormone) is currently being investigated. However, such supplements should not be taken to stimulate hormone production without medical advice. In general, it is advisable to lead a healthy lifestyle and to avoid nicotine if you want to have children.

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Source: Lifeline | Das Gesundheitsportal by www.lifeline.de.

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