Anti-Müllerian Hormone (AMH) is a glycoprotein produced in the gonads of both men and women. It is he who primarily determines the gender. In addition, the determination of the concentration of the anti-mullerian hormone (AMH test) is the best parameter for assessing the chances of infertile patients to give birth to a child by determining the so-called ovarian reserve. What are the AMH standards and their interpretation?

Anti-Müllerian HormoneAMHis a glycoprotein produced in the gonads of both women and men, more precisely by follicular granulosa cells in the ovaries and testicular Sertoli cells.

It plays a significant role in human fetal life as it is one of the key factors responsible for sex determination, as well as during human adult life.

It enables the assessment of a woman's fertility and her ability to have children by determining the so-called ovarian reserve.

It has been proven that the determination of the concentration of the anti-Mullerian hormone is the best parameter for assessing the chances of infertile patients to give birth to a child.

Role of AMH in fetal life

The anti-Mullerian hormone plays a key role in the proper development of external and internal sexual organs during human fetal life. In the initial stage of embryo development, its reproductive system is not differentiated, and the gonad buds may develop towards both the ovaries in girls and the testicles in boys. Only certain signals cause the development in one specific direction, female or male.

AMH and male gender

At the time of gonadal differentiation towards the nucleus, anti-Mullerian hormone is produced by Sertoli cells and testosterone by Leydig interstitial cells.

The main role of AMH is to block the development of Müllerian ducts and, consequently, their disappearance. In the absence of the anti-Mullerian hormone, the Müllerian ducts would develop into female sexual organs such as the vagina, uterus, and fallopian tubes during further embryonic development.

Testosterone is responsible for the development of the male characteristics of the fetus, it induces the differentiation of the Wolff ducts into male accessory glands, epididymis and exiting pathways.

If the male fetus has a low or no AMH concentration, it causes thissimultaneous development of male and female genitalia.

It follows that the time and size of the increase in AMH and testosterone levels during human fetal life are extremely important for proper sexual differentiation in male fetuses. Disruptions at various stages of the biosynthesis of these hormones may lead to insufficient masculinization of male fetuses.

AMH and female gender

This does not mean, however, that the anti-Mullerian hormone is not produced by the female sex at all. During utero, female fetuses do not develop the testicles, but the ovaries, so the anti-Mullerian hormone is not produced at this stage of life, but its concentration in women increases significantly during puberty, when it begins to be produced by the maturing ovaries.

In males, AMH levels are high in utero and in the neonatal period, then decline after puberty.

In females, in contrast, AMH levels increase during puberty and then gradually decline to very low levels in postmenopausal mature women.

The role of AMH in a woman of childbearing age

Antimullerian hormone plays a significant role in women in the reproductive period, it enables the assessment of the follicular maturation process (folliculogenesis), it is a predictive factor predicting the possibility of getting pregnant, assesses the fertility of a woman, allows to predict the success of in vitro fertilization, and even to determine the effectiveness of treatment of certain types of cancer.

Using the AMH concentration, the gynecologist can predict a woman's chance of having a baby and, if necessary, propose appropriate diagnostic and therapeutic procedures tailored individually to each patient.

AMH test - indications

The main indication for determining the concentration of AMH in the blood serum of a woman is the so-called ovarian reserve, i.e. the number of growing ovarian follicles.

At birth, a woman has a certain pool of ovarian cells in her ovaries, which decreases with time and with each menstruation. After birth, a girl's ovaries contain 1-2 million ovarian cells, only 300-500 thousand remain in adolescence, and only 400-500 oocytes mature and ovulate.

AMH concentration allows you to determine whether a woman has enough normal ovarian cells to become pregnant, or whether her fertility has significantly decreased and is approaching the perimenopause period. In the menopausal stage, AMH levels are very low, often undetectable.

Testing the concentration of the anti-Mullerian hormonehas been used to predict premature ovarian failure (POF). The fewer growing follicles there are in the ovaries, the lower the serum AMH level is.

AMH concentration is also used by gynecologists as an indicator of a woman's fertility assessment. This information is especially important for specialists in the field of medically assisted reproductive methods, incl. in vitro fertilization in fertility clinics.

It has been shown that the level of the hormone has an impact on the success of the fertilization procedure as it is a prognostic factor for the ovarian response to the process of ovulation stimulation. The more he althy, fertile ovarian cells there are in the ovaries, the higher the concentration of AMH in a woman's blood serum.

It is worth knowing that the concentration of AMH is not only used to determine the reproductive potential of a woman, but also to determine the effectiveness of the treatment of ovarian cancer (or testes in men) and the presence of a possible recurrence.

In boys, AMH levels are measured before puberty to assess nuclear tissue function. A particular indication for this examination are congenital defects of the male reproductive system, such as gonadal dysgenesis, testicular atrophy or cryptorchidism.

Preparation for the AMH test

The blood serum concentration of anti-Mullerian hormone can be tested during any day of the woman's monthly cycle, and she does not need to fasting to obtain a reliable result.

It should be remembered, however, that this test is not performed routinely and often popular laboratories do not offer it.

AMH concentration tests are most often performed in women receiving fertility treatment clinics, so this is where you should go to have the test done.

The course of the AMH study

The concentration of the anti-Mullerian hormone is determined in the venous blood serum. After disinfecting the skin in the area of ​​the elbow, venous blood is collected from the ulnar vein using a sterile, disposable needle.

After removing the needle, press the injection site with a sterile gauze for at least 10 minutes and do not lift the upper limb upwards, it will prevent an unsightly bruise.

The full cost of the test is borne by the patient and, depending on the laboratory, the prices oscillate around PLN 150. You should patiently wait about 2 weeks for the results and be sure to consult them with a gynecologist.

AMH test - standards and interpretation

Hormone levels above 3.0 ng / ml indicate high AMH levels. Maybe heevidence of an endocrine disorder such as polycystic ovary syndrome (PCOS) or the presence of a granulosa cell ovarian tumor.

The result should be consulted with a gynecologist, but on its basis it is impossible to diagnose any disease entity, it is necessary to extend the diagnosis with imaging tests and other, more detailed laboratory tests.

A hormone concentration between 3.0 and 1.0 ng / ml indicates normal AMH levels for women of childbearing age.

Hormone levels below 1.0 ng / ml indicate low AMH levels. Physiologically, it occurs in postmenopausal women, but it may also be a sign of premature ovarian decline. If the result concerns a woman at a younger age, a gynecological consultation and further diagnostics are necessary.

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