Anti-Mullerian hormone: norm in women, analysis and norm indicators in the table

If, after a year of normal sexual activity and the desire to have a child, pregnancy has not occurred, a visit to the doctor is necessary, who, as a rule, will prescribe the appropriate diagnosis. The main study before IVF is to determine the level of anti-Mullerian hormone. AMH analysis is an indicator of the number of healthy eggs and mature follicles.

What is AMG

Anti-Mullerian hormone is an indicator of the ability of a woman’s body to perform reproductive functions. AMH is produced in the follicles. The amount of the substance is not dependent on other hormones and the menstrual cycle. The hormonal indicator is constant, which makes it possible to calculate the number of mature eggs.

Low AMH during IVF in a woman

AMH (Mullerian inhibitory substance) is the main marker indicating ovarian aging. Even with an unchanged female cycle, a decreased level of AMH signals the onset of ovarian exhaustion. A reduced amount of AMH indicates abnormalities in reproductive function, but IVF remains possible in this case.

AMH hormone - when to take it

If a woman cannot become pregnant for a long time, it is necessary to undergo examination. This information is also useful for men who are having trouble becoming a father. This is the first and main indication when to donate blood to the AMH hormone to both sexual partners. If anti-Mullerian hormone continues to be produced in insufficient or excessive concentrations, additional hormonal treatment cannot be avoided. Other indications when analysis is required are presented below:

disrupted menstrual cycle;
diagnosis of diseases in women's terms;
previous surgical intervention;
repeatedly unsuccessful IVF;
late reproductive age of pregnancy planning;
impaired ovarian function;
premature sexual development.

In what cases is a hormone test necessary?

The AMH test allows you to determine the reserve of ovarian function. Indications for the study are:

Lack of conception for a long period.
Causeless infertility.
IVF with negative results.
Elevated FSH levels.
Diseases of the ovaries (granulosa cell neoplasms in the organs of the reproductive system, polycystic disease).
Slow maturation of the body.

Antiandrogen therapy can also be a cause of low AMH levels.

Carrying out analysis

A blood test for Anti-Mullerian hormone may be prescribed:

To determine the presence or absence of disruptions during puberty;
To identify the causes of infertility;
If there are problems with sex determination (called false hermaphroditism);
When identifying and further monitoring cancer processes that have affected the ovaries;
To identify the causes of unsuccessful in vitro fertilization.

Research before IVF

The patient undergoes a gynecological examination, instrumental and laboratory tests. A gynecological examination is carried out to visually assess the condition of the organs of the reproductive system and to exclude congenital and acquired pathologies.

Smears are taken to determine the cleanliness of the vagina by examining the microflora. Bacteriological tests make it possible to identify infectious sexually transmitted diseases. Cytology smears from the cervical canal provide timely detection of malignant growth and precancerous conditions.

Treatment

To bring anti-Mullerian hormone back to normal in women by age, it is necessary to decipher the test and start from the causes of the disorders. Treatment can only be prescribed by a doctor. In this case, the patient should consider several tips:

If the AMG content is low, it is impossible to increase its level with medications. All existing medications are aimed at maintaining the proper functioning of the ovaries and only help prevent pathology.
If the level is elevated, taking hormonal medications is strictly not recommended. This can be explained by an increased risk of dysfunction of the heart, liver and kidneys.

With increased

If the AMH hormone exceeds the norm, the woman is recommended:

adjust your diet, get rid of bad habits that negatively affect your health;
if you are overweight, you should get rid of it;
normalize physical activity on the body (increase it or reduce it);
reduce stressful situations to a minimum;
bring the daily routine back to normal (if necessary, increase sleep time);
treatment of polycystic disease (if detected).

At reduced

If a woman has low AMH levels, the doctor selects an appropriate method of therapy based on her age.

