What kind of hormone is amg and how to decipher it. Amg hormone, what is it. Why do reproductive specialists pay so much attention to anti-Mullerian hormone?

The formation of the reproductive system in an embryo according to the female or male type, spermatogenesis, maturation of follicles - all these functions are performed by anti-Mullerian hormone. In the medical literature there are several names for this substance: anti-Mullerian, anti-Mullerian, anti-Mullerian hormone, its abbreviated name is used - AMH.

AMH and the human reproductive system

The biologically active substance is produced in representatives of both sexes. In women, the hormone is produced by primary follicles, in men - by Sertoli cells and testes. Unlike other hormones, the secretion of AMH is practically not controlled by the brain.

The AMH hormone influences the formation of tissues in a developing organism. This substance plays a special role in the formation and development of the human reproductive system. At the initial stages of individual development, it is impossible to determine the gender of a normal embryo.

The early embryo has both a female origin (Müllerian ducts) and a male origin (Wolffian ducts). During further development of the embryo Anti-Mullerian hormone is of decisive importance in the formation of female and male genital organs.

The purpose of the Müllerian ducts is the formation of the female reproductive system, since the uterus, fallopian tubes and other female genital organs develop from them.

In order for the formation of male genital organs to begin, the Müllerian ducts must be destroyed. This is precisely the task that anti-Mullerian hormone (AMH) performs. Its concentration in male embryos increases already from the 8th week of intrauterine development.

Further, the action of the substance is aimed at the formation of full-fledged male genital organs. After birth, a male infant continues to produce anti-Mullerian hormone in the testicles until puberty. Insufficient concentration of the substance in boys leads to serious problems:

• the testicles do not descend into the scrotum;
• the development of an inguinal hernia is likely;
• false hermaphroditism;
• reproductive dysfunction.

AMH is present in small quantities in men in adulthood. And yet, it plays an important role in the processes of conceiving a child, as it affects the process of spermatogenesis.

In women, AMH behaves differently. Its synthesis also begins during intrauterine development. From the moment of birth until the onset of puberty, the amount of this substance in girls is insignificant. With the onset of puberty and before the onset of the first signs of decline in reproductive function associated with menopause, the situation changes dramatically.

AMH levels remain quite high during this extended period of a woman's life. Anti-Mullerian hormone in women is of decisive importance in the maturation of follicles, the onset of ovulation, creating conditions for fertilization. It does not directly affect conception; it is rather an indicator of the state of a woman’s reproductive health

The substance is present in the body of representatives of both sexes and is very important for reproductive function. Decoding the analysis for the amount of AMH allows you to establish:

• quantitative characteristics of ovarian reserve;
• presence of ovarian cancer;
• qualitative characteristics of spermatogenesis.

An analysis to determine the concentration of AMH is prescribed if young people of childbearing age have problems conceiving a child, it is necessary to identify the causes of infertility, there is a need to confirm a diagnosis related to cancer.

Increased content

Elevated AMH hormone indicates:

• about delayed sexual development in a young man;
• about the manifestation of cryptorchidism (location of the testicle outside the scrotum);
• about the presence of polycystic disease or ovarian tumor;
• about gonadotropic insufficiency.

Reduced content

The reasons for increased hormone levels are:

• gonadotropic hypogonadism;
• overweight;
• underdevelopment of the gonads (testes or ovaries);
• premature maturation of women;
• menopause and menopause;
• genetic disorders.

Anti-Mullerian hormone and pregnancy

A low concentration of anti-Mullerian hormone in a woman’s body can cause reproductive dysfunction. Low AMH levels are associated with the number of germ cells in a woman. The hormone is figuratively called the “egg counter”

Despite the fact that AMH levels do not depend on the amount of other hormones, a thorough hormonal study should be carried out to determine the chances of conception. There are several hormones responsible for the formation of female cells and ovulation: progesterone, luteinizing hormone, follicle stimulating hormone.

For example, the process of releasing a mature, viable egg is ensured by the ratio of anti-Mullerian and follicle-stimulating hormone (FSH). With an acceptable ratio of low AMH and high FSH, conception is possible with a high degree of probability. In medical practice, cases have been described in which women experienced miscarriages with low AMH levels. It is worth noting that the level of this substance is in no way associated with spontaneous abortion.

When AMH levels are low, gynecology uses the technique of ovarian stimulation to obtain healthy eggs. In the future, they are used for fertilization and gestation using alternative methods.

A low level of anti-Mullerian hormone may be evidence of pathological processes in the body. When they are eliminated, normal levels of the substance are restored.

Anti-Mullerian hormone and IVF

The in vitro fertilization procedure allows the process of fusion of a mature egg and a viable sperm to take place in a test tube. After 2-5 days, the resulting embryo is transferred to the uterine cavity. Anti-Mullerian hormone does not affect the process of attachment and further intrauterine development of the embryo.

