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What is AMH ?
AMH stands for Anti-Mullerian Hormone. It is also called MIS ( Mullerian Inhibiting Substance) . Since AMH is produced directly by the ovarian follicles, 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 produce a lower number of oocytes compared with women with higher levels.
AMH Reference ranges Interpretation:
AMH levels do not change significantly throughout the menstrual cycle and decrease with age. Healthy women, below 38 years old, with normal follicular
status at day 3 of the menstrual cycle, have AMH levels of 2.0 – 6.8 ng/ml (14.28 – 48.55 pmol/L).
Ovarian Fertility Potential pmol/L ng/mL
Optimal Fertility 28.6 - 48.5 4.0 - 6.8
Satisfactory Fertility 15.7 - 28.6 2.2 - 4.0
Low Fertility 2.2 - 15.7 0.3 - 2.2
Very Low / undetectable 0.0 - 2.2 0.0 - 0.3
High Level > 48.5 >6.8
AMH levels do not vary with the menstrual cycle and can be measured independently of the day of the menstrual cycle.
AMH can be used for
1. Evaluating Fertility Potential and ovarian response in IVF – Serum AMH levels correlate with the number of early antral follicles. This makes is useful for prediciting your ovarian response in an IVF cycle. Women with low AMH levels are more likely to be poor ovarian responders.
2. Measuring Ovarian Aging – Diminished ovarian reserve, is signaled by reduced baseline serum AMH concentrations. Women with poor ovarian reserve who have entered the oopause have low levels of AMH.
The other tests in a fertility center to check ovarian reserve include checking your inhibin levels.
However, these are new and expensive tests, and is still not easily available. This is why the gold standard for ovarian reserve testing is still the Day 3 FSH level.
One confusing thing about AMH is that there are at least 2 scales out there and innumerable clinic definitions of what is "normal" - it depends on which assay they use and which study! One scale is ng/ml and one is pmol/l. The pmol/l scale runs from 0 to about 48; the ng/ml runs from about 0-10. On the ng/ml scale some say less than 1 is low and some say less than 2.
If any one of the tests for ovarian reserve was truly accurate then it would eliminate the need for the others ! The fact that there are so many ( FSH, oestradiol, AMH, antral follicle count, inhibin) suggests none of them are truly reliable. If one test were the right one then that is the one we'd all be given and it would tell us the answer!
Please do remember that doctors do not treat numbers - we treat patients, so don't obsess over just one number is isolation.
The final proof of the pudding is in the eating - and your response to superovulation is the best way of assessing your ovarian reserve. If you grow eggs well, then you should not worry about your "numbers" !
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