During puberty, a decrease in hormones can have unpleasant consequences, so it is extremely important to identify the cause as quickly as possible. During reproductive age, it is often advised to take hormonal medications, which can affect the functioning of the ovaries and temporarily stop it. Thanks to this, it will be possible to preserve the ovarian reserve for the woman.

Sometimes it is possible to achieve the AMH norm in women by taking a long vacation and improving the emotional background.

Preparing for the AMH test

To obtain the most accurate results, you must follow these recommendations:

the analysis is taken on the 3rd day of the menstrual cycle;
physical activity should be avoided for 3 days before the procedure;
eliminate stressful situations;
the day before taking the test, you should not smoke or drink alcoholic beverages;
One hour before the test, you are prohibited from drinking or eating.

Important! It is contraindicated to carry out a test to determine the level of AMH in the presence of inflammatory processes or infectious diseases.

Modern methods of preimplantation diagnostics (PGD) make it possible to transfer only genetically complete embryos into the uterine cavity, which makes it possible to increase the efficiency of IVF.

How is the AMH test performed?

Blood for testing is taken from a vein, the analysis takes 2-3 minutes to 2 days. After drawing blood, using a special serum, the AMH level is determined.

AMH concentrations vary greatly throughout life in both women and men.

Factors that reduce hormones

The decrease in ovarian function reserve is influenced by the patient’s childbearing age, which is characterized by changes over time. A decrease in the functioning of the reproductive system can also be observed during a normal female cycle. An AMH level that does not reach 1.0 ng/ml, obtained in a laboratory test, means that there is almost no chance of fertilization, not excluding the IVF method.

How to increase AMH using folk remedies

Folk remedies, according to reviews from women and medical specialists, help restore normal hormonal levels.

These include royal jelly, honey and vitamin D.

Vitamin D can be obtained by walking outside in sunny weather or by taking pharmaceutical medications.
At the pharmacy you can buy the biological supplement “DHEA” or vitamin D3. Taking the vitamin is effective when the AMH concentration is less than 0.5. It is necessary to take the drug after consultation with a medical specialist. You need to independently study the instruction card attached to the drug. Some people have allergic reactions to vitamin D. In such cases, you will have to get it naturally from sunlight.
Even in everyday life, doctors recommend taking a course of vitamin D in the winter, since it is at this time that solar activity is minimized, and the body needs its use.
Royal jelly and honey, according to traditional medicine adherents, also help increase the hormone. This type of treatment is effective in conjunction with a special diet. It has been proven that beekeeping products have a beneficial effect on the human body, strengthening it from the inside. The daily dose is calculated based on the woman’s weight category; it can vary in the range of 100-500 mg. Before use, it is necessary to find out whether the woman has any reactions to beekeeping products, because they are an allergenic product. Royal jelly is rich in carbohydrates, amino acids, proteins, minerals and vitamins.

Royal jelly will help:

improve the condition of the immune system;
strengthen the heart;
improve lymphatic flow;
relax the uterine muscles;
bring blood pressure back to normal;
improve thyroid function;
improve hormone balance.

This remedy is also indicated for pregnant women; it helps get rid of insomnia, mood swings and spontaneous miscarriage. The period of admission varies from 1 to 3 months. A dose of bee jelly should be taken 1 hour before meals. It has been proven that a strengthened body is capable of partial self-healing, as well as restoring the entire hormonal balance in women to normal.

Article design: Mila Friedan

Normal AMH levels in women and men

The resulting hormone is studied over several days. Therapy is prescribed based on the picture obtained by studying the AMH level. If the hormone level is below normal, it is concluded that the woman’s reproductive system is not able to produce healthy eggs that would be sufficient for IVF. The indicators are very dependent on age; normal values are presented in the table.

This table shows normal (reference) AMH values for men and women by age. AMH values <1 ng/ml in women indicate a significant decrease in ovarian reserve.

