Anti-Mullerian Hormone (AMH) is secreted by immature follicles within the ovaries. With each ovarian cycle, a number of follicles are ‘recruited’ from primordial follicle pool. These then begin to develop in response to Follicle Stimulating Hormone (FSH). It is during this stage of development that the granulosa cells within each follicle secrete AMH. However usually only one dominant follicle will reach full maturation resulting in ovulation as it released from the ovary.
AMH plays an important part in fetal develpment of the reproductive organs – it blocks the development of mullerian ducts evolve into the fallopian tubes, uterus and vagina in males. However the role of AMH in adult females is still not fully understood. Since AMH inhibits development of primordial follicles, it is suggested that it helps moderate the rate at which follicle reserve is used up. As some follicles grow, the AMH they secrete allows the rest of the primordial follicles to wait in the wings until needed. It is this effect that has led some to wonder the use of artificial AMH as a contraceptive and investigate it’s role in Polycystic Ovarian Syndrome (PCOS). AMH levels have also been correlated to estrogen secreted by ovarian follicles – so it is suggested that AMH plays a part in the development or secretion of this estrogen.
The level of AMH circulating in your blood will fluctuate throughout the menstrual cycle but it is not thought to change enough to skew your results – which is why you can be tested at any point. However since research has demonstrated a small drop after ovulation in the individual without looking at a large cohort of women, we at The Norwich Natural Fertility Partnership recommend you get your AMH test done in the first part of your cycle alongside FSH and LH.
Women undergoing fertility tests are routinely offered AMH testing to check ovarian reserve. It is used alongside FSH to give an idea of how many potential follicles a woman has (AMH) combined with how hard the pituitary gland is working to encourage their growth (FSH). Low AMH is associated with lower IVF outcomes. Less follicles can lead to fewer mature follicles in the stimming phase, which leads to less choice in final selection. High AMH levels are linked to Ovarian Hyper Stimulation Syndrome (OHSS). AMH levels provide useful data to the IVF provider in deciding the dose during stims.
However it is still very difficult to measure egg quality! It will decrease with age – but AMH in itself is not a reliable indicator of final egg quality. We have seen women distraught over their low AMH and high FSH levels in our clinic – only to achieve healthy pregnancies within a few months.
A low AMH result certainly doesn’t mean you can put off baby making any longer – but neither should it terrify you into believing the only way forward is through donor eggs. Although your reserves may be low – the conditions in which each follicle develops and matures depends on how you are living your life right now. That’s why at
The Norwich Natural Fertility Partnership we place so much emphasis on eating well, managing stress levels and good pelvic circulation! By being at the peak of health we believe each mature follicle has a better chance to develop to it’s full potential – thereby increasing the odds of a healthy embryo.