To carry out the procedure, you need to obtain a healthy egg. Low and high concentrations of the substance have a negative effect on ovarian stimulation. If the amount of the substance is insufficient, it is not possible to obtain mature eggs. The collected cells are not ready for fertilization (it does not occur or the embryonic tissues do not divide correctly).

With a high level of AMH, a dangerous condition is observed - ovarian hyperstimulation. This can lead to swelling, poor circulation of the pelvic organs and pose a threat to the patient’s life.

Anti-Mullerian hormone is of decisive importance in the formation of sex in the embryo. Its level is quite high in boys before puberty, which indicates the importance of the substance in the process of proper formation and functioning of the genital organs of the future man. In women, hormone levels rise sharply only after puberty. It is an indicator of the state of her reproductive system and the possibility of becoming a mother.

Anti-Mullerian hormone plays an important role in a woman's body. This is an organic product that is produced by special ovarian cells; its level changes during puberty, and with the onset of menopause it is reduced to zero. If anti-Mullerian hormone is low, can you get pregnant? This question worries many women.

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What it is

AMH hormone - what is it? It begins to be produced in girls from the moment of birth. As soon as a girl begins to menstruate, its level increases.

Maximum concentration of AMH in women observed in the age range from 20 to 30 years, which is why these 10 years are considered the most favorable for the birth of a child.

Anti-Mullerian hormone affects puberty and the ability to conceive a child. The peculiarity is that its level entirely depends on the functioning of the ovaries; the production of AMH is not controlled by the brain.

For this reason, in girls this organic product is present in unchanged quantities until the onset of puberty. During premenopause, at the age of 40–45 years, AMH production decreases, hormonal levels change, and the woman experiences. In addition, a low content of organic product in the blood significantly reduces the ability to conceive.

Anti-Mullerian hormone is responsible for the functioning of the follicles and the number of mature eggs In addition, estrogen is completely dependent on AMH. It influences the formation of the female genital organs of the embryo; its level determines how the uterus, appendages and vagina of the girl are formed.

AMH norm in women

The normal level of this substance in women depends entirely on age and external factors. If anti-Mullerian hormone is elevated, many couples are unable to conceive and are forced to resort to IVF. To plan a pregnancy, an AMH test is required.

Normal indicators:

• girls – 1.8–3.4 ng/ml;
• women of reproductive age (norm for conception) – 2.1–7.2 ng/ml;
• the norm for menopause is 0–1.1 ng/ml.

Quantitative indicator of this substance may vary depending on the characteristics of the body or the presence of pathologies of the reproductive system. Some people produce more AMH at age 50 than a young girl at age 25.

Note! The production of this organic substance does not depend on a woman’s menstrual cycle or her diet.

A test to determine the level of anti-Mullerian hormone is prescribed to women who cannot become pregnant or when planning to conceive using IVF.

AMH analysis

A blood test can only be taken in a clinic setting; To get the result, two hours is enough. Except in situations where there is a problem with pregnancy, take anti-Mullerian hormone recommended for diagnostic purposes. The following conditions are indicated:

• disturbances have been noted during puberty in girls;
• infertility of unknown etiology is suspected;
• the level of follicle-stimulating hormone is significantly increased;
• upon the onset of early menopause or menstrual irregularities;
• in case of unsuccessful IVF procedures.

How to take an anti-Mullerian test? Blood must be donated for AMH on days 2–5 of the menstrual cycle, during this period the result will be most accurate. You also need to adhere to general recommendations:

• after suffering an infectious disease, blood should be donated no earlier than two weeks after recovery;
• exclude stressful situations and increased physical activity 2-3 days before blood sampling;
• You should never smoke before taking the test;
• alcohol consumption must be stopped 5 days before blood donation;
• The test is taken on an empty stomach, you can only drink water.

It is not always possible to determine the cause of deviations from the norm using one AMH analysis, but it is still quite informative. The result can be tracked dynamics of decrease in the supply of female eggs and freeze the material for future fertilization purposes.

Reasons for deviation from the norm

Normally, the level of the substance in the blood decreases after 45 years. If this happened earlier, the following pathologies may be the cause:

• puberty occurred prematurely;
• premature menopause;
• female infertility;
• a small number of eggs in the ovaries;
• mechanical injuries;
• excess weight due to endocrine disorders.

Important! A low level during pregnancy is dangerous because the child may be born a hermaphrodite, with the sexual characteristics of both a boy and a girl.

In order to prevent the development of pathology, the patient is prescribed hormone replacement therapy in order to eliminate the cause of the deviation and normalize hormonal levels.