What Causes AMH Deficiency

The main reasons for low hormone levels are:

Menopause. Characterized by the cessation of the female cycle. There is no ovulation, the reproductive system loses its functions.
Anorchism. Male pathology, in which there is congenital underdevelopment of the organs of the reproductive system. This pathological condition is also characterized by underdevelopment of the prostate gland.
Low levels of ovarian reserve. The number of eggs capable of fertilization is not produced due to the age characteristics of the female body.
Underdevelopment of the gonads. Pathologies are possible in women and men. More often these are congenital defects of the ovaries and testicles.
Accelerated puberty. The accelerated development of body systems, including the reproductive system, is a violation of the maturation of the body.
Pathological changes in the pituitary gland. With this deviation, changes occur in the organs of the female reproductive system, which leads to a decrease in luteinizing hormone, which ensures the functioning of the reproductive system.

Obesity is also considered one of the reasons for low levels of anti-Mullerian hormone.

What do the analysis results depend on?

There are a number of factors that provoke negative AMH results:

age over 40 years;
ovaries with a volume of less than 3 cm3;
the level of follicles in the ovary is below 10-15 pcs.

The last subpoint is especially important, since with a small number of follicles when stimulating the egg, the response will not be significant, which will lead to negative results of conception, including artificial insemination.

Reasons for decreased AMH levels

If the level of the hormone decreases, this can cause problems with conception or complete infertility. This can happen as a result of:

limited supply of eggs;
early puberty in women;
excess body weight in adulthood;
early onset of menopause.

There is also a natural decrease in anti-Mullerian hormone. It happens with age. However, if such a situation arose prematurely, there is a risk of pathologies occurring. If the amount of the hormone decreases during pregnancy, this leads to the risk of developing hermaphroditism in the fetus. This means that the child will have characteristics of both sexes. So, in girls the Müllerian duct can form, and in boys the Wolffian duct. As a treatment for the pathology, hormonal therapy may be prescribed.

Having done an analysis for anti-Mullerian hormone and found out that its level is very low, patients who want to get pregnant strive to increase it by any means. However, many women forget that the results of blood tests for hormones only provide an indirect assessment of their health. Today there are a number of ways that make it possible to slow down the rate of menopause after 35 years.

To increase the value of the indicator, you have to completely bring your health back to normal. Most often, early menopause occurs as a result of excess weight. The presence of extra pounds worsens the patient's quality of life. This factor has a negative impact on the functioning of the endocrine system. It has been proven that with every 5 extra kg a woman's chance of pregnancy decreases by 4%.

If a woman over the age of 35 wants to get pregnant, she will first need to give up bad habits. It has been proven that smoking negatively affects hormonal levels. The fact is that cigarettes contain substances that lead to disruption of estradiol levels. If the patient is able to overcome a bad habit and get in shape, this will increase the chances of successful conception by 30%.

The daily menu will also need to be reviewed. It is necessary to exclude coffee and foods that lead to sudden changes in blood pressure from the diet. If a woman cannot completely refuse them, it is necessary to limit the consumption of these products during the period of ovulation. In 2010, researchers from the United States were able to prove that diet is directly related to hormonal levels. The likelihood of conception decreases with the consumption of sweets and baked goods. But eating food that is rich in vitamins and minerals can normalize metabolic processes. All this helps normalize ovulation. The content of the hormone estrogen in the blood is increased by dairy products whose fat content is more than 2.5%.

Clinical significance of AMH testing

The level of the hormone in the blood determines the number of cells ready for fertilization. Using an AMH test, the following is assessed:

Preservation of the follicular reserve. If the level of anti-Mullerian hormone is reduced, one can judge about premature ovarian depletion, which can be possible with massive sclerosis of the ovaries, as well as as a result of surgery on the appendages.
Functioning of the ovaries.
Potential fertility indicators, especially in young women.
Prospects for results with IVF. If AMH levels are below normal, standard protocols will likely result in a weak follicular response.
Danger of developing hyperstimulated ovarian syndrome. This happens especially often if the ACG rate is increased during IVF.

The onset and possible causes of early menopause are also assessed.

