An Anti-Mullerian Hormone (AMH) Test is a simple blood test done to measure the amount of anti-mullerian hormone in the blood. AMH is present in both men and women and has a crucial role in the development of reproductive organs. 1 In males, the testes produce AMH whereas in females, ovaries produce AMH. In males, AMH levels are elevated during childhood but begin to decline gradually during puberty. In females, their levels increase after puberty and in women of reproductive age, this hormone is a direct measure of an individual's egg count.

The AMH test reflects the reproductive health of females and is used to diagnose ovarian function. The test gives an insight into the ovarian reserve of a female. Ovarian reserve refers to the number of eggs remaining in the ovary. As ovarian function declines with aging, it may be difficult to conceive. In males, AMH testing can help detect fertility issues. Testing for AMH is important in diagnosing the reduction in the egg count and aids in identifying if you have a short window period for conception. 1 The test, thus, helps in proactive family planning and guides in making decisions for treatment infertility in women.

Prerequisites

Getting an AMH test does not require any special preparations. Fasting is not required before undergoing the test. However, it is important to inform your doctor about your usage of oral contraceptives as it may affect the test results.

The best time to get tested

You can get the AMH test at any time during the day at your convenience. Unlike reproductive hormones, the menstrual cycle does not have any influence on AMH levels. This indicates that AMH testing can be done at any time point during the cycle.

Eligibility for AMH test

The AMH test is suitable for individuals experiencing fertility problems, undergoing IVF treatment, or exhibiting symptoms of conditions like polycystic ovarian syndrome (PCOS). Women receiving treatment for ovarian cancer can also undergo AMH testing. For male babies and children, the test is significant for determining the health of their reproductive organs.

Cautions before taking the AMH test

It is important to note that the AMH test cannot predict fertility or the likelihood of pregnancy. If you are trying to conceive or want detailed information about your reproductive health consider additional testing as per the recommendations of your doctor.

The AMH test is a valuable tool utilized in reproductive medicine to assess various aspects of fertility and reproductive health. Here's why the AMH test is crucial and who may benefit from it:

Detecting Ovarian Reserve: The AMH test measures the number of eggs remaining in the ovaries, known as ovarian reserve. This parameter naturally declines with age.

Predicting Response to Fertility Medicine: For individuals undergoing fertility treatments such as in vitro fertilization (IVF), AMH testing helps predict how the ovaries will respond to fertility medications. High AMH levels correspond to better response. It also helps determine the doses of medications given for infertility treatment.

Predicting Menopause Onset: Declining AMH levels correlate with the approach of menopause. AMH testing can help detect signs of premature menopause (before age 40) or early menopause (before age 45).

Diagnosing Polycystic Ovarian Syndrome: The AMH can be conducted for someone experiencing symptoms of PCOS, a hormonal disorder such as irregular menstrual periods, acne, weight gain, and excessive hair on the face, stomach, chest, or thighs.

Monitoring Ovarian cancer : The AMH test is conducted to monitor the treatment of certain types of ovarian cancer.

Undescended Testicles: An AMH test may be conducted for male infants whose testicles are not located in the scrotum. The test can help determine if there are healthy testicles within the body.

Ambiguous Genitalia: For babies born with genitals that are not distinctly male or female, AMH testing, along with other diagnostic tests, helps determine the cause of the disorder and confirm the baby's sex.

The normal range for AMH levels in the blood for men is between 0.9 and 13.89 ng/mL. For women, the normal range of AMH varies based on their age as follows:

Age 18-24 years: 1.62-9.95 ng/mL

Age 25-29 years: 1.20-9.05 ng/mL

Age 30-34 years: 0.80-8.18 ng/mL

Age 35-39 years: 0.11-6.72 ng/mL

Age 40-44 years: 0.10-5.78 ng/mL

Interpretation

When AMH levels are high:

• In women, this may suggest a larger ovarian reserve, potentially facilitating conception. It could also indicate the presence of polycystic ovary syndrome (PCOS), although diagnosis requires additional tests.

• In pubertal or prepubertal males, it could indicate McCune-Albright syndrome or varicocele (enlarged veins in the scrotum).

When AMH levels are low:

• In women, a low AMH level may imply a reduced ovarian reserve, indicating a shorter window for conception. It might also signify proximity to menopause, although the exact timing cannot be predicted. In women under 40 years of age who are experiencing menopausal symptoms, it could suggest primary ovarian insufficiency.

• In males, decreased AMH may indicate severe congenital hypogonadotropic hypogonadism (AMH decreased in puberty), nonobstructive azoospermia, Klinefelter syndrome or male senescence (age-related decrease).

Additional Notes

1. AMH measurement can be used to monitor the ovarian reserve.

2. For women with ovulation problems, the measurement of serum AMH levels enables better characterization of the type of ovarian dysfunction, particularly hyper gonadotropic anovulation associated with ovarian insufficiency such as polycystic ovary syndrome.

3. Its measurement in the circulation helps to estimate the number of antral and pre-antral follicles present in the ovaries and is menstrual cycle independent.

4. In males, abnormal AMH levels can help diagnose various fertility issues like delayed puberty, problems with hormone production leading to low testosterone, inability to produce sperm, Klinefelter syndrome, varicocele (enlarged veins in the scrotum), McCune-Albright syndrome (a genetic disorder), and age-related male infertility.