If anti-Mullerian hormone is elevated (exceeds 7.2 ng/ml), the following factors may cause the deviation:

• increased physical activity due to working conditions or sports training;
• late puberty;
• a state of constant stress, fear;
• abuse of alcohol, smoking, drugs during pregnancy and conception;
• pathological lack of ovulation at the genetic level;
• ovarian tumors of a benign or malignant nature.

To reduce the production of AMH, drug treatment is used, after first conducting a full diagnostic examination. Throughout the course of treatment, the patient should keep complete peace and strictly avoid stress.

If therapy to eliminate infertility does not bring results, the woman may be referred for artificial insemination.

How to increase your AMH levels

Many women wonder if they can get pregnant if their AMH levels are low.

Low AMH does not exclude this possibility, but the chances are significantly reduced. If the analysis shows a deviation from the norm to a lesser extent, the woman is referred for IVF.

The level of AMH does not affect the very possibility of having children; pregnancy can occur even with deviations.

The hormone is an indicator of pathologies. The diagnosis of infertility is made only when the rate is very low.

No less important is the question of how to increase anti-Mullerian hormone in women. This cannot be done with medication. it is necessary to eliminate the cause, which provoked a deviation from the norm. Under no circumstances should you do this yourself; you need the help of a qualified specialist.

It is believed that it is possible to increase the hormone in women using folk remedies, using beekeeping products as food additives. They have a restorative effect and improve lactation, but there is no evidence that they increase AMH levels. It is necessary to periodically take blood tests in order to monitor reproductive function and timely eliminate the root cause of deviations.

AMH norm for conception

The normal level at which conception is possible is considered to be 2.0-7.2 ng/ml. To determine the possibility of getting pregnant ovarian stimulation required, as a result of which healthy eggs capable of fertilization should be produced. Low AMH and ovarian response to stimulation are considered indications for artificial insemination. Follicular reserve cannot be normalized by any means. Most often, this result is due to the following factors:

• patient over 40-45 years old;
• ovarian volume< 3 см3;
• each ovary contains< 5 антральных фолликулов на 3 день менструального цикла;
• follicle-stimulating hormone is reduced;
• previous ovarian surgery;
• course of chemotherapy or radiation therapy.

In this case, the desired goal may not come even as a result of the IVF procedure.

What is biosterone

Biosterone or dehydroepiandrosterone is a broad-spectrum steroid, considered the hormone of youth.

Applicable to normalize hormonal levels and strengthening the immune system, is not considered a medicine. It is better to consult a doctor before use.

Reception begins with small doses, which are gradually increased.

To improve the quality of eggs for women over 40 years of age, the recommended course is 25 mg three times a day for three months; with the onset of pregnancy, the drug should be discontinued. It must be remembered that DHEA has an impressive list of contraindications and side effects.

Important! Biosterone should absolutely not be used in the presence of tumor processes in the body and in patients at risk of developing cancer.

Video: the role of AMH, normal blood levels

Conclusion

The level of anti-Mullerian hormone in the blood can be changed when the cause of the deviation is stress or the development of pathology. The woman undergoes treatment, and over time, AMH may return to normal. If the deviation is congenital, it is impossible to change the hormonal level. Therefore, in order to plan pregnancy, it is necessary to monitor hormonal levels.

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The so-called anti-Mullerian hormone is present in the female body from birth. Its reserves are depleted only at the onset of menopause. It is known that this important element is involved in the accounting of eggs; doctors use it this way: they measure the AMH level in a woman, and based on the results of this analysis, they make a verdict containing the number of egg units prepared for fertilization. Not everyone who takes a test for anti-Mullerian hormone has a normal level; below we will examine this issue, which is important for all women.

AMH or anti-Mullerian hormone

In what cases is an AMH test prescribed?

It happens that at first a woman is examined to find out the state of other hormones, not including AMH in the list. According to the results of such standard tests, the most important hormones can be found to be normal. It is often possible to observe a situation where, with a sufficient concentration of other hormones, the problem remains in place - pregnancy does not occur with normal sexual life. Then, to increase the depth of examination of the body, doctors prescribe tests to find out in what concentration the anti-Mullerian hormone is. Although it is not included in the initial hormonal tests, it should still be noted that due to this indicator it is possible to find out the real potential of the ovaries. So, the doctor decides to do an extended Efort Test, not only in cases of problems with fertilization. It may also be required if a woman has a history of failed IVF procedures, where an inadequate response to sufficient stimulation was recorded. When infertility is diagnosed, but it is impossible to find out its nature, such a test is also done. In addition, an extended analysis helps shed light on situations: elevated follicle-stimulating hormone, determining the effectiveness of antiandrogen therapy, removing or confirming suspicions of polycystic lesions or granulosa cell tumors localized in the ovarian zone. Even the youngest women require this extended analysis, prescribed to determine the preconditions that led to delayed or too early puberty.