Reasons for increased AMH levels

Anti-Mullerian hormone levels are considered elevated if their value exceeds 7.3 ng/ml. Typically this condition occurs as a result of:

lack of ovulation or development of polycystic ovary syndrome;
late puberty;
intense sports training or heavy physical labor in women;
development of neoplasms in the ovarian area;
bad habits of the patient or frequent encounters with stressful situations.

Reducing the level of anti-Mullerian hormone is carried out using drug treatment. Its selection is made based on the results of the examination. During the therapy period, the patient should lead a quiet life. It is necessary to try to avoid conflict and stressful situations. If it is not possible to bring the indicator back to normal, an IVF procedure may be prescribed during infertility treatment.

Features of IVF with FSH deviations

If, when analyzing tests for AMH, it is discovered that the level of anti-Mullerian hormone is underestimated, the chances of pregnancy are very low due to the difficulty of selecting the required number of cells that are adequate for fertilization.

Cell donation

The embryo obtained from the test tube is implanted into the uterus. If the level of performance of the functions of the ovarian reserve is insufficient, the fusion of sperm and egg does not occur, which prevents the creation of a finished embryo. In such cases, it is often proposed to use germ cell donation from young women.

Important! If you manage to get a fertilized embryo with a low AMH level, the chance of getting pregnant remains low.

Hormone therapy

With IVF, hormonal therapy is required.
Often, women over forty years of age experience involuntary abortions, as well as chromosomal abnormalities in the intrauterine child, therefore, before IVF, hormonal therapy should be carried out to increase the number of cells capable of fertilization. Doses of medications are doubled, but such therapy does not affect the health of a woman who is under constant medical supervision.

How to prepare: recommendations

To clarify AMH indicators, you will need venous blood. The biomaterial is taken on an empty stomach, in the morning, necessarily, after resting for 10–15 minutes, to avoid nervousness and fluctuations in data.

Before analysis you cannot:

smoke for several hours;
drink alcohol for two days;
overexert yourself in the gym, be nervous, have sexual intercourse within 24 hours before your visit to the laboratory;
You should not take medications on the day of the test. If tablets or drops are needed for vital reasons, then you need to notify your doctor about this nuance. For patients with chronic pathologies of the heart and blood vessels, hypertension, it is advisable to come to the laboratory for 8 hours, donate blood, and then take medications.

Inaccurate data on test results often arise during long-term treatment with antibiotics or hormonal compounds, the use of oral contraceptives, obesity, and reluctance to give up smoking and alcohol for a certain period before the analysis. In rare cases, the cause of false results is improper storage of biomaterial. Excessive intake or significant deficiency of vitamin D also affects the values of the hormone.

IVF protocols for low AMH levels

There are the following ways to implement an IVF program if the AMH level is low:

Classic IVF with stimulation. Used if anti-Mullerian hormone is low in both ovaries.
Modified cycle. Obtaining 2-4 follicles by using low doses of medications. Used to reduce the load on the patient’s body. The cost of the protocol is also reduced. The woman's rapid recovery after stimulation makes it possible to increase the frequency of artificial insemination programs.
Japanese protocol. Freezing of embryos is used, followed by isolating the strongest one and transferring it into the uterine cavity with minimal hormonal stimulation.
Shanghai Protocol. 2 stimulations and 2 punctures are performed during the menstrual cycle. With this method, it is possible to increase the number of viable cells in less time.

Often, depending on how the clinical picture manifests itself, methods of artificial insemination are selected one by one. When choosing any method of artificial insemination, it must be preceded by preimplantation genetic screening.

Normalization methods

It is possible to normalize the amount of anti-Mullerian hormone provided that menopause has not yet occurred. When choosing a technique, doctors take into account the following factors:

age group;
the presence of concomitant pathologies;
causes of hormonal fluctuations, etc.

Attention! If the ovarian reserve in a woman’s body has been exhausted, then neither therapy nor traditional methods will bring the desired effect.

