Amg 3.5 what does it mean. AMH - the norm in women and the reasons for the deviation. Determination of ovarian reserve by AMH

Anti-Müllerian hormone is produced by ovarian cells, namely, the primary follicles that originate in them. The hormone is produced from the onset of puberty until the onset of menopause. In young girls, its level is low. Its maximum amount is found upon reaching the age of 30 and decreases by the age of 40. It is responsible for reproductive ability and shows how many follicles and eggs are left in a woman.

The concept of anti-Müllerian hormone and its role in the female body

The anti-Müllerian substance begins to be produced in the girl when she is still in the womb. Its level remains low until puberty. From that moment on, its concentration grows until the woman is 30 years old. This is followed by a gradual decrease in AMH. The zero value of the amount of the hormone is observed by the beginning of menopause. When AMH synthesis stops, the body is unable to produce an egg.

AMH performs several unrelated tasks in a woman's body:

• promotes tissue growth;
• regulates reproductive function.

By the content of the hormone in the body, you can determine how many eggs a woman has left until the end of her reproductive age. The analysis of AMH to check the number of eggs is resorted to after checking the hormonal balance and the normal production of female hormones at each stage of the menstrual cycle: estrogen, progesterone, luteinizing, FSH.

Analysis should be done to determine the cause of the lack of conception and identify possible pathology. Why donate blood for AMG:

• infertility, the cause of which is not established;
• unsuccessful attempts at fertilization, incl. with IVF;
• high content of follicle-stimulating hormone;
• suspicion of polycystic ovaries;
• the likelihood of an ovarian tumor;
• to evaluate the results of treatment with antiandrogenic drugs;
• with untimely puberty;
• to determine the timing of menopause.

Rules for preparing for blood donation for analysis to determine the level of the hormone

Practice shows that the concentration of anti-Müllerian hormone does not change at different stages of the cycle. It is not influenced by external factors, drugs, etc. Despite the stable level of AMH, doctors prescribe blood donation at the beginning of the menstrual cycle, on days 3-7 (normally on the 5th). For a woman in menopause, it does not matter when blood is donated. To properly pass the analysis, you need to prepare:

• exclude physical activity 3 days before visiting the laboratory;
• avoid stress;
• do not smoke, do not drink alcohol the day before the procedure;
• do not eat fatty foods per day;
• in the morning on the day of the analysis, do not eat or drink.

If a woman is sick or has recently had an infectious or viral disease, the analysis is not taken. The rules for testing require blood sampling in the morning on an empty stomach. Only 1 glass of water is allowed.

For the study, venous blood is needed. The laboratory assistant will apply a tourniquet, ask you to clench your fist to fill the vessel. After pierce it with a needle and draw blood. Laboratory analysis can be carried out 2-5 days. In this case, reagents are used to detect the content of the anti-Mullerian substance (hormone). After that, the anti-Mullerian hormone is compared with the table of norms. An accelerated procedure is possible in private laboratories.

AMH norms in women of different ages

Anti-Müllerian hormone has different levels in different age periods and may deviate from the norm. If AMH is lowered or increased, this does not necessarily indicate the presence of pathology, since each organism is individual.

Anti-Mullerian hormone has the following norms for different ages:

Decryption is carried out by a specialist of a particular laboratory, because the norm of an individual institution may not correspond to generally accepted standards. This is possible due to the use of different reagents, due to which the tables of parameters differ.

The norm at 20-30 years old is 4-6.8 ng / ml. An increased or decreased indicator is not considered a deviation: 2.2-4 and up to 8 ng / ml. If the level is significantly higher or lower, this indicates a pathological process.

Reasons for the increase

Disruptions in the hormonal background occur under the influence of external and internal factors. An increase in AMH is possible due to addiction. An unhealthy lifestyle usually leads to an increase. High rates are observed with:

• late puberty;
• long-term use of antidepressants, drugs for the treatment of oncology;
• lack of ovulation due to a decrease in the secretion of gonadotropic hormones;
• non-maturation of eggs;
• taking drugs to stimulate the ovaries;
• AMH receptor mutations;
• polycystic ovaries;
• defects in follicle-stimulating and luteinizing hormone receptors (genetic, on the corpus luteum);
• carrying out antiandrogenic therapy;
• transferred severe infectious diseases: tuberculosis, syphilis, tumors, osteomyelitis.

Why can AMH be lowered?

A low concentration of anti-Müllerian substance is observed with a decrease in ovarian reserve and reproductive capacity and is closely related to menstrual irregularities. When approaching menopause, its level should be within the normal range for a particular age, but be below the generally accepted average. If the rate is low in a young girl, the cause may be a delay in sexual development.

When its amount is significantly lower in women of reproductive age, pathological processes occur in the body. It is better to take up treatment and raise its level. Downward deviations are caused by the following factors:

• obesity;
• excessive physical activity;
• stress;
• early sexual development (eggs began to mature much earlier, which is why at some point their reserve is exhausted);
• operations were performed on the ovaries, during which part of the organ was removed;
• repeated stimulation, taking hormonal drugs for ovulation;
• pituitary tumor;
• genetic underdevelopment of the ovaries (gonadal dysgenesis).

How to bring the indicator back to normal?

