Anti-Mullerian Hormone - AMH
AMH, or Anti-Müllerian Hormone, is a hormone produced by small follicles in the ovaries. AMH testing is not available through the NHS in primary care due to cost considerations. However, it can be used in secondary care as part of fertility investigations to help assess a woman's response to ovarian stimulation. AMH levels can also be used privately to estimate the time to menopause or to diagnose and monitor women with polycystic ovary syndrome (PCOS). At Sirona Health, we offer this test because we believe women should have the option to make informed decisions about whether it could be beneficial for them.
Interpreting AMH (Anti-Müllerian Hormone) results can be quite complex.
AMH levels naturally peak around the age of 25 and then gradually decline until they are undetectable at menopause.
There is a wide range of values that can be considered "normal," so it's essential to interpret the results in the context of each individual woman.
Additionally, different laboratories use various testing methods, which can lead to different reference ranges for normal values. It can also be reported in many different units. As a result, comparing AMH levels across different labs can be challenging.
Age Range (years)
18-25 yrs: 7.28 - 104.46 pmol/L
26-30 yrs: 4.93 - 95.60 pmol/L
31-35 yrs: 2.57 - 71.90 pmol/L
36-40 yrs: 1.29 - 40.56 pmol/L
41-45 yrs: 0.07 - 21.35 pmol/L
For these reasons, it's crucial to consult with a healthcare provider after having an AMH test. This will ensure that the results are properly understood and tailored to your specific situation.
AMH in women with PCOS
Serum AMH levels are typically two to three times higher in women with PCOS compared to those with normal ovaries, and the AMH level often correlates with the severity of the condition.
For some women with irregular cycles or symptoms of elevated androgens, such as acne or hirsutism, an AMH test can help diagnose PCOS without the need for an ultrasound.
However, there is no consensus on the exact AMH level that should be used for diagnosis, particularly in women over 40. While some studies propose a single cut-off level for all ages, others suggest age-specific thresholds.
The chart illustrates the recommendations from two studies using the assay provided by Sirona Health.
As always, individual interpretation is key, especially given the limited clinical evidence in this area.
AMH and menopause
The challenge until recently with using AMH levels is that the levels within 2 years of the final menstrual period become so low than they can’t reliably be detected by conventional AMH testing. A test has been developed in the USA called the MenoCheck which can detect very low levels. This lab uses pg/ml so the levels can’t be compared with the assay used by Sirona Health. They found that women whose AMH values were 5-10 pg/mL (roughly 0.03–0.07 pmol/L) had a 50% chance of having their final menstrual period (FMP) within 11 +/- 2 months and a 75% chance of having their FMP within 24 +/- 3 months. Women with AMH levels > 20 pg/mL (roughly 0.14 pmol/L) are unlikely to become postmenopausal in the next 2 years. This can be used as an additional piece of the jigsaw puzzle but does not necessarily correlate to perimenopausal symptoms. At the moment it is also not offered within the UK so we will have to ‘watch this space’ to see if any laboratories start offering it in the UK. Longitudinal measurements of AMH can however enable doctors to individualise the prediction of menopause and may help in decision making around management of menopausal symptoms, heavy menstrual bleeding, or contraceptive choices.
AMH and fertility
AMH is not a good indicator of your chances of getting pregnant naturally, as it is only an indicator of quantity not quality of eggs, but it is a helpful indicator of how you will respond to ovarian stimulation as part of IVF treatment. It can therefore be used to help you to decide how long to keep trying to conceive naturally before seeking IVF treatment, and will provide the fertility team with useful information to help inform you of your chances of success from IVF.
Normal ovarian reserve would be approximately 7.14 - 28.56 pmol/L.
Low ovarian reserve would be less than 7.14 pmol/L.
Very low ovarian reserve would be less than 3.57 pmol/L.
References:
Dewailly D. Age-stratified thresholds of anti-Müllerian hormone improve prediction of polycystic ovary syndrome over a population-based threshold. Clin Endocrinol (Oxf). 2017 Dec;87(6):649-650. doi: 10.1111/cen.13479. Epub 2017 Oct 12. PMID: 28949024.
Baker VL, Gracia C, Glassner MJ, Schnell VL, Doody K, Coddington CC, Shin SS, Marshall LA, Alper MM, Morales AJ, Pavone ME, Behera MA, Zbella EA, Shapiro BS, Straseski JA, Broyles DL. Multicenter evaluation of the Access AMH antimüllerian hormone assay for the prediction of antral follicle count and poor ovarian response to controlled ovarian stimulation. Fertil Steril. 2018 Aug;110(3):506-513.e3. doi: 10.1016/j.fertnstert.2018.03.031. Epub 2018 Jun 28. PMID: 29960708.