Blood Tests Anti-Müllerian Hormone (AMH) test – assessment of ovarian reserve

What is ovarian reserve?

Ovarian reserve is defined as the number or quantity of oocytes (egg cells) remaining in the ovary. The number of egg cells differs from their quality, which refers to the potential of a fertilized egg cell to result in a live birth. While men produce sperm throughout their adult lives, women are born with their entire supply of egg cells (approximately 1-2 million). The quality and quantity of these egg cells decline over a lifetime, with a sharp decrease starting at age 36.

How is a woman’s ovarian reserve assessed?

The assessment of ovarian reserve is based on a gynecological examination of the ovaries and certain laboratory tests, which are performed using blood samples: sex hormones FSH, LH (as well as their ratio FSH/LH), inhibin B hormone in the early follicular phase (day 2 or 3 of the menstrual cycle), and Anti-Müllerian Hormone (AMH) levels, which can be measured independently of the cycle.

What is AMH (Anti-Müllerian Hormone)?

AMH is a glycoprotein hormone secreted by cells in the developing egg sacs (follicles). The level of AMH in the blood is, therefore, a good indicator of ovarian reserve in women and is considered the gold standard for its assessment.

Indications for AMH testing – AMH tests are used for:

• Infertility: if you have been trying to conceive for more than six months, check the status of ovarian reserves.
• Assisted reproduction: preparation for IVF or other fertility treatments, as low AMH levels may indicate a potentially poor response to IVF (while high levels may indicate an excessive response to IVF drugs).
• Assessment of ovarian condition in PCOS (polycystic ovary syndrome).
• Evaluation of the rate of entering menopause.
• Suspected ovarian tumor that secretes Anti-Müllerian Hormone.
• Pregnancy planning: if you want to conceive in the future (check ovarian reserves).
• Assessment of ovarian reserves after ovarian surgery, chemotherapy, or trauma (evaluate how it has impacted your fertility).

What influences the value of AMH hormone?

The level of AMH hormone decreases with age. Factors that affect the value of this hormone in women of reproductive age include:

• Polycystic Ovary Syndrome (PCOS) – the most common ovulatory disorder
• Consequences of ovarian surgical intervention
• Obesity
• BRCA mutations
• Chemotherapy
• Vitamin D deficiency

At what time in the menstrual cycle should AMH be taken?

Since AMH levels do not change throughout the menstrual cycle, a blood sample can be taken at any time of the month, independent of the biological phases of the cycle.

Is special preparation required for this test?

No, special preparation is not required. You can provide a blood sample at any time of the day and month (it is not cycle-dependent). However, it is advisable not to come to the laboratory for testing immediately after a meal.

What do the results mean – low and high AMH values?

The test results provide insight into the remaining quantity of eggs and the number of fertile years one may have left. Unfortunately, they do not tell us about the quality of the follicles themselves. A low AMH level may indicate a smaller number of remaining eggs. A high AMH level generally signals a larger number of remaining eggs, which can mean that a woman may have an easier time getting pregnant or producing eggs for fertilization during fertility treatment. However, it’s important to keep in mind that AMH is only one piece of the puzzle when it comes to a woman’s fertility—there are many other important factors. Additionally, a very high AMH level may indicate a condition such as polycystic ovary syndrome (PCOS).

Can the AMH hormone level be increased, and how?

Currently, there is no scientifically proven evidence or guidelines on how to positively influence AMH levels. Ongoing studies may provide answers in the future, but as of now, we do not have any established methods for increasing AMH levels.

Reference values for AMH

At BioDiagnostica Laboratories, we determine AMH levels in blood using the automated ECLIA method from Roche Diagnostics. The broad measuring range, along with the precision and sensitivity of this test, are the main reasons why we have chosen to implement this method in our routine diagnostics.