Blood test for AMH anti-Mullerian hormone - what is it in women, norms and causes of deviation. What to do if anti-Mullerian hormone is low

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Impossibility on your own naturally Conceiving a baby is often associated with hormonal imbalances in a woman. Among the great variety of endocrine disorders, AMH deficiency stands out. The level of this hormone is extremely important for reproductive function both men and women, but it “works” differently for representatives of different sexes.

Before IVF, an AMH test is mandatory. What should the Mullerian inhibitor standards be, is it possible to get pregnant in an IVF protocol with a low level of this substance, and how to increase the concentration of AMH, we will tell you in this article.

What it is?

AMH (anti-Mullerian hormone) was discovered back in the 19th century, when protein molecules affecting growth processes in organs reproductive system, was discovered by the German naturalist and biologist Johann Muller. He found that embryos, regardless of gender, have common feature- a tube-canal from which the epididymis are formed in male embryos at approximately 9 weeks of pregnancy under the influence of AMH. This is how sexual differentiation occurs.

In female embryos, AMH is not produced and, by default, the channel-tube begins to form in the fallopian tubes, ovaries. In girls, AMH begins to be produced only after birth.

The functions of the Mullerian inhibitor are to ensure human sexual function throughout life. In women, the AMH level indicates the functioning of the ovaries and the maturation of the egg. Mullerian inhibitor regulates follicular growth and its concentration decreases with age. The amount of AMH in a woman’s blood plasma is a fairly accurate indicator of the ovarian reserve; it can indicate the approximate number of eggs that remain “in reserve”.

Before puberty in girls, AMH is detected in extremely low concentrations. With the onset of puberty, the level of Müller inhibitor begins to increase, and then gradually decreases throughout life. During menopause, AMH is not detected in blood plasma.

AMG norms for IVF

As already mentioned, the concentration of Müller inhibitor in the blood plasma is directly proportional to age. Therefore, the norms depend on how old the patient is at the time of planning the in vitro fertilization protocol. The norm for women under 35 years of age is 4.0-6.5 ng/ml. The level of AMH is considered slightly disturbed at levels of 2.5-4.0 ng/ml. An indicator of 0.3-2.2 ng/mg is considered reduced. Concentrations less than 0.3 ng/ml are considered low levels.

For women over 35 years of age, the norms are different. Normal level considered 1.5-4.0 ng/ml. An indicator of 1.0-1.3 ng/ml can be considered conditionally normal. A low level is 0.5-1.0 ng/ml, and a critical decrease is considered to be less than 0.5 ng/ml.

These normative values ​​are typical for women whose infertility is not caused by hormonal disorders, and, for example, in obstruction of the fallopian tubes or thinning of the endometrium. But in most cases, women with endocrine disorders or concomitant endocrine problems, and therefore the minimum standard AMH value for IVF is 0.6-0.8 ng/ml.

On average, for in vitro fertilization, the AMH concentration is required to be from 0.6 ng/ml to 2.4 ng/ml.

Women who are planning a pregnancy for a long time took oral contraceptives, most often suffer from low levels of anti-Mullerian hormone, since such drugs suppress the production of AMH and lead to premature menopause.

Deviations from norms and pregnancy prognosis

A high AMH level before the IVF procedure should alert the attending physician. Patients whose Müller inhibitor concentrations are elevated to 6.5-7 ng/ml are more likely to develop ovarian hyperstimulation syndrome - dangerous complication the first stage of in vitro fertilization. High levels of the hormone slow down or completely block the growth of follicles, therefore, obtaining the required number of eggs for in vitro fertilization will not be easy.

When anti-Mullerian hormone levels are low, the chance of pregnancy decreases because few follicles are formed. If laboratory values ​​are below normal at the protocol planning stage, the doctor may assume that the ovarian response to hormonal stimulation of superovulation will be weak.

Low AMH levels reduce the likelihood of pregnancy even during IVF with ICSI, when the sperm is injected under the oocyte membrane using a thin hollow needle. A reduced level of a hormonal substance indicates poor quality of eggs, and therefore, even if pregnancy occurs as a result of an IVF protocol, the likelihood of a miscarriage or frozen pregnancy is still early stages will be high.