If the analysis is carried out to identify the causes of infertility, it is necessary to adhere to the recommendations and appointments of a specialist. A slight deviation of the AMH index from the upper or lower limit does not indicate the absence of the possibility of conception in a natural way. In this case, it is enough to use folk remedies, follow a special diet, reduce the level of physical activity, and avoid stress.

If the indicator is significantly lowered or overestimated, it is necessary to undergo a full examination to identify possible pathologies. If the cause is found and its timely elimination, it will be possible to bring the anti-Mullerian substance back to normal.

If the level is low and the woman still plans to have children in the future, the doctor will recommend freezing the eggs, because. increasing it later will be problematic. Timely detection of a decrease in the level of AMH will allow a woman to learn about the approach of menopause and prepare for it, take urgent measures.

Medications

If AMH is below the norm, infertility or the approach of menopause is possible. There are currently no drugs that increase the level of the hormone. Vitamin D3 and the steroid hormone dehydroepiandrosterone have a beneficial effect on the normalization of AMH. When planning pregnancy, hormonal therapy is carried out, which gives good performance in one of the following areas:

• stimulation of the ovaries to increase the number of eggs - when planning a pregnancy or IVF at the moment;
• inhibition of ovulation for a certain period, so that reserves are not spent - for conception in the future.

If the level of AMH is slightly elevated, it is not necessary to take urgent measures when planning a pregnancy. This makes it more likely to get pregnant. Feature - no need for stimulation. If conception is not planned at the moment, it is indicated to lower the rate through the suppression of ovulation to save cells for a future pregnancy.

If the anti-Mullerian hormone is elevated, during IVF this threatens with hyperstimulation. The ovaries produce a large number of follicles. Embryo replanting is contraindicated in such a cycle, which means that the process is delayed for several months. After a slight suppression of the ovaries, IVF is carried out.

Many believe that Ovarium increases the level of the hormone. Ovarium injections are prescribed in preparation for IVF to reduce FSH with reduced AMH.

Non-drug remedies

To increase the level of anti-Müllerian hormone, many people take dietary supplements. Before purchasing such a drug, you should be tested, fully examined and receive doctor's recommendations for existing indications.

Many foreign experts advise the use of royal jelly and propolis, incl. in the form of dietary supplements. It is believed that these bee products have a beneficial effect on conception, strengthening and preparing the body. The systematic consumption of seafood and vitamin D can also increase the content of AMH. The latter can be obtained while walking on sunny days.

There are no other folk methods on how to increase anti-Mullerian hormone. If the deviation is caused by obesity, physical and emotional overload, diseases, the cause must first be eliminated.

The inability to conceive a baby on your own in a natural way is often associated with hormonal disorders in a woman. Among the great variety of endocrine disorders, there is a lack of AMH. The level of this hormone is extremely important for the reproductive function of both men and women, but it “works” in different sexes in different ways.

Before IVF, an AMH analysis is mandatory. What should be the norms of the Muller inhibitor, is it possible to get pregnant in the IVF protocol with a low level of this substance, and how to increase the concentration of AMH, we will tell in this article.

What it is?

AMH (anti-Müllerian hormone) was discovered back in the 19th century, when protein molecules that affect growth processes in the organs of the reproductive system were discovered by the German naturalist and biologist Johann Müller. He found that embryos, regardless of gender, have a common feature - a tube-channel, from which, approximately at the 9th week of pregnancy, the epididymis is formed in male embryos under the action of AMH. This is how gender differentiation happens.

In female embryos, AMH is not produced and, by default, the canal-tube begins to form in the fallopian tubes, ovaries. In girls, AMH begins to be produced only after birth.

The functions of the Mueller inhibitor are to ensure the sexual function of a person throughout life. In women, the level of AMH indicates the functioning of the ovaries, the maturation of the egg. Muller's inhibitor regulates the growth of follicles and decreases with age. The amount of AMH in a woman's blood plasma is a fairly accurate indicator of the ovarian reserve, it can indicate the approximate number of eggs that remain "in reserve".

Before puberty in girls, AMH is determined in extremely low concentrations. With the onset of puberty, the level of the Müllerian inhibitor begins to rise, and then gradually decreases in the course of life. During menopause, AMH in blood plasma is not detected.

AMG norms for IVF

As already mentioned, the concentration of Müllerian inhibitor in blood plasma is directly proportional to age. Therefore, the norms depend on how old the patient was at the time of planning the in vitro fertilization protocol. The norm for women under 35 is 4.0-6.5 ng / ml. A slightly disturbed AMH level is considered at 2.5-4.0 ng / ml. An indicator of 0.3-2.2 ng / mg is considered low. A concentration less than 0.3 ng/mL is considered low.

In women over 35, the norms are different. The normal level is considered to be 1.5-4.0 ng / ml. Conditionally normal can be considered an indicator of 1.0-1.3 ng / ml. A low level is 0.5-1.0 ng / ml, and an indicator of less than 0.5 ng / ml is considered a critical decrease.

These normative values ​​are typical for women whose infertility is not caused by hormonal disorders, but, for example, by obstruction of the fallopian tubes or thinning of the endometrium. But in most cases, women with endocrine disorders or concomitant endocrine problems have to resort to IVF, and therefore, the value of 0.6-0.8 ng / ml is set as the minimum standard value of AMH for IVF.

