Ovarian reserve and the anti-mullerian hormone: What’s it all about?
The infamous biological clock … How many of us have been put under pressure by it? Even though every organism is different and there can always be exceptions, one thing is certain: as a woman’s age increases, the chance of a natural pregnancy decreases. The AMH value not only provides information about the concentration of a woman’s eggs, but also about possible diseases.
AMH level: your ovarian reserve and the anti-mullerian hormone.
One of the reasons for this is the limited supply of eggs that every woman is born with. In this article, we look at the topic of ovarian reserve and its hormonal parameter — the anti-mullerian hormone.
What is an ovarian reserve?
A quick review of biology lessons: to conceive a child, the male sperm and the female egg are needed. Once these have found each other and joined, pregnancy begins. So far, so good.
The man’s sperm is constantly renewed, whereas the woman only has a certain number of eggs at her disposal: The so-called ovarian reserve. This reserve is reduced by several eggs with each menstrual period. From 40 to 1000 follicles can be used up per cycle. As soon as the ovarian reserve is exhausted, menopause occurs.
How is my ovarian reserve measured?
The egg reserve shows how many viable eggs are currently available in the woman’s ovaries. The combination of two markers provides information about this: the number of follicles in the ultrasound and the AMH level.
1. the number of follicles on ultrasound
To determine this parameter, a sonogram of the ovaries is performed, which is known as the antral follicle count (AFC). This procedure is done at the beginning of the cycle and provides information about the number of follicles in which the eggs can later mature.
During the examination, all the follicles that have a diameter between 2 — 10 mm are added together. A value between 6 and 10 follicles indicates a normal ovarian reserve. On the other hand, a value of less than six follicles indicates a low ovarian reserve.
2. Anti-Müllerian hormone in the blood
Another measured value is the anti-müllerian hormone (AMH), which we will look at below.
The anti-müllerian hormone
AMH has two main functions:
1. sexual differentiation
The hormone plays an important role in the sex formation of the embryo. If it becomes a boy, the hormone is secreted and leads to the regression of the so-called Müller ducts. If it is a girl, the hormone is not produced, allowing the ducts to form a uterus, fallopian tubes and a vagina.
2. parameters for assessing the ovarian reserve
As already mentioned, anti-müllerian hormone is an indicator of the state of oocyte reserve in the ovaries. It is produced in the granulosa cells and surrounds the follicles in which the oocytes mature.
Thus, the AMH concentration corresponds to the number of maturing ovarian follicles and makes it possible to assess the current oocyte reserve. In other words, if the AMH level is high, the ovaries have enough eggs.
How is the anti-mullerian hormone measured?
The AMH level is determined by taking a blood sample. The cost of the test is between 30 and 150 euros and can be covered by health insurance if it is medically necessary. However, it is advisable to make an arrangement with your own health insurance company.
The following standard values apply for the anti-müllerian hormone: A result of more than 1 ng/ml indicates sufficient ovarian supply. Whereas a value of less than 1 ng/ml is a clear indication of a reduced ovarian reserve and the possible early onset of menopause.
The anti-müllerian hormone is also a good indicator of ovarian functional reserve because it can be measured at any time. The values remain stable and are not subject to cycle-related fluctuations.
However, the results should always be considered in context.
For one thing, the age of the patient is crucial. The same value can have different meanings in a 30-year-old and a 36-year-old.
Second, new studies indicate a connection between the AMH level and the use of contraceptives. Hormonal contraceptives cause the level of the anti-müllerian hormone to drop by up to 30%! Thus, a meaningful result can only be determined after discontinuing the birth control pill.
A negative test is by no means a reason for despair! The number of follicles and the anti-müllerian hormone only provide information about the quantity of the patient’s remaining eggs. The result can therefore be used to calculate an approximate time span in which the woman could still become pregnant.
But whether a pregnancy is possible at all, depends very much on the quality of the available eggs, the fertility of the partner and other factors. Therefore, a woman with a low egg reserve may be fertile and more likely to conceive than a patient with many but non-functional eggs.
What is the anti-müllerian hormone measured for?
In addition to determining the egg reserve, the anti-müllerian hormone is also helpful in diagnosing various diseases. In women, these include the following diseases:
- Menopause/menopause: the value is below 0.4 ng/mL.
- Cycle disorders
- Polycystic ovary syndrome (PCOS)
An examination of the anti-müllerian hormone is also useful for women whose hormonal stimulation is planned as part of fertility treatment. Based on the results, the dosage of the necessary medication can be determined so that the risk of hormonal overstimulation can be reduced.
In men, the test can also help to determine infertility or to assess testicular function.
When is the anti-müllerian hormone too high?
A value of over 5.0 ng/ml indicates a high anti-müllerian hormone in the blood. If this is the case, a detailed examination should definitely be carried out. The cause of an excessively high AMH level could be polycystic ovary syndrome, in which the ovaries of the affected person are surrounded by many small cysts (or incompletely matured follicles). Unfortunately, there is still no cure for this disease and it can lead to infertility.
The anti-müllerian hormone is too low: What can be done?
Unfortunately, there are no remedies or medical interventions that can prevent the depletion of the egg reserve in the body. Regardless of the number of pregnancies or contraceptive methods used, the supply decreases as a woman ages.
However, this does not only affect women of advanced age. In a few cases, the egg reserve can also decrease drastically at a young age.
Factors such as lifestyle, diseases or genetic predisposition can have an effect on this. For example, scientists have found that the likelihood of pregnancy in a female smoker decreases by 4% each year. The amount of nicotine does not play a role, rather each individual cigarette contributes to the problem. With this in mind, anyone who is striving to fulfil their own child wish should give up smoking completely.
Another piece of advice for couples who wish to have children is to pay attention to a healthy lifestyle. Scientific studies show that being overweight reduces the probability of a natural pregnancy at least as much as smoking. Although these measures will not increase the egg reserve, the patient’s lifestyle can only influence how quickly it is exhausted.
If pregnancy is not desired or possible at the current time, doctors advise so-called cryopreservation — freezing the eggs.
There are also a number of potential therapies, such as taking DHEA (dehydroepiandrosterone), but their effect has not yet been sufficiently tested and proven.
In order not to harm your own body or to give up hope prematurely, we recommend that you seek advice from your doctor. This will help you find the best approach for your specific case.
Social freezing: success rates
What is the ideal age to freeze my eggs? This is an often asked question in the context of social freezing. A simplified answer would be that it is generally better to freeze at a younger age than at a later age. However, it is not quite that simple.
At Fertilly, we have made it our mission to accompany couples (homosexual and heterosexual) and singles on the way to fulfilling their child wish. In doing so, it is important to us to create transparency in the area of fertility services, to provide information and knowledge on the topics of pregnancy and fertility and to help you to find the most suitable Fertility Center. Through cooperation with first-class Fertility Centres and clinics in Europe, enquiries about Fertilly are given preferential treatment. This means that our patients avoid the usually long waiting times and get appointments more quickly.
If you would like more information about Fertility Centers, success rates and prices, please contact us using this questionnaire. We will advise you free of charge and without any obligation.
Answer the first questions in the online form in order to book an appointment. This way we can better address your needs during the conversation.
We will find the best contact person for your individual needs. Schedule 20 minutes for the consultation.
We will introduce you to the right fertility clinic from our network, make an appointment and accompany you until your wish for a child is fulfilled.