Hormone concentration indicators must be taken into account when choosing the nature of the protocol. If the AMH level in the woman’s blood plasma is below 0.71 ng/ml, stimulation is carried out high doses antagonists in combination with FSH. If the hormone concentration in a woman’s blood is above 0.71 ng/ml, but does not exceed 2.1 ng/ml, then a long protocol is usually prescribed, in which hormones that suppress ovulation and causing the condition artificial menopause, and then - follicle-stimulating hormones.

The probability of conception with successful IVF and elevated level AMH is higher than at reduced concentrations. The lower the values, the more difficult it is for a woman to become pregnant, even after embryo transfer. In general, the success rate of an IVF protocol in Russian clinics is estimated at 35-45%. With a significant decrease in AMH, the predicted probability of successful pregnancy does not exceed 25-30%. There is a chance of pregnancy if a woman has no other accompanying pathologies uterus, cervix, endometrium.

Low AMH levels in natural cycle does not exclude the possibility of getting pregnant, but makes it even less likely. Without appropriate preliminary therapy, IVF in a natural cycle with such indicators is avoided.

It is always important to install the real reason reducing the Muller inhibitor so that before any IVF protocol the woman can undergo targeted treatment of the pathology.

How to get tested correctly?

A sample is used for research venous blood women. Based on a referral from a gynecologist, reproductive specialist or endocrinologist, a woman should contact the laboratory within 3-5 days menstrual cycle. It is during this period of time that the AMH indicator is most adequate.

The AMH level is extremely unstable, and therefore you need to prepare for the blood test in advance - reduce physical exercise a week before visiting the clinic, get a good night's sleep and prevent your health from deteriorating. Any illnesses you have had in the last 2-3 weeks, as well as taking antibiotics or anticonvulsants may lead to distorted test results.

The stress and emotional turmoil that a woman experiences leads to fluctuations in the level of anti-Mullerian hormone. 10-12 hours before you should avoid eating, 3 hours before you should not drink water. A few hours before donating blood, it is advisable not to smoke or drink strong tea or coffee.

On average, the test result becomes known after 48 hours. In some laboratories, the test takes about a day.

Is it possible to increase AMH?

Since the concentration of Müllerian inhibitor is unstable, it can vary - rise and fall depending on many factors. For example, in summer and spring, the level of the hormone in a woman’s body increases by about 15-18%. Therefore, it is often associated with vitamin D, which is produced when human skin comes into contact with sunlight.

DHEA (dehydroepiandrosterone) therapy is considered effective. This hormonal treatment prescribed for very low AMH levels 3-4 months before IVF. In most cases, combined with vitamin D, hormonal treatment provides positive result, and AMH tests before the IVF protocol show more high level anti-Mullerian hormone.

Sometimes doctors recommend that women take the anti-menopausal drug Melsmon. It is produced in Japan based on placental cells. Like any other product in the placentotherapy line, the drug has its advantages and disadvantages, but often the effect of taking it is significantly exaggerated by the manufacturers.

A woman with a reduced level of Müller inhibitor is recommended to be treated exclusively healthy image life. A noticeable increase in the hormone is observed if sugar and baked goods are completely eliminated from the diet. AMH increases and as a result of a decrease excess weight.

If a woman has problems with fat metabolism, then she first needs to consult an endocrinologist - he will help create a diet therapeutic nutrition to improve lipid metabolism. Losing weight by 5 kilograms increases the likelihood of pregnancy by about 4%, and if a woman brings her weight into line with a normal body mass index for her age, then AMH levels will rise to a level sufficient to make IVF more likely to succeed. Losing excess weight increases your chances of pregnancy by about 10%.

Coffee, strong tea and other foods and drinks that help increase blood pressure, are detrimental to follicles and significantly reduce AMH. Therefore, in the fight for the right to become a mother, it is important to give up such drinks.

One of the indicators possible infertility- level of anti-Mullerian hormone in a woman’s body. Based on this indicator, reproductive specialists decide whether to resort to IVF and whether to use a donor egg. What kind of hormone is this, is it possible to increase its level, and in general, why is it “anti-Mullerian”?

• Why is the hormone “anti-Mullerian”?
• Function of anti-Mullerian hormone in a woman’s body
• Why do reproductive specialists pay so much attention to anti-Mullerian hormone?
• AMH: normal, decreased and increased values
• How to prepare for testing on AMG

Who was “against Mueller”?

