Pu­blished: 10. Fe­bruary 2022 | Up­dated: 14. De­cember 2023 Author: Jenia Chor­naya | Re­viewed by Jenia Chor­naya

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.

In ad­di­tion, AMH le­vels can be de­ter­mined from the com­fort of your own home with our self-test.

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.

Ovarian reserve

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:

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.

About Fer­tilly

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.

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