Anti-Mullerian hormone and its normal level

In order to correctly determine the hormone level, an analysis is taken at the beginning of the cycle, optimally on the third to fifth day. Before donating blood, it is unacceptable to expose yourself to physical activity or the destructive effects of stress, and you should not eat food. When it is discovered that you have recently had an acute illness or the body is in a state of illness, you should not take the test. A healthcare worker examining the blood is able to adequately determine how many active follicles are present; they are produced by anti-Mullerian hormone; the norm for women varies from 1 to 2.5 ng/ml. But the result does not always fit into this range; sometimes the indicator turns out to be outside the norm, upward or downward, this happens for various reasons.

Anti-Mullerian hormone: present in women from birth

AMG: what do you need to know about it?

Basically, an abnormally high level of AMH detected in a woman signals the following problems in the body:

• polycystic ovarian lesions,
• delayed sexual development,
• the presence of granulosa formations on the ovaries.

These are the most common reasons for an increase in the hormone in question.

Decreased anti-Mullerian hormone

The situation with a low level of anti-Müllerian hormone indicates various processes occurring in the female body; we indicate the most common conditions and pathologies that accompany a decrease in the level:

• premenopausal changes,
• decreased ovarian reserve due to age,
• state of obesity.

The most probable reasons for the decrease in AMH in women are named.

Is it possible to change the AMH level?

The fact is that anti-Mullerian hormone is only an indicator reflecting the fact that antral follicles are present in the ovarian cavity. If you try to lower or increase the content of this hormone with drugs, you will still not be able to influence the process of egg formation in the ovaries. Results will only be achieved with an approach that begins with eliminating the causes of the lack of healthy eggs.

After taking a hormone test

When the laboratory technicians, by examining the woman’s venous blood, have drawn their conclusions and given the result, there is no need to try to independently evaluate these data and in no case should you take any measures with self-medication, even if it is clearly noticeable that there are deviations from the norm. When the norm for the AMH substance is not found, but, on the contrary, overestimated or underestimated data are obtained, this issue should be resolved together with a specialist, for example, a reproductologist or endocrinologist. It also happens that blood is re-donated, for example, for another laboratory, and the results are different. This can happen due to an erroneous study against the background of improper preparation of the patient for blood donation.

It is not necessary that when analyzing for anti-Mullerian hormone, the norm in the results will be stated, but you still should not be upset; it is better to promptly begin to take measures to eliminate the detected pathology.

Diagnosis of infertility includes many studies, but one of the main ones is an analysis of a woman’s hormones. The levels of endocrine hormones that regulate the functioning of the reproductive system are routinely determined. If such a study does not produce results, an additional test for anti-Mullerian hormone is prescribed.

Anti-Mullerian hormone (AMH) is present in the body of both sexes. The hormone is produced by the gonads from birth, but only during puberty does it reach its maximum.

In men, AMH levels are high during periods of growth and puberty, as the hormone is involved in the development of the genital organs. With a critical decrease in AMH levels, a man may be unable to conceive a child. After puberty, the level decreases, but the hormone continues to be produced until the end of life.

The importance of the hormone for women is different. The concentration of AMH remains in the blood from birth to menopause. In the female body, anti-Mullerian hormone is produced by the granulosa tissue of the ovaries. Accordingly, the more cells are involved in the process, the higher the hormone level will be. At the onset of menopause.

How is the number of eggs determined?

Experts call anti-Mullerian hormone an “egg counter,” because its level reflects the number of viable eggs. The number of germ cells capable of fertilization is established in a girl’s body at the stage of intrauterine development.

During puberty, there are up to 300 thousand of them, if the girl does not have serious pathologies. This number of cells is called the ovarian reserve. Each menstrual cycle in a healthy woman is marked by the maturation of germ cells, from which the most capable and high-quality ones are released.

The process of maturation of germ cells in the body of a sexually mature woman does not stop during pregnancy and the use of contraceptives. Anti-Mullerian hormone itself does not play an important role in the process of fertilization, but its diagnostic potential is enormous.

The concentration of AMH in a woman’s blood can be determined and her ovarian reserve can be assessed during the extended Efort test. When is the Efort test prescribed:

• absence of pregnancy while maintaining a normal sex life without using contraception;
• infertility for unknown reasons;
• history of unsuccessful IVF;
• late puberty;
• determining the results of antiandrogen treatment;
• polycystic ovary syndrome;
• suspected ovarian tumor;
• increased levels of follicle-stimulating hormone.

Modern medicine makes it possible to predict the premature depletion of egg reserves and plan pregnancy in such a way as to be on time. To conduct the study, it is necessary to collect anamnesis and determine the indicators of FSH, LH and AMH.