Anti-Mullerian hormone received its unusual name in honor of the German naturalist Johann Muller, who lived in the 19th century. It was this scientist who discovered that human embryos up to the 6th week have the same development of the genital organs - this is the so-called “Müllerian duct”, from which the vagina, uterus and fallopian tubes in women are then formed. In future men, at the 9th week of embryonic development, a special hormone begins to be released, which “triggers” the development of the Müllerian duct along a different path - converting it into the epididymis. Because its action is directed “against” women's path development of the Müllerian duct, the hormone was called anti-Müllerian hormone (AMH - anti-Müllerian hormone).

Function of anti-Mullerian hormone in a woman’s body

Normally, AMH begins to be produced before birth, during 32-36 weeks of pregnancy. However, up to puberty, its amount is insignificant. The concentration of AMH increases sharply during puberty, and reaches a maximum between 20 and 30 years of age in women. Further, the secretion of the hormone decreases, but remains stable until the onset of menopause. Why does its content change so much?

” Anti-Mullerian hormone in women is produced directly in the follicles - by granulosa cells, one of the layers surrounding the egg. However, not all follicles produce AMH, but only those that are ready for immediate growth and, subsequently, ovulation.

In general, the number of eggs in a woman’s body is determined at the time of their laying, at 11-12 weeks of intrauterine development. However, it immediately begins reverse process death of primary follicles, which is called atresia. So by the time of birth, the number of eggs in the body of a newborn girl decreases several times, to 1.5 million, and at the time of the first menstruation there are no more than 300 thousand left.

All this huge number of follicles are in a “dormant” state and will never be used - these are the so-called primordial follicles, about 50 microns in size (they can only be detected during microscopic examination fabrics). During a woman's lifetime, no more than 500 of them can mature.

This process is “triggered” by the action of follicle-stimulating hormone (FLH), which begins to be produced in the brain (pituitary gland) during puberty. Of course, not all follicles mature at once - about 25 follicles are simultaneously in the preantral and antral phases of development. Their size is already from 150 to 500 microns, and they can be easily detected (and counted) during ultrasound examination.

” One (sometimes two or three) follicles reach the ovulation stage at a time, and it is the anti-Mullerian hormone that “slows” them down on their way. On the one hand, it promotes the growth and development of the preantral follicle, on the other hand, it partially inhibits the action of FSH, preventing all 25 follicles from “starting” at the same time.

When the follicle size reaches approximately 8 mm (large antral follicle stage), another anti-Mullerian hormone begins to be produced instead, called inhibin B. It gives the pituitary gland feedback- “that’s it, no more FSH to be produced, the required number of follicles ready for ovulation has already been achieved.”

Why do reproductive specialists pay so much attention to anti-Mullerian hormone?

As you probably understand, anti-Mullerian hormone is produced directly by maturing follicles. Its amount does not depend on the phase of the menstrual cycle. Its concentration does not directly affect the processes of conception and pregnancy (since it ceases to be produced in a mature egg).

” Since anti-Mullerian hormone is produced in follicles that are ready for growth and development, its quantity allows one to quite accurately determine the so-called “ovarian reserve” - how many potential follicles are ready for ovulation, and therefore how high the probability of conception is.

Of course, the number of antral follicles can be assessed using ultrasound, but such a study is subjective, and its results inevitably depend on both the quality of the equipment used and the skill of the specialist. AMH analysis is impartial and completely accurate, which is why it is used in preparation for the IVF procedure.

AMH: normal, decreased and increased values

As you will notice, the concentration of AMH in a woman's body increases at the time of puberty, reaches a maximum at the peak of fertility from 20 to 30 years, and gradually decreases to zero at menopause.

Average normal levels of anti-Mullerian hormone at different ages

However, average figures are typical for women who do not experience problems conceiving. Therefore, reproductologists have their own scale, focused on the lower limits of hormone concentration.

An AMH reading above 1.0 ng/ml indicates sufficient high probability pregnancy occurs naturally.

AMH level above 0.2 ng/ml - pregnancy can occur as a result of IVF.

The reasons that cause a decrease in AMH levels do not necessarily indicate potential infertility. For example, if a woman has one ovary or part thereof surgically removed, then the AMH level may be reduced, but this does not prevent natural attack pregnancy.

