A guide to AMH

The AMH Test Explained

AMH stands for Anti-Mullerian Hormone. AMH is produced directly by the ovarian follicles and therefore AMH levels correlate with the number of antral follicles in the ovaries. It has been documented that women with lower AMH have lower antral follicular counts and therefore produce a lower number of eggs compared with women with higher levels.
Most fertility specialists now use AMH routinely in fertility assessment to assess the ovarian function and to predict the remaining reproductive lifespan. It can be assessed on any day of your period and it does not vary with the menstrual cycle. It cannot predict outcome of treatment. It is important to understand that AMH will naturally decline with age. Occasionally, high levels can be suggestive of Polycystic Ovarian Syndrome in some patients.

AGE	Median AMH level (pmol/l)
20-29 years	13.1 – 53.8
30-34 years	6.8 – 47.8
35-39 years	5.5 – 37.4
40-44 years	0.7 – 21.2
45-50 years	0.3 – 14.7

Age related reference intervals in women – using the Roche Elecsys AMH Assay

AMH and Antral Follicle Count

Antral Follicles are normally between 2 and 8 millimetres in size when viewed during an ultrasound scan. The numbers of these follicles is related to the cohort of all follicles within the ovary. Reproductive ageing is closely associated with the quantity and quality of the pool of follicles in the ovaries. An Antral Follicle Count combined with an AMH blood test has become powerful and more meaningful tool for the assessment of reproductive potential.

Antral Follicle Count	Ovarian Fertility Potential	AMH pmol/L
0-7	Very low / Undetectable	Less than 4.9
8-15	Low Fertility	4.9 – 16.2
Above 15	Normal Fertility	Greater than 16.2

The table above shows the levels of AMH and how they are related to Fertility Potential and Antral Follicle Counts

An AMH level is the test of choice for measuring ovarian reserve. It can be measured on any day of the cycle and does not vary from cycle to cycle. This is why most infertility specialists today use AMH to check ovarian reserve, rather than the old FSH level.
An AMH level can also be very useful for young women who want to postpone childbearing and want to check their fertility. Many women these days are postponing having a baby in order to pursue a career. Fertility declines with age and it is not possible to predict the rate of decline for an individual woman. Some women may wrongly assume that if they are having regular periods, that their fertility is fine, however this is not always the case. If your AHM is low, you might want to re-think your priorities. If it’s normal, then you could decide to postpone childbearing, but do get the test repeated every year. If it starts dropping, this is a sign you might want to pay attention to your biological clock before it is too late!