The number of follicles is counted using ultrasound. Additionally, candidate genes for premature ovarian failure are being investigated. Young girls who are at risk of early ovarian failure should implement reproductive plans and family planning in a timely manner.

There is an additional measure of protection: social and biological preservation of fertility, that is, cryopreservation of oocytes. This method is recommended for those women who are postponing having children due to temporary medical contraindications.

However, in women with increased FSH, decreased AMH, ovarian volume up to 3 ml and the number of antral follicles up to one, it is not always possible to obtain oocytes for storage. Such patients are recommended to use donor material.

Preparation for analysis

In order for the test results to be informative and accurate, it is necessary to follow all instructions for preparing for the study. Venous blood is needed to determine AMH levels. The Efort test is carried out strictly on the third or fifth day of the cycle.

A few days before the test, it is necessary to minimize physical and psycho-emotional stress. One hour before the test you should not eat or smoke. Blood donation is postponed if shortly before the woman suffered an acute infection or other serious illness.

Normal level of anti-Mullerian hormone

Only a doctor can correctly interpret the results of any analysis, since many different factors can affect the data obtained. The hormone level is almost independent of external factors such as nutrition and lifestyle. Age also does not play a role. Some women over 40 have significantly higher AMH levels than girls of reproductive age.

AMG standards:

• for women: 1-2.5 ng/ml;
• for men: 0.49-5.98 ng/ml.

When the level deviates from the norm in a woman of reproductive age, it is important to first check the reproductive system for pathologies and disorders. Anti-Mullerian hormone reflects the functionality of the ovaries, so the condition of other organs and the concentration of other hormones, as a rule, do not affect the results of the study. When identifying deviations from the norm, it is necessary to look for violations in the ovaries and the processes that regulate their work.

Reduced anti-Mullerian hormone

An indicator of less than 1 ng/ml in women of reproductive age is considered low. Before puberty and after menopause, low AMH levels are considered normal, since at this age there is no activity of the primary follicles.

A low concentration of AMH in a woman of reproductive age indicates a small number of primary follicles ready for fertilization, as well as ovarian depletion. Both of these reasons lead to the same result - difficulties in conceiving naturally and minimal response to drug stimulation.

Athymullerian hormone influences the process of tissue growth and differentiation. Differentiation is the formation of a cell genotype. In a woman with normal hormonal levels, differentiation, maturation and release of one egg occurs in one cycle. If there are disturbances, anovulatory, irregular and other disruptions in the menstrual cycle appear.

The AMH indicator is only an indicator of the number of viable eggs, but the reasons for their reduction are completely different. When AMH levels decrease, it is necessary to find and treat the cause, not the effect. This is the only way to correct consequences such as infertility and early climate change.

Reasons for decreased AMH:

• menopause;
• gonadal dysgenesis (incomplete development of glands);
• early puberty;
• obesity and other metabolic disorders;
• hypogonadotropic hypogonadism.

A decrease in AMH levels after age 30 may be a signal of early menopause. The decrease is determined by various factors, so a woman will need to consult not only a gynecologist, but also an endocrinologist and a reproductive specialist. Typically, changes in AMH concentration are detected precisely during preparation for fertilization or when determining the reasons why conception fails.

Natural conception with low AMH

The issue of natural conception with low AMH remains controversial. An indicator of less than 0.2 ng/ml is considered critical, and low - up to 1 ng/ml. With a very low AMH level, the chances of spontaneous conception are minimal.

If the hormone concentration is low, it is necessary to additionally take an FSH test. If the level of follicle-stimulating hormone is within the normal range, the chances of natural conception remain.

A serious problem is the combination of low AMH and high FSH. A decrease in AMH levels in women over 40 years of age indicates that the reserve of eggs is running out, and there is no way to force the body to produce additional ones.

If the reason for the decrease in AMH is menopause, but the woman still wants to get pregnant, hormone replacement therapy may be required. This will help delay menopause and increase the chances of natural conception.

The ability to conceive depends on the number of oocytes, the number of genetic and chromosomal mutations, the degree of sensitivity of the endometrium of the uterus, the presence of gynecological and other pathologies.

In vitro fertilization with low AMH

Low AMH determines the chances of getting pregnant naturally. If this indicator is not combined with other alarming signals, IVF allows you to achieve egg maturation and successful conception even with minimal stimulation. Therefore, a reduced AMH level does not become a contraindication to in vitro fertilization.

On the contrary, IVF will be the most likely method of conception if the level of anti-Mullerian hormone is low. The Japanese IVF protocol is recommended for a combination of low AMH and high FSH (from 15 IU/l). Minimal stimulation is separated by breaks to obtain 1-2 viable eggs in each cycle. The resulting cells are frozen and transferred to the uterus at a favorable time.

