Female Fertility: Understanding The Role Of Low And High Anti-Mullerian Hormone (AMH) Levels

AMH or Anti-Mullerian Hormone, is a hormone produced by the ovaries' small follicles and serves as a crucial indicator of ovarian reserve that provides accurate information of a woman's remaining egg quantity which further helps in planning conception. When evaluating a woman's capacity for conception, particularly as she matures, this measurement is essential. As women age the ovarian reserve naturally depletes and AMH testing becomes a handy tool for a woman to get a sense on her reproductive health and enables her to plan accordingly. AMH testing is a simple blood test that can be done at any given time as suggested by a fertility expert.

High and low AMH

Both high and low AMH levels can affect fertility; excessive levels may be linked to diseases like polycystic ovary syndrome (PCOS), while low levels frequently indicate a decreased ovarian reserve. A healthcare professional or fertility expert should evaluate the correct AMH value within a broader therapeutic context, as it varies depending on individual circumstances, including age. AMH is a lab test that fertility experts and OBGYNs use to assess a woman's egg count or ovarian reserve, giving them essential information about her reproductive health.

Impact of low and high AMH

Impact of low and high AMH levels on a woman's reproductive health and fertility varies. Let's look at the impact caused by both the conditions below:

Low AMH:

•    Reduced Ovarian Reserve: Decreased ovarian reserve, or fewer eggs in the ovaries than usual for a woman's age, is usually indicated by low AMH values.
•    Impact on Fertility: As a woman ages, having a reduced ovarian reserve may make conception more difficult. It could be a precursor to decreased fertility.
•    Response to Ovarian Stimulation: Women with low AMH may need greater doses of medicine to promote egg production and may respond less well to reproductive therapies like in vitro fertilization (IVF).

High AMH:

•    Polycystic Ovary Syndrome (PCOS):  Conditions such as PCOS, in which the ovaries have an abnormal number of tiny, immature follicles, can be linked to high levels of AMH.
•    Impact on Menstrual Cycles: An irregular menstrual cycle and difficulties ovulating are common side effects of PCOS that can impair fertility.
•    Response to Ovarian Stimulation: During reproductive therapies such as IVF, women with PCOS and elevated AMH levels may be susceptible to overstimulation.

Emphasize on the normal levels of AMH

For fertility and pregnancy, an AMH level of 1.5-4.0 ng/ml is usually considered normal; values below 1.5 ng/ml may suggest a declining ovarian reserve with a reduced egg count. The chance of getting a decent number of embryos for transfer can be influenced by the number of eggs generated during in vitro fertilization. The likelihood of creating viable embryos increases with the number of eggs recovered. Fewer eggs may result in fewer embryos and perhaps poorer IVF success rates as women age because an increased percentage of defective eggs contribute to faulty embryos. Because women in their late 30s and beyond often generate fewer eggs than those in their 20s and early 30s, these age-related variables are significant for them.

(Dr. Pallavi Prasad, Fertility Consultant, Nova IVF Fertility, Basaveshwar Nagar, Bangalore)

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