Anti-Müllerian hormone

Nicole Wendler holds a PhD in biology in the field of oncology and immunology. As a medical editor, author and proofreader, she works for various publishers, for whom she presents complex and extensive medical issues in a simple, concise and logical manner.

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The anti-Müllerian hormone (AMH) provides information about how many egg cells a sexually mature woman produces. The AMH value is therefore primarily important in reproductive medicine. It is particularly relevant for family planning, the unfulfilled desire to have children and sterility therapy. Read here how the anti-Müllerian hormone is determined and what significance it has.

What is the anti-Müllerian hormone?

The anti-Müller hormone (named after the German anatomist Johannes Peter Müller) plays an important role in embryonic development: it regulates the differentiation of the genital organs between the eighth and eleventh week of pregnancy. When it becomes a boy, the so-called Sertoli cells of the embryonic testicle produce the anti-Müllerian hormone (AMH). As a result, the paired Müller corridors recede. In a female embryo there is no anti-Müllerian hormone - the two Müllerian ducts remain and develop into the uterus, fallopian tubes and vagina.

The hormone only plays a role in women during puberty. Then the ovaries - to be precise, the granulosa cells located there - produce the anti-Müllerian hormone. These cells surround the growing, stimulable follicles, which after maturation can release an egg cell that is capable of fertilization (ovulation). AMD regulates follicle growth.

How much anti-Müllerian hormone is present in the body can be determined using a blood analysis.

Anti-Muller Hormone: Clinical Significance

women

In women, the AMH concentration correlates with the number of mature follicles in the ovary. Reproductive medicine can therefore use the hormone to draw conclusions about the so-called ovarian functional reserve: If there is little anti-Müllerian hormone in the blood, the number of growing follicles that can be stimulated is reduced. This knowledge is important when clarifying sterility and when planning in vitro fertilization (IVF).

In addition to the ovarian reserve, the determination of the anti-Müllerian hormone is also relevant for other clinical questions. In summary, AMD is determined in women in the following cases:

Assessment of the ovarian functional reserve and fertility potential (e.g. in the case of menstrual disorders and the unfulfilled desire to have children)
Prognosis for artificial insemination using in vitro fertilization (IVF)
Assessment of the hormonal stimulability of the ovaries for artificial insemination
Predicting menopause (menopause)
Follow-up control for granulosa cell tumor
Assessment of damage to the ovaries by chemotherapy or radiation therapy (the AMH value decreases in a dose-dependent manner, since the cytotoxic therapy destroys the active egg cell follicles)
Multiple ovarian cysts in the context of polycystic ovarian syndrome (anti-Müllerian hormone too high)

men

The anti-Müllerian hormone is measured in men in connection with the following questions:

Infertility with existing or previous disorder of testicular descent (through the inguinal canal into the scrotum)
Lack of sperm in the ejaculate (azoospermia)

Children / adolescents

The measurement of the AMD value can be indicated in the context of the following questions:

premature puberty (precocious puberty: AMD decreased) or delayed puberty (tarda puberty: AMD increased)
intersex malformations / diseases
Undescended testicles (cryptorchidism or testicular dystrophy)
Absence or complete inability of both testicles to function (anorchia)

Anti-Müllerian hormone: normal values

Adult fertile women between the ages of 18 and 30 contain between one and 5 nanograms of anti-Müllerian hormone in one milliliter of blood, and sometimes a little more. From the age of 30, the AMH concentrations decrease. If the value is below one nanogram per milliliter, there are few egg cells that can be stimulated and the ovarian function is considered to be limited.

The anti-Müllerian hormone table gives an overview of the reference ranges:

women	Anti-Müllerian hormone
Normal fertility	1 to 5 ng / ml
Residual ovarian function	0.8 to 1.0 ng / ml
menopause	<0.1 ng / ml
Polycystic Ovarian Syndrome	5.0 to 15.0 ng / ml
men
Standard value	3.0 to 5.4 ng / ml

Anti-Müller hormone when trying to have children

The ovarian functional reserve is particularly interesting for women over 30 who want to have children. If you have difficulties conceiving naturally, there may not be enough mature follicles in the ovary. In this case, the determination of the anti-Müllerian hormone will help.