The IVF duct in a natural cycle is used in cases where a woman’s ovarian reserve is depleted for one reason or another. Ovulation stimulation is carried out minimally or not at all. Over the course of several cycles, doctors try to obtain at least one egg, which is fertilized and transferred to the uterine cavity.

A short IVF protocol with ovarian stimulation is indicated for a slight decrease in AMH, which does not accurately indicate egg deficiency. It is necessary to take into account the level of FSH, the age of the patient, the results of previous protocols and stimulations. If all these indicators are normal, the chances of conception are high, so a short protocol is carried out.

Preparation for IVF with low AMH levels may include the use of transdermal testosterone, androgens, estrogens, DHEF, hCG, LH, L-arginine, corticosteroids, aromatose. Herbal medicine and hirudotherapy are recommended.

When to use donor eggs

A third of women of advanced reproductive age cannot become pregnant even through IVF. Requires the use of donor eggs. Artificial ovarian stimulation is most often ineffective in cases of low AMH in combination with other disorders. On the contrary, additional stimulation may further deplete egg reserves.

Indications for oocyte donation:

• increased FSH;
• decreased anti-Mullerian hormone;
• insufficient ovarian volume (less than 3 ml);
• absence of antral follicles or presence of only one.

If a woman does not want to use donor material, the most promising IVF protocol is used, although stimulation in such patients is most often ineffective. In this case, the best option would be to listen to the recommendations of your fertility specialist.

Increased AMH levels

A woman's AMH level is considered elevated when it exceeds 2.5 ng/ml. It must be taken into account that when preparing for IVF, this figure should be slightly exceeded. An increase will indicate that stimulation is working and the chances of successful fertilization are high. Reasons for increased AMH levels:

• tumor;
• polycystic ovary syndrome;
• delayed sexual development;
• defects in luteinizing hormone receptors.

All reasons for increased AMH levels can be divided into two groups. The first includes conditions in which the follicles mature normally, but the eggs do not leave the glands. This can be observed in polycystic ovary syndrome, when the follicle grows and develops, but is not able to overcome the cystic surface.

The second group includes an increase in AMH concentration against the background of proliferation of ovarian granulosa tissue. The most obvious reason is tumor transformation of the gonads. If elevated AMH is detected, an ovarian ultrasound is first prescribed. After detection of tumors or polycystic disease, it is necessary to undergo long-term treatment and re-test. Most likely, the results will improve significantly.

Therapy for elevated AMH

Treatment of the causes of increased AMH is carried out taking into account the woman’s age and the goals that need to be achieved in this way. Therapy for polycystic ovary syndrome includes normalization of body weight, nutritional correction, adequate physical activity, rest and work regimen.

A woman should normalize her hormonal levels and carbohydrate metabolism. After this, it is possible to stimulate ovulation or surgically ensure the release of the egg outside the ovaries. Treatment tactics for hyperplastic processes in the ovaries are agreed upon with an oncologist. If malignant neoplasms are detected, the issue of conception is postponed until complete recovery.

How to increase AMH

An increase in AMH levels does not lead to an increase in the chances of natural conception. Stimulating hormone production with drugs does not change the number of viable eggs, and therefore does not solve the problem of infertility. In this case, treatment consists of identifying and eliminating the causes of the decrease in hormones.

Often artificial stimulation is ineffective, since a decrease in AMH indicates premature menopause. Such patients are recommended to pay attention to assisted reproductive technologies. Even if the results of the AMH test deviate from the norm, you should not panic ahead of time.

Reduced or increased anti-Mullerian hormone is not an indicator of absolute infertility and the inability to conceive a child on your own. It is necessary to take into account many other factors and only then make a decision about artificial stimulation and in vitro fertilization.

[08-093 ] Anti-Mullerian hormone

1705 rub.

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Anti-Mullerian hormone ensures sex differentiation in the embryo, and is also involved in spermatogenesis and follicle maturation. It serves as an indicator of the function of the gonads, and is used to find out the cause of impaired sex differentiation, male and female infertility, as well as in the diagnosis of certain tumors.

Synonyms Russian

AMH, Mullerian inhibitory substance.

SynonymsEnglish

Anti-Müllerian hormone, AMH, Müllerian inhibiting factor, MIF, Müllerian-inhibiting hormone, MIH, Müllerian-inhibiting substance, MIS.

Research method

Chemiluminescent immunoassay.

Units

ng/ml (nanograms per milliliter).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for research?

• Do not eat for 12 hours before the test.
• Avoid taking estrogens and androgens for 48 hours before the test.
• Do not smoke for 30 minutes before the test.

