Ovarian Reserve (AMH) Test
AMH- Anti Mullerian Harmone is also known as Mullerian Inhibiting Substance(MIS).
Harmone secreted in granulosa cells of Follicles .
Good marker for egg quality – much better marker then FSH level.
Ovarian reserve is the pool of eggs present in the ovaries at any given time. Low ovarian reserve is when there is a physiological decrease in the number of eggs, resulting in an insufficient number to ensure a reasonable chance of pregnancy. Generally, it is caused by aging ovaries.
Females begin life at one of the earliest stages of development with millions of eggs. Unfortunately, nature plays a cruel trick by letting the vast majority of them decay before they are ever needed for reproduction.
In utero, there is a rapid multiplication of germ cells starting at six to eight weeks. By the time the female fetus is at 16-20 weeks, she has a peak of six to seven million eggs. This number declines to one to two million eggs at birth, falling even further to 250,000 to 500,000 eggs at puberty.
At 37 years of age, a woman will only have 25,000 eggs and at menopause less than 1000.
There are three types of eggs in the ovary:
— a pool of immature eggs,
— eggs that are selected to mature and prepare for ovulation in a particular cycle,
— a pool of atrophic or dead eggs. The eggs are encased in follicles that support and nourish them until they mature, though the vast majority never do so.
Every month, a certain number or percentage of immature eggs are selected for maturation. One of these eggs will ovulate and the rest will regress, die and be reabsorbed into the ovary through atresia. The number of eggs selected is dependent on the number of immature eggs in the pool.
During a woman’s childbearing years, a decreased level of AMH may indicate a low number and quality of eggs (low ovarian reserve) with diminishing fertility, resulting in minimal or less responsiveness to IVF treatment. It can also indicate that the ovaries are not functioning normally (premature ovarian failure).
A decreasing level and/or significant decline in AMH may signal the imminent onset of menopause. Negative to low levels of AMH are normal in a female during infancy and after menopause.
An increased level of AMH is often seen with PCOS but is not diagnostic of this condition. Increased AMH may also indicate an increased or even excessive responsiveness to IVF and a need to tailor the procedure accordingly.
(women under age 35)
AMH Blood Level
High (often PCOS) Over 4.0 ng/ml
Normal 1.5 – 4.0 ng/ml
Low Normal Range 1.0 – 1.5 ng/ml
Low 0.5 – 1.0 ng/ml
Very Low Less than 0.5 ng/ml
Results can be reported in pmol/l or ng/ml
The conversion factor is 1 ng/ml = 7.14 pmol/l
Therefore if AMH is 1 it could be as high as
1ng/ml which is equal to 7.14 pmol/l
….and converted from DSL to Beckman (x5) = 35.7 pmol/l
So check the reference range for your lab before interpreting a result!
The actual mechanics in scientific terms, as to how this occurs, are as yet unclear as there is not sufficient research in this field.
Commonly women with low AMH levels are advised to consider donor eggs
through IVF, with minimal attempt at natural conception.
Can AMH raise naturally?
Western medicine does not have much to offer,
Certain research indicates that
-Ayurvedic Herbal drugs
-Yoga and Diet
– Increasing Blood Circulation to Ovaries through certain massage techniques
Can help to improve the Ovarian Reserve.
Amrutwel Women’s Clinic