- The AMH test is an easy blood test that determines the amount of anti-MĂĽllerian hormone, which is secreted by granulosa cells of the small ovarian follicles and thus gives a direct estimation of ovarian reserve.
- AMH levels slowly drop as you age, but a reduced ovarian reserve can be the case for women in their twenties without showing any outward symptoms or menstrual cycle changes.
- Having regular periods does not rule out the possibility of having an abnormal ovarian reserve. AMH testing is the only sure method to independently assess ovarian function without being influenced by cycle regularity.
- Zemya IVF & Fertility Clinics perform AMH tests along with other thorough assessments of reproductive health for women at any point in their fertility journey.
For many young women in their twenties, the idea of fertility seems like something to be concerned with later, when the time is right. However, the choices and the understanding women carry with them during these years can be deeply impactful on their reproductive lives. Ovarian reserve tests, and the anti-MĂĽllerian hormone (AMH) test in particular, are one of the most useful and accessible means women can use to gain an understanding of their reproductive lives before they are ever in the mindset to try for a family. At Zemya IVF & Fertility Clinics, as one of the best and top-class fertility clinics in South Delhi, providing the best and most advanced infertility treatments, the AMH test is one we encourage young women to undertake.
What Is Ovarian Reserve?
Ovarian reserve describes not only the number but also the quality of eggs available in a woman’s ovaries at a particular point in her life. A woman is born with all the ovarian follicles she will ever have in her lifetime. These small fluid-filled sacs within the ovaries each contain an egg at various stages of development. Since birth, this stock has slowly been used up over the years. AMH levels decline as a woman ages reproductively, and after the thirties, the decline is more rapid until the ovarian follicles are completely used up at menopause.
Unlike many facets of health, this resource is not renewable. Knowing the current status of a woman’s ovarian reserve and whether it is falling faster than anticipated for her age is actually important information, especially to those who are thinking of delaying conception.
What Is the AMH Test?
The anti-MĂĽllerian hormone (AMH) test is a very simple blood test that determines the amount of anti-MĂĽllerian hormone circulating in the blood. AMH is synthesized exclusively by granulosa cells of small ovarian follicles. Therefore, the level of AMH in the blood is a direct measure of the number of small ovarian follicles active in the ovaries at the time and, consequently, a fairly accurate indicator of the total ovarian reserve.
One of the main benefits of this test is that it is relatively convenient. Unlike a follicle-stimulating hormone test, which requires that this hormone level be tested during the follicular phase of a woman’s menstrual cycle, an AMH test can be conducted at any point in a woman’s menstrual cycle using a simple blood test. It is also relatively easy to interpret and can be done in conjunction with other markers of ovarian function.
What Do AMH Test Results Mean?
Normal levels of AMH vary depending on age, although as a general rule, a woman’s level of AMH in ng/ml is assessed in conjunction with her age and antral follicle count, which is the number of small follicles in the ovary that are detectable on ultrasound. An increased ovarian reserve is indicated by higher levels of AMH and a higher antral follicle count, whereas decreased values of AMH indicate a decreased ovarian reserve and a reduced number of eggs available.
By nature, AMH values in the normal range for females in their twenties are usually higher than those of older women, which reflects the fact that they still have a larger number of ovarian follicles. Nevertheless, quite a few women in their twenties have AMH levels very low compared to the normal range of their age; such a situation points to diminished ovarian reserve that, without the help of ovarian reserve testing, is difficult to detect since these women usually have regular menstrual cycles and there are no symptoms. Therefore, ovarian reserve testing in younger women is highly effective since it pinpoints those who should take urgent reproductive decisions or plan fertility preservation, as their time is running out.
On the other hand, women with polycystic ovary syndrome (PCOS), also known as polycystic ovarian syndrome, tend to have high levels of AMH, which is due to the high number of small follicles in the ovaries. Although this shows high ovarian reserve in terms of follicle number, there are still issues concerning egg quality and ovulation in women with PCOS, and high AMH levels should be interpreted under the guidance of a fertility specialist.
