Article on AMH diagnostic significance
Anti-Müllerian Hormone (AMH) is generated by the testes in males and ovaries in females. In females, AMH is essential for follicle development within the ovaries, regulating the growth of these follicles and serving as an indicator of ovarian reserve, which reflects the number of viable eggs remaining in a woman. In males, AMH is secreted by Sertoli cells in the testes. It plays a vital role in the development of male reproductive organs by triggering the regression of Müllerian ducts during embryonic development, which is necessary to form male genitalia.
AMH levels can be measured via a blood test and are commonly used in fertility evaluations and to monitor conditions like polycystic ovary syndrome/Disorder (PCOS/PCOD). For example, low AMH levels in females may indicate reduced ovarian reserve, which can impact the fertility of an individual. During fetal development, AMH is crucial for forming the sex organs of babies. In male embryos, higher AMH levels prevent the growth of female reproductive organs, while female embryos require only minimal AMH for their development. In women, AMH is produced by the cells within ovarian follicles—tiny fluid-filled ovary sacs containing and releasing eggs.
AMH levels reflect the ovarian reserve, which is the number of eggs the person has:
- Higher AMH levels mean more eggs and a higher ovarian reserve.
- Lower AMH levels mean fewer eggs and a lower ovarian reserve.
What does an AMH test tell you?
An AMH test provides insight into your remaining egg count and can indicate if your ovaries are aging prematurely, which may affect your window for conception. It can also help assess how well you might respond to injectable fertility medications designed to stimulate the maturation of multiple eggs for in vitro fertilization (IVF). Although AMH levels are related to egg count, they do not predict fertility outcomes or the timing of menopause.
AMH levels vary depending on your age. In women, AMH levels rise during adolescence, peak around age 25, and gradually decline. AMH levels are measured in ng/mL. Experts debate how to define typical AMH levels, but these are general ranges:
Average: Between 1.0 ng/mL to 3.0 ng/mL
Low: Under 1.0 ng/mL
Severely low: 0.4 ng/mL
Since labs use different equipment, the results may vary slightly from lab to lab.
A look at the significance of AMH as a biomarker
- Ovarian Reserve Assessment
AMH Levels as a Marker: AMH is a crucial indicator of ovarian reserve. It refers to the quality and quantity of a woman’s remaining eggs. Higher levels of AMH generally indicate a greater number of ovarian follicles, suggesting a higher ovarian reserve. Lower levels of AMH may indicate reduced ovarian reserve, which can be associated with conditions like diminished ovarian reserve (DOR) or approaching menopause.
Clinical Use: AMH levels can help assess fertility potential, especially in women considering Assisted Reproductive Technologies (ART) such as in vitro fertilization (IVF). They’re used to estimate how many eggs might be retrieved in an IVF cycle.
- Diagnosis and Treatment of PCOS
AMH in PCOS: Women with PCOS typically exhibit higher AMH levels because of the abundance of small follicles in their ovaries. Elevated AMH levels can support the diagnosis of PCOS, though it’s normally used alongside other diagnostic criteria such as ultrasound findings and clinical symptoms.
- Menopause and Age-Related Fertility Decline
AMH and Menopause: AMH levels decline with age, reflecting the gradual loss of ovarian follicles as women approach menopause. Testing AMH levels can help estimate the onset of menopause and assess the remaining reproductive lifespan.
- Assessment of Response to Ovarian Stimulation
AMH and IVF Cycles: AMH levels can predict ovarian response to stimulation medications used in IVF. Women with higher AMH levels often respond better to ovarian stimulation. This can help tailor treatment protocols and improve outcomes in fertility treatments.
- Ovarian Disorders
AMH in Ovarian Conditions: Low AMH levels can indicate conditions affecting ovarian function, such as Primary Ovarian Insufficiency (POI) or Premature Ovarian Failure (POF). High AMH levels, while often associated with PCOS, can also sometimes be seen in other ovarian disorders.
- Male Fertility
AMH in Men: AMH is produced by Sertoli cells in the testes. It is essential in sexual differentiation during fetal development. Elevated levels of AMH in adult men can be associated with certain types of testicular tumors or other disorders.
Advanced AMH Point-of-Care Tests
a. Lateral Flow Devices (Home-Based Kit)
Lateral flow tests, similar to pregnancy tests, have been conceptualized for AMH, but they are less commonly used in clinical practice. They are designed for simplicity and rapid results, though validation and widespread availability are still in development.
b. ELISA-Based Kit
Some ELISA-based kits for AMH can be adapted for near-POC use, providing faster results than standard lab assays. These are typically used in fertility clinics and specialized settings.
c. CLIA-Based Kit
CLIA-based point-of-care detection of AMH is a developing area, combining the accuracy of chemiluminescence with the convenience of rapid testing. CLIA involves using chemiluminescent labels to detect and quantify the presence of a specific analyte (AMH) in a sample. The process relies on a chemical reaction that emits light, which is then measured to determine the concentration of the target hormone.
Conclusion
AMH is a valuable biomarker with significant applications in fertility assessment, diagnosis of reproductive disorders, and ovarian health management. It provides valuable insights about ovarian reserve, response to fertility treatments, and certain reproductive conditions.