General information about the study

Anti-Müllerian hormone (AMH) is normally synthesized only by the Sertoli cells of the testes (both during embryonic development and after birth) and granular cells of the ovaries (only after birth). It gets its name from its unique property of preventing the development of female reproductive structures from a germ called the Müllerian duct. Although the sex of the child is determined at the time of conception, until the 6th week of pregnancy the fetus has undifferentiated sex gonads and the rudiments of the internal reproductive structures of both sexes: the mesonephritic duct (Wolfow) and the paramesonephritic duct (Müllerian). Initially, the fetus develops according to the female type. At the same time, the Müllerian duct stimulates the development of the uterus, fallopian tubes and upper part of the vagina, and the cells of the Wolffian duct are destroyed. Conversely, in the presence of suppressive factors, the Müllerian duct is destroyed, and the Wolffian duct gives rise to the epididymis, vas deferens and seminal vesicles - thus, the development of the reproductive system occurs according to the male type. One of these factors, which ultimately determines the anatomical male gender of the child, is anti-Mullerian hormone. It is produced by the Sertoli cells of the testicle from about the 7th week of embryonic development. Its main function is to suppress the formation of female reproductive structures from the Müllerian duct. If a genetically male fetus has mutations in the anti-Müllerian hormone gene or mutations in its receptor gene, then the development of the Müllerian duct continues and, along with the internal male reproductive structures, female reproductive structures (uterus, fallopian tubes or cervix) are also formed. In this case, the child has normally developed testicles, internal male reproductive structures (epididydymis, vas deferens and seminal vesicles) and external male genital organs; sex at birth is determined to be male and it is not possible to suspect a developmental anomaly.

Another important function of the AMH is the descent of the testicles from the abdominal cavity into the scrotum. If AMH is abnormal, testicular descent is impaired. Delayed descent of the testicles (cryptorchidism) is the most common pathology of the genitourinary system in boys, it occurs in 30% of premature and 5% of full-term children. As a rule, testicular descent still occurs spontaneously by the 3rd month of life. If this does not happen by 6 months, surgery is performed to move the testicles from the abdominal cavity or inguinal canal to the scrotum (orchidopexy). Most patients with AMH deficiency or insensitivity have cryptorchidism and are considered for such surgery. It is often during orchidopexy that additional internal female reproductive structures are discovered and persistent Müllerian duct syndrome is suspected. In addition to anatomical defects that increase the likelihood of inguinal hernia in children, this syndrome is associated with infertility.

Doctors observing a boy with cryptorchidism face certain difficulties. This pathology can occur both in cases of impaired testicular descent and in their absence. These deviations have completely different prognosis and treatment, so their correct differential diagnosis is necessary. Ultrasound can detect testicular tissue in the abdominal cavity or inguinal canal only in 70-80% of cases, while AMH is a specific (98%) and sensitive (91%) indicator of the presence of testicular tissue. A positive test for AMH in a boy indicates an abnormal descent of the testicles, which can be corrected with surgery. The absence of AMH makes it possible to diagnose anorchia (congenital bilateral absence of testicles), in which surgery is not indicated. In this regard, AMH measurement can be used for the differential diagnosis of cryptorchidism.

AMH concentrations vary significantly throughout life. A boy's AMH level is low at birth, but increases significantly by 6 months. During childhood and adolescence, AMH gradually decreases and reaches its lowest values ​​in adulthood. Unlike newborn boys, the level of AMH in female infants is normally very low (undetectable) and remains so in childhood and adolescence. During puberty in girls, it increases slightly and throughout adult life corresponds to that in adult men. AMH levels are not normally detected after menopause. Thus, AMH concentrations in boys and girls during the neonatal period and early childhood are significantly different, so AMH can be used to diagnose syndromes of impaired sex differentiation. If an infant has external genital structures that have both female and male characteristics, AMH in combination with some other indicators allows not only to determine the true sex, but also to identify the cause of impaired sex differentiation. For example, isolated dysfunction of testosterone-producing Leydig cells is accompanied by underdevelopment of the external male genitalia, while the concentration of AMH synthesized by Sertoli cells remains normal. On the contrary, underdevelopment of the external male genitalia, resulting from underdevelopment of the testes, accompanied by loss of both Sertoli and Leydig cells, is characterized by a low AMH value. In newborn girls, the level of AMH is very low (undetectable). In this regard, an AMH test can be used to diagnose sex differentiation disorders and identify its cause.

Despite the fact that the main function of AMH is realized during the development of the embryo, this hormone carries out a number of tasks after birth. In the body of an adult man, it is involved in the regulation of androgen synthesis. Serum AMH levels in men with non-obstructive azoospermia (lack of sperm in the ejaculate due to impaired sperm formation) are 50% lower than in patients with obstructive azoospermia (lack of sperm in the ejaculate due to an obstruction in the vas deferens). This laboratory indicator is an even more accurate method of differential diagnosis of two types of azoospermia than the traditionally used follicle-stimulating hormone (FSH) test, so AMH can be used to identify the cause of male infertility.