How to increase anti-Mullerian hormone

To increase AMH, patients need to act as follows:

take hormone-containing medications prescribed by your gynecologist/reproductologist;
put your weight in order;
switch to a balanced diet;
normalize sleep;
ensure proper rest;
Give the body moderate physical activity.

Attention! In the process of carrying out therapeutic and preventive measures, you can use folk recipes. For example, to increase anti-Mullerian hormone, it is recommended to consume seafood, honey, and propolis.

IVF with donor eggs with low AMH

There are 2 methods of artificial insemination with donor cells:

In vitro fertilization with vitrified donor cells. The most accessible method. Donor eggs are thawed, fertilized with the husband's sperm, and embryos are cultured and transferred to the uterus.
Artificial insemination with fresh donor cells. This type of IVF is complex and expensive. Taking into account the wishes of the couple, a donor is individually selected to undergo stimulation. The eggs obtained from the donor during puncture are fertilized with the husband's sperm. The cultured embryos are placed in the patient's uterus.

Often, in various clinical situations, it is recommended to alternate methods of artificial insemination to obtain effective results.

Important! In women with reduced AMH levels, when changing the tactics of using donor eggs, the effectiveness of the procedure increases by an order of magnitude.

Consequences of deviation from the norm

If the level of biologically active substances shifts in one direction or another from the norm, this may mean the appearance of pathological processes in the ovaries. For a more detailed study of the disease and diagnosis, additional examination is required.

As for the consequences, they depend on how much the tests differ from the norm. A small difference may not be critical, but if the level is much higher or lower than the normal level of anti-Mullerian hormone in women, then problems with fertilization arise.

Is it possible to get pregnant with low AMH?

Low AMG reduces the chance of pregnancy, but there are a few other factors to consider to get a clearer picture. A lack of hormones is most often accompanied by the absence of follicles in the ovary. As a result of this pathology, the woman does not ovulate.

Ultrasound helps detect the presence of ovulation. If the test shows that ovulation occurred properly and the hormone levels were close to normal, then in some cases the woman can become pregnant on her own. Conception is also possible with the help of IVF.

Predictions for ovarian tissue depletion

In reproductive medicine, it is very important to predict the depletion of ovarian tissue. To this end, you should:

organize a thorough collection of pathological history;
collect anamnesis of heredity;
conduct laboratory diagnostics with determination of AMH, FSH, LH;
conduct a high-precision ultrasound to count the number of antral follicles;
perform a genetic analysis of premature ovarian failure.

If a woman is found to have significant risks, she should immediately take advantage of her reproductive potential. The doctor should inform the patient that with a low AMH level, it becomes more difficult for her to become a mother every day. This applies not only to spontaneous pregnancy, but also with the help of IVF.

Indications for testing

Most often, doctors recommend donating blood for AMH during pregnancy planning. There are also a number of pathologies for which such analysis is used as part of diagnosis:

untimely puberty (it can be early or late);
suspicion of ovarian cancer;
absence of menstruation for unknown reasons;
signs of obesity in women of reproductive age;
the onset of early menopause;
revealed polycystic ovary syndrome;
infertility - hormone testing is recommended to determine the cause;
unsuccessful IVF attempts.

Important information: How to correctly take a test for total testosterone (deciphered by age)

Men also undergo this hormone test for the following indications:

diagnosis of monorchidism or cryptorchidism;
the need to check male fertility (this term refers to the ability to conceive).

Another possible reason for conducting laboratory tests is to monitor antiandrogen therapy.

Contraindications

There are no complete contraindications to the analysis of anti-Mullerian hormone, but there are temporary ones:

the patient has colds or acute respiratory diseases;
inflammatory processes of the pelvic organs;
taking hormonal medications (patients with thyroid pathologies should pay increased attention to this point);
use of medicines (homeopathic medicines are no exception).

If one of the above contraindications is present, it is better to postpone laboratory testing.