Anti Mullerian Hormone (AMH) Test

What is the AMH or Anti-Mullerian Hormone?

The Anti-Mullerian hormone is a protein-based hormone produced by granulosa cells of the growing follicles within the ovary. All women are born with a fixed number of eggs in their ovary and with time both quality and the quantity of the eggs go down. The test is used as an “ovarian reserve” marker making it related to infertility tests.

The AMH hormone is produced by the reproductive organs of both the male and females and the purpose and quantity of the hormone depends on age. In a human fetus, the hormone plays a very important role in the development of sex organs. For a baby with male (XY) genes, a sufficient quantity of the hormone will be produced to promote the formation of the male organs. In case there is insufficient AMH production to stop the formation of the female organs, both sexes may get formed.

What does the AMH level indicate?

The AMH secretion is maximum during preantral and small antral stages of follicle development. No AMH is secreted once the follicles are over 8mm. For this reason, the hormone levels are fairly constant and the testing can be done on any day of the woman’s cycle. The more the number of ovarian follicles a woman has, the more quantity of AMH her ovaries can produce.

Hence, by reading the levels of AMH from the test, doctors can find out about the “ovarian reserve” of a woman. Women with polycystic ovaries (PCOS) have high AMH hormone values. Those with few remaining follicles and close to menopause have lower levels of AMH. While AMH can provide an idea about the quantity of the remaining eggs, it does not indicate anything about their quality.

What is the AMH test?

The test results are also used to determine the responsiveness of a woman to ovarian stimulation for in vitro fertilization (IVF) fertility treatment. It also helps to determine the exact dose of hormones that should be used during IVF. Women who have undergone ovarian surgery due to endometriosis, ovarian cyst or ovarian torsion generally have lower levels of the hormone. Women who are under stress and mental pressure also have their AMH levels on the lower side and find it difficult conceiving.

Why do I need to undergo an AMH test?

Apart from specific medical conditions, the AMH test is mostly done on women who are finding it difficult to get pregnant. Some of the important reasons for which the test is conducted are mentioned below.

– For women who have been trying to conceive for over six months, and need to check the ovarian reserve with respect to their age.

– For any patient who is considering IVF or other fertility treatments, low levels of AMH could result in a poor response to IVF. On the other hand, higher levels of the hormone may indicate an exaggerated response to the IVF medication.

– For patients who have undergone chemotherapy or ovarian surgery and want to know how it has affected fertility.

– In case an ovarian tumor is suspected.

– If you would like to plan for a future pregnancy, and just want to understand your current position.

– For the treatment of polycystic ovary syndrome (PCOS) or to evaluate the effectiveness of ovarian cancer treatment.

– To predict the start of menopause or to find out the reasons for early menopause.

It is done in infants in case the external sex organs are not properly formed or to assess the function of the testicles in an infant boy. The test is also used to diagnose the condition of amenorrhea, the lack of menstruation in young women.

How is an AMH test performed?

The test is performed by collecting a blood sample from the body. The drawing process is also called venipuncture, as blood is drawn from a vein. The site is generally located on the inside of the elbow or the back of the hand. The process is conducted through the following steps.

– The spot where the needle will be inserted is disinfected by an antiseptic. An elastic band is tied in the upper arm to make the veins swell with blood, thus making collection easier.

– A needle is inserted into the vein and the required volume of blood is drawn through it in an attached tube.

– The needle is withdrawn gently and pressure is applied on the puncture site to prevent any excess bleeding. The spot is then covered with a sterile bandage.

– The process is very simple and you may feel minor pain or a stinging sensation as the needle is inserted. Since the size of the veins and arteries vary from one person to the other, finding the right vein can be difficult for some and multiple punctures may be needed.

In some cases, there might be a blood clot or some swelling in the puncture site which gets cured in a few days. Chances of infection or excessive bleeding are rare but might happen in exceptional cases. Some patients may feel dizzy or light-headed after the blood is withdrawn.

What is the price for an AMH test in India? 

The cost for an AMH test in India can vary between Rs 1000 to Rs 2500 depending on the place and the facilities involved.

When will I get the test results?

The test results are generally provided within a day but it may take several days depending on the centre for testing

What is the normal range for an AMH test?

The AMH levels for healthy adult women initially increase until early adulthood and then gradually decrease with age and finally becomes nil. The normal interpretation of the test results is listed in the table below.

What do the results mean?

The interpretation of the test results has been mentioned in the table attached above. If you are looking to get pregnant, high levels of the hormone indicate a better chance of that. Lower levels can indicate that you might face difficulties in getting pregnant or you might be approaching menopause.

In case the AMH levels are normal but you cannot get pregnant, the doctor may order further tests to pinpoint the reason. For patients undergoing treatment for ovarian cancer, a doctor can interpret the results to check whether the treatment is working or not. In infant females or in senior females after menopause, the hormonal levels can be low or even nil.

In an infant, low levels of AMH can indicate a hormonal or genetic problem resulting in genitals that are not clearly male or female. For a male child with undescended testicles may have a normal level of AMH. It means that the testicles are present but not physically located where they are supposed to be. For a female child with male characteristics, the AMH levels will be in the male reference range.

Do I need to fast for the AMH test?

Fasting or any other food restriction is not necessary before the test.

What else do I need to know before I appear for an AMH test?

The following points can be noted before appearing for the AMH test.

– For the best assessment of a woman’s ovarian reserve, the doctor may order an AMH as well as an FSH test. With age, the AMH levels decrease whereas the FSH levels increase.

– The levels of AMH are not an exact indicator of conditions like a premature ovarian failure or polycystic ovary syndrome. It is up to an experienced doctor to assess the results and make the right diagnosis.

– Diminished ovarian reserve is not a symbol of premature aging but the hormonal levels just indicate that the woman’s overall egg count is lower than it should be in that particular age.

In many cases, the AMH test is used along with an ultrasound to give an exact picture of the ovarian reserve. Special ultrasounds can assess the number of follicles between the sizes of 2mm and 10mm.

Can pregnant women undergo an AMH test?

There are no restrictions on a pregnant woman from undergoing an AMH test

Is the AMH test possible for new-born babies?

The test is possible for new-borns and is done under medical supervision.