Understanding AMH and Female Fertility

What is Anti-Müllerian Hormone (AMH)?

Anti-Müllerian Hormone (AMH) is a hormone secreted by granulosa cells in ovarian follicles (these cells produce oestrogen, progesterone and other hormones. These hormones play a large part in the female reproductive system, from menstruation to ovulation to egg implantation). In females, it serves as a marker of ovarian reserve, which is indicative of a woman’s remaining egg supply and her potential fertility.

Role of AMH in Female Reproductive Health Ovarian Reserve:

AMH is produced by small antral and pre-antral follicles, which are in the early stages of development. The level of AMH in a woman’s blood correlates with the number of these follicles, providing an estimate of her ovarian reserve. Unlike other reproductive hormones, AMH levels remain relatively stable throughout the menstrual cycle, making it a reliable marker.

1. Folliculogenesis Regulation: AMH helps regulate the growth and development of ovarian follicles by inhibiting the initial recruitment of primordial follicles (the starting point of follicular development) and the sensitivity of growing follicles to Follicle-Stimulating Hormone (FSH). This regulation ensures that not all follicles are recruited at once, preserving the ovarian reserve over a woman’s reproductive lifespan.
2. AMH and Fertility Predicting Ovarian Response: In assisted reproductive technologies (ART) like In Vitro Fertilisation (IVF), AMH levels are used to predict how well a woman will respond to ovarian stimulation. Higher AMH levels generally indicate a better response to stimulation, meaning more eggs can be retrieved during IVF cycles.
3. Assessing Fertility Potential: AMH levels provide an estimate of a woman’s fertility potential. Women with higher AMH levels are likely to have a greater number of available eggs, whereas those with lower AMH levels may face challenges in conceiving due to a diminished ovarian reserve.
4. Diagnosing and Managing PCOS: Women with Polycystic Ovary Syndrome (PCOS) often have elevated AMH levels due to an increased number of small antral follicles. Measuring AMH can aid in diagnosing PCOS and monitoring the effectiveness of treatments aimed at normalising ovarian function. Predicting Menopause: AMH levels decline with age and become undetectable at menopause. Measuring AMH can help predict the onset of menopause, providing valuable information for women planning their reproductive futures.
5. Clinical Applications of AMH Fertility Preservation: AMH testing is useful for women considering fertility preservation options, such as egg freezing, by providing an estimate of the remaining fertile years and the optimal timing for such procedures.
6. Oncofertility: For cancer patients undergoing treatments that may affect ovarian function, AMH levels can help assess the risk of infertility and guide decisions about fertility preservation before treatment.
7. Personalised Fertility Treatments: Understanding an individual’s AMH levels can lead to personalised fertility treatment plans, optimising the chances of successful conception by tailoring the approach to the patient’s specific ovarian reserve.

Factors Influencing AMH Levels Age:

AMH levels peak in a woman’s 20s and early 30s, then gradually decline, becoming very low or undetectable around menopause.

1. Medical Conditions: Conditions like PCOS can elevate AMH levels, while factors such as ovarian surgery, chemotherapy, or radiation therapy can significantly reduce AMH levels.
2. Diet & Lifestyle: Factors such as smoking can negatively impact AMH levels and overall ovarian reserve. Maintaining a healthy lifestyle with a balanced diet, regular exercise, and avoiding smoking can support better reproductive health.

Conclusion

Anti-Müllerian Hormone (AMH) is a vital biomarker for assessing female fertility. Its role in estimating ovarian reserve, predicting ovarian response to stimulation, diagnosing conditions like PCOS, and aiding in the management of fertility preservation strategies makes it indispensable in reproductive medicine. Understanding AMH levels empowers women with crucial information about their reproductive health, enabling informed decisions about family planning and fertility treatments.