In a woman’s body, AMH is involved in the maturation of follicles, as well as their selection for ovulation. It is synthesized by granule cells of growing follicles, inhibits the growth of neighboring primordial follicles, and also reduces the sensitivity of growing follicles to the action of FSH. All this contributes to the final maturation and ovulation of one follicle every month. Since AMH is synthesized by growing follicles, their quantity is assessed by its concentration. In turn, the number of growing follicles reflects the number of resting primordial follicles, which are called the functional ovarian reserve. This reserve decreases with age, as well as in conditions accompanied by premature menopause (for example, chemotherapy). Assessing functional reserve using AMG allows you to answer many questions. Quite often, a modern woman deliberately postpones having a child. It has been proven that the probability of conceiving a first child within 1 year for a woman over 31 years of age decreases by 6 times compared to younger women. By the age of 41, quantitative and qualitative changes in the follicles in the vast majority of cases lead to so-called natural infertility, and it occurs much earlier than menopause. Therefore, assessing the functional reserve of the ovaries makes it possible to determine the approximate age of menopause and infertility (infertility), which can be taken into account by young women when planning pregnancy. Low AMH levels indicate the onset of menopause within the next 5 years. The advantages of the AMH test are that the concentration of this hormone does not change significantly during the menstrual cycle and also remains constant from one cycle to the next.

Assessment of the functional reserve of the ovaries using AMH is also carried out when selecting and preparing patients for in vitro fertilization programs for the treatment of female infertility. Patients with insufficient functional ovarian reserve and reduced AMH respond worse to ovulation stimulation, and pregnancy occurs less frequently. On the other hand, AMH is used to assess the risk of overstimulation of ovulation. Not only is it accompanied by abdominal discomfort and the production of more defective eggs, but it can also lead to a life-threatening condition - ovarian hyperstimulation syndrome. AMH makes it possible to identify patients with a high risk of excessive stimulation of ovulation, which is necessary for further selection of the optimal infertility treatment regimen.

AMH is a marker for ovarian tumors originating from granular cells (granulosa cell tumors). They account for about 3% of ovarian neoplasms. The so-called adult variant of the tumor is more common, observed in pre- and postmenopausal women (the average age at which the tumor is diagnosed is 51 years). At the same time, along with increased production of AMH, the amount of estrogens significantly increases, which leads to endometrial hyperplasia, which is manifested by menstrual irregularities in the premenopausal period. In postmenopausal women, hyperestrogenism most often manifests itself as uterine bleeding or endometrial adenocarcinoma. In men, excess estrogen is accompanied by gynecomastia. Other rare hormonally active ovarian tumors include Sertoli cell tumors. In both cases, AMH levels will be significantly elevated.

Repeated AMH tests can be used to monitor tumor treatment.

What is the research used for?

• For differential diagnosis of the causes of cryptorchidism: delayed testicular descent or anorchia (as well as persistent Müllerian duct syndrome).
• To diagnose disorders of sex differentiation and identify its causes.
• To diagnose non-obstructive azoospermia as a cause of male infertility.
• To assess the functional reserve of the ovaries for the purpose of planning pregnancy and predicting the onset of menopause.
• To identify groups of patients with insufficient or excessive response to stimulation of ovulation during in vitro fertilization programs and correction of treatment of female infertility.
• For the diagnosis of granulosa cell tumors of the ovaries and testes and monitoring their treatment, as well as for the diagnosis of neoplasms from Sertoli cells.

When is the study scheduled?

• With cryptorchidism - the absence of testicles in the scrotum of a newborn boy.
• If a newborn has external genital structures that have both female and male characteristics.
• In the differential diagnosis of obstructive and non-obstructive azoospermia.
• When is the age at which infertility and menopause are predicted?
• When identifying groups of patients: a) with an insufficient response to ovulation stimulation and an unfavorable prognosis for pregnancy; b) with an excessive response to ovulation stimulation and an unfavorable prognosis for the development of ovarian hyperstimulation syndrome.
• For symptoms of hyperestrogenism in women (uterine bleeding) and men (gynecomastia).

What do the results mean?

Reference values

	Age (years) / Tanner stage	Reference values, ng/ ml

For females: AMH values

Reasons for increased levels of anti-Mullerian hormone:

• polycystic ovary syndrome;
• hormonally active tumors of the testicles and ovaries.

Reasons for decreased levels of anti-Mullerian hormone:

• menopause;
• low functional reserve of the ovaries;
• anorchia and testicular dysgenesis;
• persistent Müllerian duct syndrome.

What can influence the result?