Anti-Müllerian hormone: normal levels in women and role in fertility

What is Anti-Müllerian Hormone (AMH)?

Anti-Müllerian hormone is a protein produced by both male and female bodies. In women, it is synthesized by ovarian follicles and is the main biomarker of ovarian reserve, which refers to the quantity and quality of eggs. In men, AMH is produced by Sertoli cells in the testes and plays a key role in the development of the reproductive system during embryonic stages.

Importance of AMH for Female Fertility

In women, the AMH level is used to evaluate:

• reproductive potential;
• the choice of the optimal ovulation stimulation protocol;
• the appropriateness of resorting to IVF;
• the prognosis of menopause;
• the state of the ovaries in case of suspected gynecological pathologies;
• the likely response to infertility treatment.

Polycystic Ovary Syndrome (PCOS) and AMH (https://natuvitro.com/fr/blog/polycystic-ovary-syndrome-symptoms-and-treatment)

PCOS is one of the most common hormonal disorders in women of reproductive age. It is characterized by a high number of immature follicles, resulting in significantly elevated AMH levels. Women with PCOS may experience irregular periods, anovulation, acne, hirsutism (excessive hair growth), and other symptoms of hormonal imbalance. A high AMH level may suggest this disorder and predict the patient’s response to ovarian stimulation during IVF.

Normal Anti-Müllerian Hormone Levels in Women

• Up to 24 years: AMH level of 4.0 to 6.8 ng/ml — very high probability of conception.
• Between 25 and 30 years: level of 2.5 to 5.0 ng/ml — high fertility.
• Between 31 and 35 years: level of 1.5 to 4.0 ng/ml — moderate chances of conception.
• Between 36 and 40 years: level of 1.0 to 3.0 ng/ml — notable decrease in ovarian reserve.
• Between 41 and 45 years: level of 0.5 to 2.0 ng/ml — high risk of difficulties in conceiving.
• Between 46 and 50 years: level of 0.1 to 1.0 ng/ml — natural conception unlikely.
• After 50 years: level below 0.1 ng/ml — depleted ovarian reserve, menopause.

Low AMH: Causes and Consequences

Causes of decline:

• age over 35;
• premature ovarian failure;
• Turner syndrome and other genetic disorders;
• chemotherapy and radiotherapy;
• surgical intervention on the ovaries;
• endometriosis;
• smoking, chronic stress, sleep disorders.

If the anti-Müllerian hormone level is below normal in women of reproductive age, it can have the following consequences:

• Decreased fertility. The main consequence of low AMH levels is a reduction in the chances of natural conception. When ovarian reserve is low, the number of eggs remains limited, and even regular ovulation does not always lead to pregnancy.
• Decreased efficacy of IVF programs. When this hormone level is low, it is difficult to obtain a sufficient number of mature eggs during stimulation. This can affect the quality of embryos and the overall success of infertility treatment.
• Early menopause. A low AMH level may indicate the onset of a process leading to premature ovarian function depletion. In this case, characteristic symptoms of menopause may appear: hot flashes, irritability, decreased libido, and mucosal dryness.
• Hormonal disorders. The decrease in the number of follicles disrupts the production of estrogen and progesterone, which affects menstrual cycle regularity, mood, and the condition of the skin and hair.

What to Do in Case of Low AMH Levels

It is important to consult a gynecologist for a comprehensive evaluation of ovarian reserve. Possible solutions:

• personalized selection of a stimulation program for IVF;
• resorting to an egg donation program;
• cryopreservation of eggs in case of delayed motherhood.

Anti-Müllerian Hormone (AMH) Test

When Should It Be Done?

AMH can be tested any day of the cycle, as its level does not depend on the menstrual phase. The test is usually performed between the 3rd and 5th day, alongside other hormonal tests.

Preparation:

• avoid intense physical exertion;
• avoid stress and alcohol in the 2 to 3 days preceding the test;
• have the blood sample taken in the morning while fasting;
• inform your doctor if you are taking hormonal medications.

How is the Analysis Conducted?

Venous blood sample, analyzed by ELISA or CLIA. Result: within 1 to 3 days.

Can AMH Levels Be Increased?

It is impossible to artificially increase AMH levels, as it reflects the number of follicles determined by nature. However, there are methods to improve the ovaries' response to stimulation. If pregnancy is anticipated in the future, it is possible to preserve eggs through cryopreservation.

## Influence of AMH on Conception and IVF

A low level of anti-Müllerian hormone (AMH) is an important marker indicating a decrease in ovarian reserve. Women with low AMH levels have an extremely limited number of eggs, and even if ovulation occurs, the quality of the oocytes may be insufficient for pregnancy to happen. This explains why many couples encounter difficulties when attempting natural conception.

In the context of in vitro fertilization (IVF) programs, a low AMH level affects the ovaries' response to hormonal stimulation. Generally, in such cases, it is possible to obtain a reduced number of eggs, which decreases the chances of fertilization, the formation of good-quality embryos, and successful implantation. However, this does not mean that pregnancy is impossible: with a well-chosen strategy and an individualized approach, the outcome can be positive.

Possible options in case of low AMH levels:

• Using donor eggs. One of the most effective methods for women with significantly reduced ovarian reserve. Material from donors can greatly increase the chances of pregnancy.
• Using gentle and ultra-short stimulation protocols. These approaches minimize the burden on the body and allow for obtaining at least a few good-quality eggs.
• Cryopreservation of oocytes at a young age. If you plan to become a mother in the future, freezing eggs can preserve your reproductive potential during a time when AMH levels are still sufficient.

AMH Levels and Types of IVF

• Classic IVF. A low AMH level requires a personalized stimulation program, often with a higher dose of hormones or alternative protocols.
• IVF with egg donation. In these programs, the AMH level of the recipient does not play a decisive role, as donor eggs are used. The main focus is on the state of the endometrium and the preparation of the body to receive the embryo.
• IVF with double donation. When donor eggs and sperm are used, the efficiency of the procedure depends exclusively on the quality of the embryos and the condition of the patient’s uterus. In this case, the AMH level has no impact on the prognosis.

High AMH: What Does It Mean?

High values are most often associated with PCOS. In this case, many small follicles produce more hormones, but ovulation may not occur. Additionally, a high AMH level may indicate a tumor, namely a granulosa cell tumor of the ovary. In both cases, diagnosis and medical monitoring are necessary.

Optimal AMH values (1 to 4 ng/ml) indicate sufficient ovarian reserve and a favorable prognosis for conception.

Frequently Asked Questions

Can an AMH test be done during menstruation?

Yes, the level of this hormone is stable throughout the cycle.

Is a low AMH level synonymous with infertility?

Not always. But it indicates a decrease in the number of eggs. IVF can help.

How quickly does the AMH level change?

Slowly. It gradually decreases with age.

Are there symptoms of low AMH levels?

No. Only a laboratory test can determine it.