On average, for in vitro fertilization it is necessary that the concentration of AMH be from 0.6 ng / ml to 2.4 ng / ml.

Women who have taken oral contraceptives for a long time before planning pregnancy are most likely to suffer from low levels of anti-Müllerian hormone, since such drugs suppress the production of AMH and lead to premature menopause.

Deviations from the norm and predictions for pregnancy

A high level of AMH before the IVF procedure should alert the attending physician. Patients in whom the concentration of the Mueller inhibitor is increased to 6.5-7 ng / ml are more likely to develop ovarian hyperstimulation syndrome - a dangerous complication of the first stage of in vitro fertilization. A high level of the hormone slows down or completely blocks the growth of follicles, respectively, it will not be easy to get the right number of eggs for in vitro fertilization.

With a low level of anti-Müllerian hormone, the chance of pregnancy is reduced because few follicles are produced. With laboratory values ​​below normal at the protocol planning stage, the physician may assume that the ovarian response to hormonal stimulation of superovulation will be weak.

A low level of AMH reduces the likelihood of pregnancy even during IVF with ICSI, when the spermatozoon is injected under the oocyte membrane using a thin hollow needle. A reduced level of a hormonal substance indicates a poor quality of eggs, and therefore, even if pregnancy occurs as a result of an IVF protocol, the likelihood of a miscarriage or missed pregnancy in the early stages will be high.

Indicators of hormone concentration must be taken into account when choosing the nature of the protocol. If AMH in a woman's blood plasma is below 0.71 ng / ml, stimulation is carried out with high doses of antagonists in combination with FSH. If the concentration of the hormone in the woman’s blood is higher than 0.71 ng / ml, but does not exceed 2.1 ng / ml, then a long protocol is usually prescribed, in which hormones that suppress ovulation and cause an artificial menopause will be used first, and then follicle-stimulating hormones .

The probability of conception with a successful IVF and an elevated AMH level is higher than with a reduced concentration. The lower the values, the harder it is for a woman to get pregnant, even after embryo transfer. In general, the success rate of the IVF protocol in Russian clinics is estimated at 35-45%. With a significant decrease in AMH, the predicted probability of a successful pregnancy does not exceed 25-30%. There is a chance of pregnancy if the woman has no other concomitant pathologies of the uterus, cervix, endometrium.

A low AMH level in the natural cycle does not rule out the possibility of getting pregnant, but makes it even less likely. Without appropriate pre-treatment, IVF in the natural cycle with such indicators is tried not to be carried out.

It is always important to establish the true cause of the decrease in the Muller inhibitor, so that before any IVF protocol, a woman can undergo targeted pathology treatment.

How to pass the analysis?

For the study, a sample of the venous blood of a woman is used. In the direction of a gynecologist, reproductologist or endocrinologist, a woman should contact the laboratory on the 3rd-5th day of the menstrual cycle. It is during this period of time that the AMH indicator is most adequate.

The level of AMH is extremely unstable, and therefore you need to prepare for a blood test in advance - reduce physical activity a week before visiting the clinic, get enough sleep at night, and prevent deterioration of health. Any diseases that have been transferred over the past 2-3 weeks, as well as taking antibiotics or anticonvulsants, can lead to a distortion of the test result.

Stress and emotional turmoil that a woman experiences lead to fluctuations in the level of anti-Müllerian hormone. For 10-12 hours you should avoid eating, for 3 hours - do not drink water. A few hours before donating blood, it is advisable not to smoke or drink strong tea or coffee.

On average, the result of the analysis becomes known after 48 hours. In some laboratories, it takes about a day to conduct a study.

Can you increase AMH?

Since the concentration of the Müllerian inhibitor is unstable, it can change - it rises and falls depending on many factors. For example, in summer and spring, the level of the hormone in a woman's body rises by about 15-18%. Therefore, it is often associated with vitamin D, which is produced when human skin comes into contact with sunlight.

DHEA (dehydroepiandrosterone) therapy is considered effective. Such hormonal treatment is prescribed for very low AMH levels 3-4 months before IVF. In most cases, in combination with vitamin D, hormonal treatment is positive, and AMH tests before the IVF protocol show higher levels of anti-Müllerian hormone.

Sometimes doctors recommend that women take the anti-climacteric drug Melsmon. It is produced in Japan based on placental cells. Like any other remedy from the line of placentotherapy, the drug has its advantages and disadvantages, but often the effect of taking it is greatly exaggerated by manufacturers.

A woman with a reduced level of Mueller inhibitor is recommended to lead an exceptionally healthy lifestyle. A noticeable increase in the hormone is observed if sugar and muffin are completely eliminated from the diet. AMH also rises as a result of weight loss.

If a woman has problems with fat metabolism, then she first needs to consult with an endocrinologist - he will help to make a therapeutic diet to improve lipid metabolism. A weight loss of 5 kilograms increases the likelihood of pregnancy by about 4%, and if a woman brings her weight into line with a body mass index that is normal for her age, then the level of AMH will rise to a level that is quite sufficient for IVF to be more likely to succeed. Getting rid of excess weight increases the chances of pregnancy by about 10%.