Why AMH Testing Matters for Women in Their 20s
The biggest misunderstanding among women in their twenties is that a regular menstrual cycle is always a sign of good ovarian function. Actually, it’s not. Even if a woman has regular periods, she might already have a significantly reduced ovarian reserve, since ovulation can keep happening even when the number of follicles has dropped very low, and changes in the menstrual cycle usually don’t become obvious until the ovaries are quite aged.
Early menopause, also referred to as premature ovarian insufficiency, is estimated to affect one in every hundred women before the age of forty, and during the early stages, there is decreased AMH and ovarian reserve well before the commencement of irregularities in the menstrual cycle. These women do not have a way of knowing they are losing their fertility potential unless they are tested for ovarian reserve, and even then, it may be too late for action.
For women who are aware of their intentions to delay childbearing, for whichever reason, having an idea of their AMH levels empowers them to make informed decisions regarding their fertility. At Zemya IVF & Fertility Clinics, the Best IVF doctor in South Delhi team often counsels young women about the significance of their AMH test results, including egg freezing, as an option for fertility preservation.
AMH Testing and Fertility Treatment Planning
The biggest misunderstanding among women in their twenties is that a regular menstrual cycle is always a sign of good ovarian function. Actually, it’s not. Even if a woman has regular periods, she might already have a significantly reduced ovarian reserve, since ovulation can keep happening even when the number of follicles has dropped very low, and changes in the menstrual cycle usually don’t become obvious until the ovaries are quite aged.
Women with low levels of AMH and diminished ovarian reserve are likely to respond with a reduced number of eggs to ovarian stimulation and may require a more individualized and/or higher dose of injectable fertility drugs to produce an adequate response. Women with high levels of AMH, especially those with polycystic ovary syndrome, are at a higher risk of developing ovarian hyperstimulation syndrome and require a controlled ovarian stimulation to prevent this side effect. Measurement of antral follicle count, in association with AMH testing, provides additional information that consistently improves predictive accuracy of ovarian response and ovarian hyperstimulation syndrome.
When a woman’s ovarian reserve is extremely low, such that her eggs are unlikely to yield viable embryos, AMH testing becomes a tool for initiating a discussion about donor eggs. This way, couples are given the earliest possible chance to learn about their options and make informed decisions regarding their journey to parenthood via in vitro fertilization.
AMH Testing and the Clomiphene Citrate Challenge Test
Traditionally, ovarian reserve testing was determined by measuring basal levels of FSH in the first follicular phase of the cycle and by performing the clomiphene citrate challenge test, which is a two-point hormonal evaluation of ovarian reserve and response to clomiphene stimulation. Although the clomiphene citrate challenge test is helpful in determining ovarian reserve, it is no longer used as often as the AMH test in determining ovarian reserve testing because of its cycle dependence, its inability to predict ovarian response in assisted reproductive technology cycles, as well as the AMH test, and its inconvenience for patients. The AMH test is more direct in measuring ovarian reserve compared with ovarian reserve tests that only use FSH levels.
Factors That Can Affect AMH Levels
Knowing the factors that affect the results of an AMH test enables women to understand their results better. One major factor is that aging causes a natural decline in AMH levels. This is the main and only factor that cannot be avoided when a woman’s ovaries age. Nevertheless, besides age, changes in AMH levels can be influenced by the presence of contraceptive hormones, which, according to some research results, have been able to decrease AMH levels only slightly; however, this decline should be reversible if usage is stopped. Also, cigarette smoking is linked to speeding up ovarian aging and lowering AMH levels. Some medical procedures, such as chemotherapy, may even lead to a marked and sometimes irreversible drop in AMH levels. Moreover, a type of ovarian cancer called granulosa cell tumor can make AMH levels rise to a great extent, and therefore, a very high level of AMH without the occurrence of polycystic ovary syndrome is a reason for further examination.
AMH Testing at Zemya IVF & Fertility Clinics
At Zemya IVF & Fertility Clinics, an Affordable IVF treatment provider in South Delhi, AMH testing is offered as a standalone fertility health checkup for women who wish to gain an understanding of their fertility health or as part of a fertility workup for couples planning to conceive or who are struggling with infertility. Our fertility doctors are able to provide women with an understanding of what AMH test results may mean to each individual woman — whether it is to reassure her of her fertility potential or to discuss fertility preservation or fertility treatments that may be needed to support each woman’s ovarian reserve.
