Author Name: Dr. Amar Karia || Mentor Name: Dr. Taruna Jhamb on April 27, 2020

Women undergoing fertility treatment are often familiar with the term AMH as it is a routine practice to do this test before starting any treatment. However a lot of people are not really aware as to what is AMH and its significance with respect to fertility. So let’s start with the basic understanding of AMH.

WHAT IS AMH?

AMH or Anti Mullerian Hormone, also known as Mullerian Inhibiting Substance (MIS) is a hormone secreted by reproductive tissues of both males and females. In unborn Males high levels of this hormone help in the development of male reproductive organs whereas in a female foetus low levels of AMH are responsible for the development of female reproductive organs.

At puberty in Females, there is a surge in the level of AMH as it is being secreted by the Antral follicles in the ovary each of which has the potential to produce a mature egg.

SIGNIFICANCE OF AMH TESTING

It is a simple blood test which can be done on any day of the menstrual cycle. It is mostly used to check a female’s ability to produce eggs which have the potential to be fertilized for pregnancy. The levels of AMH in the blood correlate with the number of potential eggs in her body. This is known as ovarian reserve. AMH levels in the blood and a woman’s ovarian reserve have a propensity to decline with advancing age. A woman with high AMH levels is more likely to achieve a successful pregnancy than a woman with low levels.

WHAT DOES HIGH AMH LEVEL IMPLY
The normal blood levels of AMH are between 2.2 -3.9 ng/ml and indicate optimal fertility. Values above 4 constitute a higher range and may be considered as pathological. Higher than normal AMH levels can be seen in two conditions:
1. Polycystic Ovarian Syndrome (PCOS): This is a condition with hormonal imbalance characterised by irregular menstrual cycles, sub fertility, obesity, excessive facial hair growth and varying degrees of insulin resistance.
2. Certain ovarian tumours like granulosa cell tumours: Monitoring of AMH levels in such patients is helpful in identifying the response to treatment.

HIGH AMH LEVELS AND PCOS

Although AMH is not a confirmatory test to diagnose PCOS, it is a very useful tool to support the diagnosis of PCOS along with other criteria like delayed ovulation, ultrasound evidence of polycystic ovaries and clinical features like hirsutism, acne, obesity etc. AMH levels are invariably higher than normal in women with PCOS. Due to high number of antral follicles in PCOS, normal menstrual function is disturbed, which leads to irregular cycles, arrest in the maturation of eggs and resultant sub-fertility. Such women often require the aid of assisted reproductive techniques to attain a successful pregnancy.

IMPORTANCE OF HIGH AMH LEVELS IN IVF

High levels of AMH means more number of antral follicles and a higher yield of oocytes during ovarian stimulation, which can ultimately lead to formation of more number of embryos. An important thing to remember here is that AMH is only a marker of the quantity of eggs, and not their quality which is actually more important in forming good quality embryos and ultimately a successful pregnancy.

Another advantage of having high AMH is that the woman undergoing treatment may also have an option of freezing extra embryos formed during a single IVF cycle for future use.

However, there is also a flip side to ovarian stimulation in women with very high AMH, as there is a risk of a potential complication called ovarian hyperstimulation syndrome (OHSS). The risk can be minimised by choosing the right ovarian stimulation protocol and/or using a milder form of stimulation as and when required.
So, in conclusion, a high AMH level does not necessarily mean that getting pregnant is impossible. With the right form of treatment and some patience, a successful pregnancy can definitely be achieved.

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