Coffee, strong tea and other foods and drinks that increase blood pressure are detrimental to follicles and significantly lower AMH. Therefore, in the fight for the right to become a mother, it is important to give up such drinks.

A woman should stop smoking - in this case, the level of anti-Müllerian hormone rises by about 25% within a couple of months after giving up a bad habit, and the chances of conception increase by 15%.

To increase the concentration of the hormone, fatty dairy products (2.5% fat and above), as well as vegetables, fruits, meat, and fish will be useful. It is advisable to take vitamins and lead an active lifestyle. However, it is better to refuse excessive physical exertion, replacing intense workouts in the gym with swimming, easy running, and cycling.

Failure in the hormonal background is one of the main reasons that becomes an obstacle for a woman who wants to become a mother on the way to pregnancy. Mentioning this problem, most will think of problems with the concentration of hormones such as prolactin, progesterone and estradiol. At the same time, they do not take into account one of the most valuable stimulants for the proper functioning of the gonads - anti-Müllerian hormone.

In gynecology, this problem is very common. Often, it is because of her that couples have to give their consent to in vitro fertilization in order to conceive.

Anti-Müllerian hormone: what is it and what is it responsible for?

Anti-Mullerian Hormone or AMH this is an organic substance, the production of which is influenced only by the functionality of the ovaries. The brain does not take any part in this process. A constant volume of this hormone in the blood of women is maintained only until puberty begins. After passing this stage, its quantity may fluctuate under the influence of various factors. AMH hormone reaches its maximum level by the age of 20-30, and with the approach of menopause, its amount gradually decreases to a minimum.

Muller's substance is an inhibitor that is responsible for stimulating the production of follicles. Subsequently, they must mature and be able to perform their tasks of fertilizing the egg. When a woman does not produce viable follicles, then we can talk about the presence of problems with reproductive function.

To detect abnormalities in the concentration of this substance in the blood, it is necessary to do an analysis for AMH (amh). The functional reserve of the ovaries is estimated on the basis of different data, but according to experts, the level of AMH in this case is the most important indicator of the condition.

Anti-Müllerian Hormone Analysis: Indications

If many attempts have been made to conceive a child, and the desired result is not absent - pregnancy does not occur, then in this case, an AMG analysis is mandatory. In addition, the reason why anti-Mullerian hormone can be sent for laboratory testing is:

• violations and the presence of anomalies in sexual development;
• a series of unsuccessful attempts at in vitro fertilization;
• granulosa cell tumor of the ovaries;
• testing for polycystic ovaries;
• abnormal levels of follicle-stimulating hormone;
• suspicion of infertility;
• control over the action of antiandrogen therapy.

This test should be done to prematurely detect the early onset of menopause, which occurs against the background of menstrual irregularities. In addition, it is a necessary analysis for IVF (in vitro fertilization). The concentration of AMH in the body will allow the doctor to determine if there is an opportunity for IVF.

Specialized laboratories take blood for an AMG test and process the results within the next three days.

AMG analysis: preparation for delivery

In women, one question often arises when they are sent for a laboratory study of AMH - how to take it right? It is best to get an answer from your doctor. You are more likely to get a more accurate result if you follow the advice of your doctor. From the general requirements, we can note the importance of a relaxed and calm state immediately before laboratory tests.

Doctors agree that the ideal time for testing for AMH hormone is 3-5 days of menstruation. During this period, the AMH hormone is stable, which allows you to find out its real amount.

Before taking an analysis, it is important to adhere to certain rules. If the doctor did not focus on them, then it is better to ask him yourself. Doctors give the following recommendations:

• pay more attention to rest and relaxation;
• testing is carried out in the morning, before meals;
• to exclude the use of alcohol;
• three days before the test, you can not be subjected to physical activity;

If it happens that a woman has been diagnosed with any disease, in anticipation of an analysis for the AMH hormone, then it is postponed until she is completely recovered. After passing the laboratory test, answers to the hands can be obtained in three days.

Evaluation of normal test results

The norm in women of reproductive age is represented by the range - 2.2 - 8 ng / ml. When observing any deviations from these limits, it can be argued that there is a pathological process. It is highly undesirable to evaluate the results on your own and start taking some measures, believing that AMH is increased or decreased.

It is better to follow the advice and recommendations of experts. You should never rule out false indicators. As a rule, this is due to the fact that the woman is preparing for the examination incorrectly or an unsuccessful day has been chosen for the test. If there are doubts about the result, it is advisable to donate blood for analysis again, but in a different laboratory.

The following table shows what is the norm of AMH in women, depending on age:

Women are characterized by three periods, each of which has its own hormone rate:

• prepubertal;
• reproductive age;
• climax.

Conditions affecting blood levels of anti-Müllerian hormone

In medical practice, cases are not uncommon when there is an abnormally high content of AMH in the blood of women. A logical question arises: what does this mean and why is this happening? Anti-Müllerian hormone in women is elevated with the following problems:

• Stein-Leventhal syndrome in which there is a violation of the functions of the ovaries;
• anovulatory infertility;
• problems with the functioning of the receptors responsible for the generation of luteinizing hormone;
• ovarian tumor or granulomatous process.