Experts recommend that you also count the follicles on ultrasound and determine the follicle-stimulating hormone (FSH) and estradiol. The AMH can also be used to assess the success of in-vitro fertilization (IVF) and to dose hormonal stimulation therapy more individually.

If the anti-Müllerian hormone is too low (<1.0 ng / ml), higher hormone doses (FSH, gonadotropin) are necessary for IVF in order to obtain sufficient egg cells. A possible ovarian overreaction after stimulation can also be avoided with the help of the AMH value. A uniform AMH threshold value for expected overstimulation does not yet exist due to different definitions, stimulation and detection methods.

The anti-Müllerian hormone and the biological clock

The biological clock is ticking - but not at the same speed for every woman. Although the serum concentration of the anti-Müllerian hormone decreases with age, there is no direct correlation with biological age. Rather, the anti-Müllerian hormone can be used to estimate the ovarian age. The number of germ cells is determined at birth and then decreases continuously - albeit at different speeds for each individual. A low AMH level can indicate that the egg reserve is running out. But the value alone is not enough to predict the chances of conceiving. Other factors, such as the quality of the fallopian tubes or the partner's sperm, also determine the success.

Menopause: anti-Müllerian hormone in decline

The function of the ovaries deteriorates with age until the menstrual period stops and menopause begins. In which phase of life this happens, however, varies greatly from woman to woman. Most have symptoms around the age of 50. In some women, however, the ovarian reserve is already exhausted before the age of 40 (premature ovarian insufficiency), in others only in their early 60s.

About three to five years before the onset of menopause, the anti-Müllerian hormone drops below the detection limit. In the age range between 45 and 50, the hormone is often hardly measurable. Nonetheless, neither questions about pregnancy chances nor about the exact start of menopause or about the continued need for contraception can be clearly answered using ANH values.

Increase anti-Müllerian hormone

In most cases, less anti-Müllerian hormone is detectable in smokers than in non-smokers. The amount of nicotine consumed does not seem to play a role here. Women with poor AMH levels and wanting to have children should better avoid cigarettes.

Potentially, taking DHEA (dehydroepiandrosterone), a steroid hormone, may improve the birth rate in women with poor AMH levels. So far, however, there is little data on this. DHEA requires a prescription in Germany.

How meaningful is the AMH value?

The AMH concentration is independent of the method of contraception and remains constant over the course of the cycle, so that the anti-Müllerian hormone can be determined at any point in time - according to the widespread opinion. At first glance, the test seems simple and safe, but the data is contradictory: more recent and more extensive studies have shown that the value fluctuates depending on the cycle, especially in young women, and falls before ovulation. Also, the longer hormonal contraception is used, the value apparently drops significantly (by up to 30 percent). There is also disagreement about the AMH levels during pregnancy.

It is also important that the AMH value does not say anything about the quality of the egg cells. Although there may be sufficient ovarian reserve, the egg cells are of such poor quality that pregnancy is difficult. Or the egg reserve and quality are satisfactory, but the fallopian tubes are not completely accessible to the egg or sperm due to adhesions. Nonetheless, the anti-Müllerian hormone is currently considered by reproductive medicine specialists to be the best parameter for assessing ovarian reserve and fertility.

And what if the anti-Müllerian hormone is too low or cannot be measured at all? Affected women shouldn't despair immediately. Even if the chances of getting pregnant as part of reproductive medicine measures decrease significantly with a bad AMD score, pregnancy cannot necessarily be ruled out.As long as there are regular menstrual bleeding, it can be assumed that egg cells are still available, even if the anti-Müllerian hormone is low or not measurable.

Tags: unfulfilled wish to have children elderly care interview