We should not forget that sometimes we ourselves lead to the fact that anti-Mullerian hormone is elevated. Abuse of bad habits, such as smoking and excessive consumption of alcoholic beverages, often leads to the fact that AMH is elevated.

If the doctor finds that the anti-Mullerian hormone is elevated, then additional studies are prescribed. After their passage, treatment will be prescribed, the purpose of which will be to normalize the amount of hormones. In most cases, if a woman complies with all prescriptions, the treatment gives a positive result.

Polycystic ovaries- This is the most common pathology that leads to the fact that AMH is elevated. In this case, physical activity and diet are prescribed as treatment. Also, therapy is carried out that contributes to the normalization of metabolism. If the treatment does not give the desired results, and the anti-Mullerian hormone is elevated, as it was, and the patient did not manage to wait for the long-awaited pregnancy, then it may be necessary to think about surgical intervention.

For cases in which the level of this hormone in the body is high, scientists have not yet been able to develop drugs that can reduce the concentration of the hormone in the blood to normal.

If AMH is elevated, this is not a reason for frustration. You should, as soon as possible, seek help from specialists: a reproductologist and an endocrinologist. Additional studies will help determine the reason why anti-Mullerian hormone is elevated and, based on their results, treatment will be prescribed.

Causes of low AMH

It happens that there is a low AMH in women. This happens in the following cases:

• sudden weight gain;
• when ovarian reserve decreases;
• ovarian failure;
• infertility;
• unnaturally rapid sexual development;
• mechanical damage to the ovaries;
• violation of the cycle;
• genetic anomalies.

Women over 40 experience pre-menopausal changes. This is the most common cause of low AMH. During this period, the first failures in the passage of the menstrual cycle begin to occur.

Low AMH predominates in cases associated with premenopausal changes that begin to appear in women after 40 years of age. This period is also characterized by the first violations in the menstrual cycle. The analysis of AMH allows, taking into account this knowledge, to predict with sufficient accuracy the time of onset of menopause. Thus, a woman can be ready for this even 4 years before it starts. This is important for women with premature menopause, because they have a chance to have children.

For a young age, low AMH is the consequences of being overweight and too fast puberty. The use of drugs that affect the hormonal background during chemotherapy causes the ovaries to work at an unnatural active pace. This overvoltage significantly affects the volume of the hormone in the body.

Pregnancy with a low concentration of AMH: is it possible?

If we take into account the fact that anti-Müllerian hormone is an indicator that allows us to assess the state of the ovaries and follicular reserve, then when dealing with its low concentration, there is an absence of a dominant follicle with an egg. The consequence of this is the lack of ovulation.

The presence of ovulation and the number of follicles are determined by ultrasound. This procedure will allow you to find out if you have ovulated or not. Also, the data obtained will help to find out how serious the situation with a low level of the follicular apparatus is. If during ultrasound the doctor detects the presence of ovulation and the level of hormones that are responsible for ovulation and the formation of follicles are within the normal range, then the woman will have a good chance of conceiving a child on her own or with the help of IVF, even with low AMH.

Is it possible to increase the concentration of AMH?

How to increase AMH in women is a common question that arises sharply for every expectant mother when she finds out about poor results after passing the test. If laboratory tests have shown low AMH, then it is urgent to begin to deal with the source of the anomaly, which negatively affects the level of the hormone. Therapy can help ensure a desired pregnancy. This can be achieved by increasing the number of viable eggs. Doctors in some cases recommend artificial ovarian stimulation to women in order to increase the production of active eggs. Also, such a procedure is done for IVF.

Thinking about the problem: how to increase anti-Mullerian hormone in women, you need to be aware that this is not a source of pathology, but only a symptom. In order to bring the AMH hormone within the normal range in its volume, you need to start with the treatment of the underlying disease. The level of development of pharmacology has made it possible to create hormonal drugs capable of increasing the amount of AMH in the blood for a limited period. Only this will in no way contribute to an increase in the number of fully functioning eggs. Therefore, this method will not cure infertility.

Recent research in pharmacology has become a solution to the problem. DHEA drug positively affects the volume of follicles and returns the hormone AMH to acceptable limits. It is a steroid hormone that stimulates androgen receptors. The drug allows you to increase the number of antral follicles. Only a doctor can prescribe these medicines. Self-medication with hormonal drugs can significantly harm your health.

Vitamin D3 preparations to increase AMH

• Minisan. The drug is available in tablets (1 tablet contains 10 micrograms of the substance), as well as in drops (5 drops = 12.5 micrograms of vitamin).
• Aquadetrim (1 drop of the drug contains 12.5 mcg of vitamin).
• Vigantol (1 drop = 16.5 mcg of vitamin).
• Natecal D3. Chewable and lozenge tablets (1 tablet contains 10 micrograms of vitamin D3).

How to increase AMH in women without the use of drugs?

There are harmless methods, following which will increase the amount of AMH in the blood, without the threat of hormonal imbalance. You can increase AMH in women with folk remedies, for example, by getting vitamin D3 into the body, naturally, by sunbathing. In addition, you can safely take it in tablets, these vitamins are freely available at any pharmacy. If we compare AMH analyzes in summer and winter, then for the first case the concentration will be higher by 15-18%.

How to increase anti-mullerian hormone in women if its level deviates downward due to obesity or early menopause?

The most important thing in this matter is the elimination of the initial causes that lead to disturbances in the generation of the hormone by the eggs. To delay the onset of menopause, modern methods of hormonal therapy are used. A nutritionist can help solve the problem of being overweight. In extremely rare cases, the level of the hormone decreases under the influence of stress, but after overcoming a difficult life situation, its amount returns to normal.

AMG hormone and IVF

If, blood tests show that anti-Mullerian hormone is elevated, then there is a possibility of developing ovarian hyperstimulation. This complication contributes to a decrease in blood circulation in the pelvis. In addition, such an ailment provokes the appearance of edema, which carries a serious danger to life.

In vitro fertilization is allowed if the level of AMH in the body fluctuates between 0.6-2.4 ng / ml. A critical level of 1.1 ng / ml and below may indicate that the number of mature eggs that are already ready for fertilization is not enough to guarantee a positive result.

It is important not to forget that the level of this hormone acts only as an indicator. To prescribe treatment, you need to establish the source of the low level of the hormone AMH.

If the low content of AMH in the blood is not the result of age-related changes, but this pathology is caused by dysfunctions of the reproductive organs, then before IVF is performed, the diagnosed disease is first treated.

Whether IVF will bring the desired result depends largely on the indicators of anti-Müllerian hormone. Small indicators indicate that it is impossible to postpone the conception of a child for a long time, and if there is a desire to become a mother, then you need to act now. With low AMH, IVF is performed if the following 2 conditions are met:

1. The level of anti-Müllerian hormone in the blood should not be less than 0.6 ng / ml. This is the limiting indicator, which still allows you to find the necessary amount of genetic material in order to carry out successful fertilization)
2. The content of follicle-stimulating hormone in the body should be within the normal range. If the concentration of FSH is exceeded in combination with a reduced AMH, then the probability of a successful pregnancy tends to almost zero. With this combination of factors, a woman is recommended to use donor eggs.

Reproductive function can be impaired under the influence of many reasons. Therefore, a low level of AMH does not mean that you can put an end to the possibility of conceiving a child. The main thing is to establish the cause of the anomaly, causing a failure in the reproductive function. To do this, you will have to pass the necessary tests and, based on their results, begin to undergo treatment. Modern medicine in its arsenal has many tools that allow women to feel the joy of motherhood.

Related videos

One of the indicators of possible infertility is the level of anti-Müllerian hormone in a woman's body. Based on this indicator, reproductive specialists decide whether to resort to the IVF procedure and whether to use a donor egg. What is this hormone, is it possible to increase its level, and in general, why is it “anti-Mullerian”?

• Why the hormone is "anti-mullerian"
• The function of anti-Müllerian hormone in the body of a woman
• Why Reproductionists Pay So Much Attention to Anti-Müllerian Hormone
• AMH: normal, low and high
• How to prepare for the test on AMG

Who was "against Muller"?

The anti-Müllerian hormone got its unusual name in honor of the German naturalist Johann Müller, who lived in the 19th century. It was this scientist who discovered that human embryos up to the 6th week have the same development of the genital organs - this is the so-called "Mullerian duct", from which the vagina, uterus and fallopian tubes are then formed in women. In future men, at the 9th week of embryonic development, a special hormone begins to be released, which “starts” the development of the Mullerian duct in a different way - it transforms it into the epididymis. Since its action is directed "against" the female path of development of the Müllerian duct, the hormone was called anti-Müllerian (AMH - anti-Müllerian hormone).

The function of anti-Müllerian hormone in the body of a woman

Normally, AMH begins to be produced even before birth, during the 32-36th week of pregnancy. However, up to puberty, its amount is insignificant. The concentration of AMH rises sharply during puberty, and reaches a maximum between 20 and 30 years of a woman. Further, the secretion of the hormone decreases, but remains stable until the onset of menopause. Why does the content change so much?

” Anti-Mullerian hormone in women is produced directly in the follicles - granulosa cells, one of the layers surrounding the egg. However, not all follicles produce AMH, but only those that are ready for immediate growth and, in the future, for ovulation.

In general, the number of eggs in a woman's body is determined at the time of their laying, at 11-12 weeks of intrauterine development. However, the reverse process of the death of primary follicles, which is called atresia, immediately begins. So by the time of birth, the number of eggs in the body of a newborn girl decreases several times, to 1.5 million, and at the time of the first menstruation, there are no more than 300 thousand of them at all.

All this huge number of follicles is in a "sleeping" state and will never be used - these are the so-called primordial follicles, about 50 microns in size (they can only be detected during microscopic examination of tissues). No more than 500 of them can mature in a woman's lifetime.

This process is “started” by the action of follicle-stimulating hormone (FLH), which begins to be produced in the brain (in the pituitary gland) during puberty. Of course, not all follicles mature at once - about 25 follicles are simultaneously in the preantral and antral phases of development. Their size is already from 150 to 500 microns, and they can be easily detected (and counted) during an ultrasound examination.

” One (sometimes two or three) follicles reach the stage of ovulation at the same time, and it is the anti-Mullerian hormone that “slows down” them on the way. On the one hand, it promotes the growth and development of the preantral follicle, on the other hand, it partially inhibits the action of FSH, preventing all 25 follicles from “starting” at the same time.

When the size of the follicle reaches approximately 8 mm (the stage of a large antral follicle), another anti-Müllerian hormone, called inhibin B, begins to be produced instead of it. It gives the pituitary gland feedback - “that’s it, no more FSH is produced, the required number of follicles ready for ovulation has already been reached.”

Why Reproductionists Pay So Much Attention to Anti-Müllerian Hormone

As you probably understand, anti-Mullerian hormone is produced directly by maturing follicles. Its amount does not depend on the phase of the menstrual cycle. Its concentration does not directly affect the processes of conception and pregnancy (since it ceases to be produced in a mature egg).

” Since anti-Mullerian hormone is produced in follicles ready for growth and development, its amount allows you to quite accurately determine the so-called "ovarian reserve" - ​​how many potential follicles are ready for ovulation, which means how high the probability of conception is.

Of course, the number of antral follicles can also be estimated using ultrasound, but such a study is subjective, and its results inevitably depend both on the quality of the equipment used and on the skill of the specialist. The analysis of AMG is impartial and completely accurate, which is why it is used in preparation for the IVF procedure.

AMH: normal, low and high

As you have noticed, the concentration of AMH in a woman's body rises at the time of puberty, reaches a maximum at the peak of fertility from 20 to 30 years, and gradually decreases to zero at menopause.

Average normal levels of anti-Müllerian hormone at different ages

However, the average figures are typical for women who do not experience problems with conception. Therefore, reproductologists have their own scale, focused on the lower limits of the hormone concentration.

An AMH value above 1.0 ng / ml indicates a fairly high probability of pregnancy in a natural way.

The AMH index is higher than 0.2 ng / ml - pregnancy may occur as a result of IVF.

The causes that caused a decrease in AMH levels do not necessarily indicate potential infertility. For example, if one ovary or part of it is surgically removed from a woman, then the level of AMH can be reduced, but this does not prevent the natural onset of pregnancy.

” Naturally, the question arises - is it possible to somehow increase the level of AMH in order to increase the chances of conception? No, you can’t: anti-Mullerian hormone is produced by an active follicle (and not vice versa: AMH does not stimulate the primordial follicle). So a low AMH level is just an indicator of reproductive problems.

In general, it can be said with regret that the reasons for the decrease in the production of anti-Müllerian hormone are not completely clear. In addition to the obvious ones (menopause, ovarian surgery, the use of hormonal drugs), there are also non-obvious cases of a decrease in AMH. One reason could be obesity.

The level of AMH may be higher than normal, and this also does not indicate reproductive health and high fertility. Thus, often the concentration of anti-Müllerian hormone is higher in women with polycystic ovary syndrome, and an ultra-high level indicates the presence of granulosa cell tumors of the ovaries.

How to prepare for the AMH test

Although the level of AMH in general does not depend on the phase of the menstrual cycle, it is usually handed over for convenience along with other hormonal tests, on days 3-5 of the cycle. Before analysis it is not recommended:

eat within 2-3 hours (you can drink clean water without restrictions);

stop taking hormonal drugs two days before the analysis (only in agreement with your doctor!);

eliminate physical and emotional overstrain for at least a day before the test;

do not smoke for 3 hours before the study.

Although the concentration of AMH is almost independent of the phase of the menstrual cycle, fluctuations are possible over a short period of time (the reasons for this have not been fully investigated).

So if the results of the analysis are unsatisfactory - do not panic, the doctor will definitely advise you to retake it and, perhaps, next time the indicators will be more optimistic.

Prepared by Anna Pervushina

Mueller-inhibiting protein, or anti-Mullerian hormone (AMH), is a substance secreted by preantral and small antral follicles, in which egg maturation begins at this time. The name of this substance comes from the name of the Müllerian ducts. During the prenatal period, their cells are continuously dividing to form the uterus, its tubes and vagina.

What is Anti-Mullerian Hormone responsible for?

Its main purpose is to block (inhibit) the action of the pituitary follicle-stimulating hormone (FSH) and the further growth of follicles.

Throughout the reproductive age, eggs mature in the ovaries. Initially, they are located in primordial, inactive follicles. In each cycle, some of them (from 3 to 30) begin to grow, and as a result, one of the eggs fully matures. The remaining follicles, which began to develop at the same time, are absorbed.

At birth, a girl's ovaries have about 1-2 million primordial follicles. By the time of the first menstruation, there are 300-400 thousand of them. Then their number continues to decrease, and by the time it reaches 1000.

During each cycle, FSH secreted into the blood by pituitary cells acts on one of these follicles and turns it into a dominant one. An egg matures in it and ovulation occurs. This process ends in postmenopause. Anti-Mullerian protein blocks the action of FSH on the remaining primordial follicles, preventing them from entering the growth phase.

The follicles themselves require a certain threshold level of FSH in the blood in order to proceed to the preovulatory stage of growth. Low levels of AMH increase their sensitivity to stimulation, causing faster follicular growth and premature ovulation.

With aging, the number of primordial follicles decreases and the amount of anti-Müllerian hormone decreases. In practice, the concentration of AMH is used to determine the degree of fertility of the patient, that is, her ability to become pregnant.

How to take an analysis

Preparation for the delivery of the analysis:

1. For 2 days, eliminate fatty and spicy foods from the diet.
2. On the evening before, take a light dinner, do not eat in the morning.
3. Avoid stress and physical exertion for 2 days.
4. Do not smoke for 12 hours before the study.

On what day of the cycle to donate blood for anti-mullerian hormone?

Usually, the study is scheduled for 3-5 days after the start of menstruation, but fluctuations during the month are not significant. Therefore, this rule can be neglected. Blood is taken from the cubital vein. The result is usually ready in 2 days.

Blood sampling for anti-Mullerian hormone is made from the cubital vein

The study is mandatory for all women before. The values ​​obtained will show whether you can use the ovarian stimulation protocol and get your own eggs (with normal AMH values) or whether a donor germ cell is required (with an extremely low result). Additional indications for examination are high FSH values ​​​​and the ineffectiveness of the ongoing ovarian stimulation, in order to clarify whether the woman herself is able to provide a mature egg.

The level is determined by a blood test. Its value most accurately reflects the number of follicles, that is, the patient. An additional indicator is the determination by ultrasound of the number and size of antral follicles in each cycle.

FSH and estradiol levels are also part of the routine ovarian reserve test. However, the level of the latter is constantly changing, so the study does not provide accurate information about the activity of the follicles.

The indicators of the norm for conception depend on the age of the woman:

Deviations of indicators from the norm

Data deviation from the norm can be a sign of many diseases, including the impossibility of conception.

Low AMH and infertility

The results of the study, which showed the level of anti-mullerian protein below the norm, can be observed in such conditions:

• Primary ovarian failure

The condition is accompanied by loss of hormonal and reproductive function of the ovaries, as well as premature menopause. Usually the disease is associated with chromosomal abnormalities. In primary ovarian insufficiency, the level of AMH in the blood is very low or undetectable.

• endometriosis

The disease is accompanied by the growth of the endometrium outside the uterine cavity and is a potential cause of premature menopause, which is observed in more than half of the patients. In patients with increasing age, the decrease in AMH levels is more pronounced than in healthy women.

• Ovarian insufficiency

Patients with malignant tumors who received radiation or chemotherapy often have ovarian failure, which is accompanied by a low level of anti-Müllerian protein.

An anti-Müllerian hormone test may be helpful in this situation before starting treatment. It helps to assess the risk of infertility after chemotherapy or radiation.

• Autoimmune conditions

Low levels are seen in lupus, Crohn's disease, and autoimmune thyroiditis.

Increased concentration of AMH

It is noted in such diseases:

• polycystic ovary syndrome

In patients, the concentration of androgens is increased and the number of antral follicles is increased, the content of anti-Müllerian hormone is also increased. The exact cause of the increase in AMH is unknown.

A large amount of AMH is associated with other signs of polycystic ovaries - lack of menstruation and insulin resistance. Interestingly, in the treatment of PCOS, the amount of anti-Müllerian protein also decreases. It is possible that there is also feedback. Then substances that suppress AMH activity could be used for the treatment of polycystic disease. This area of ​​pharmacology is now being actively studied.

• ovarian cancer

Since AMH is produced by the ovarian granulosa cells, high levels of this hormone may be a sign of a granulosa cell tumor. Also, this indicator is used for dynamic monitoring of patients treated for this disease, for the timely diagnosis of relapse.

The value of AMH in the clinic

In addition to the number of follicles, the level of anti-Müllerian protein determines their qualitative characteristics. Both of these characteristics are critical to assessing a woman's reproductive potential.

Ovarian reserve testing is indicated in such cases:

• low birth weight;
• type 1 diabetes;
• systemic lupus erythematosus;
• transferred operations on the ovaries;
• transferred due to myoma.

Research helps:

• develop an individual plan for the treatment of infertility;
• predict early menopause;
• accurately determine the state of the ovarian reserve in any phase of the cycle, in contrast to FSH, estradiol and inhibin B;
• to determine the possible fertility in patients with ovarian cancer.

The determination of anti-Müllerian hormone is very important in preparation for IVF, as it provides information about the increase in the number of eggs ready for stimulation and maturation.

In addition, AMH prevents the development of ovarian hyperstimulation syndrome by the injected follicle-stimulating hormone. Norm indicators for IVF are not lower than 0.8 ng / ml.

Other indications for determining the concentration of the hormone:

• unclear gender of the baby or cryptorchidism;
• persistent Müllerian duct syndrome;
• low levels of sex hormones;
• granulosa cell tumors.

Analysis Disadvantages

The level of the test substance can be affected by the individual characteristics of the female body, the use of contraceptives and other drugs, as well as the consequences of ovarian surgery. There are no exact laboratory standards accepted worldwide. Therefore, each laboratory uses normal values ​​recommended by the instrument manufacturer or self-collected data from healthy women.

The decoding of the analysis is carried out by comparing the obtained value with the so-called reference value, that is, taken as the norm. The reference value is printed on the form.

Can You Get Pregnant With Low Anti-Müllerian Hormone?

The results of studies have shown that even at a concentration of less than 4 ng / ml, pregnancy is possible.