” The question naturally arises - is it possible to somehow increase the level of AMH to increase the chances of conception? No, you can’t: anti-Mullerian hormone is produced by the active follicle (and not vice versa: AMH does not stimulate the primordial follicle). So a reduced AMH level is simply an indicator indicating reproductive problems.

In general, we can say with regret that the reasons causing a decrease The production of anti-Mullerian hormone is not completely clear. In addition to the obvious (menopause, surgery on the ovaries, use hormonal medications) there are also non-obvious cases of decreased AMH. One of the reasons may be obesity.

The AMH level may be higher than normal, and this also does not indicate reproductive health and high fertility. Thus, the concentration of anti-Mullerian hormone is often higher in women with polycystic ovary syndrome, and an ultra-high level indicates the presence of granulosa cell tumors of the ovaries.

How to prepare for testing for AMH

Although AMH levels generally do not depend on the phase of the menstrual cycle, for convenience it is usually taken along with other hormonal tests, on days 3-5 of the cycle. Before analysis it is not recommended:

eat food within 2-3 hours (drink clean water possible without restrictions);

stop taking hormonal drugs two days before the test (only by agreement with the attending physician!);

exclude physical and emotional stress for at least a day before taking the test;

do not smoke for 3 hours before the test.

Although the concentration of AMH is almost independent of the phase of the menstrual cycle, its fluctuations are possible over a short period of time (the reasons for this have not been fully investigated).

So if the test results are unsatisfactory, don’t panic, the doctor will definitely advise you to retake it and, perhaps, next time the results will be more optimistic.

Prepared by Anna Pervushina

Normal levels of anti-Mullerian hormone in women responsible for the moment of growth and formation of tissue cells. In the fair sex, the hormone is produced by the ovaries, using special cells from birth, and they continue to be produced until the onset of menopause.

Anti-Muller hormone must have a certain level. This makes it possible to find out the probability of conception using natural way at the certain time.

Features of anti-Mullerian hormone

What is it? Anti-Mullerian hormone in women has a basic purpose; it is a protein molecule that has a great effect on sexual development and maturation. It is of greatest importance because it serves as a determinant of female conception.

His main task – trigger follicular growth, create an environment in the ovaries that is conducive to the functioning of the hormone. Anti-Muller hormone in women helps the body adapt to reproduction and promotes the production and release of a full-fledged egg, despite unfavorable factors environment.

The most common pathology, polycystic ovary syndrome, promotes an increase in Müller hormone in the blood. His treatment is aimed at medical procedures, promoting metabolism.

For treatment to be effective, you should change your diet, following healthy food, eliminate physical activity.

If, after all the treatment methods carried out, a woman was unable to conceive a child, then treatment in gynecology is possible using surgical intervention.

An increase in the level of anti-Muller hormone in women can contribute to bad habits: alcohol abuse and smoking. Impairments in anti-Muller hormone levels may be observed in women as a result of stress and chronic diseases.

If during testing it was detected in the blood increased rate AMG, there is no need to rush to get upset. Recommended immediate appeal to specialists - a reproductologist, as well as an endocrinologist, who will prescribe additional tests and help a woman who has this problem.

If you follow all the advice and prescriptions of the doctor and undergo a course of treatment, in many cases the most favorable prognosis is observed.

How to increase or decrease the hormone level

There is no method by which anti-Mullerian hormone can be forcibly lowered or increased from the norm. This is due to the fact that the substance is produced by the egg itself.

When a malfunction occurs in its operation, which can manifest itself with childhood, then the hormone is produced in an amount that is insufficient to promote conception. This can lead to infertility.

The production of anti-Muller hormone in women has no connection with the presence of other hormones and does not affect menstruation.

Moreover, the performance of the hormone is not particularly affected by food, lifestyle, environment. Age is also not the main indicator. After all, women are often able to give birth even at 45 years old.

Experts from the West advise monitoring girls over 12 years of age for the presence of normal levels of anti-Muller hormone. It is imperative to monitor the normal levels of the substance in women after her age has crossed the 35-year mark and she is still planning to conceive a child.

Conclusion

Foreign experts practice prescribing dietary supplements to women to increase Amh levels. This method is good for improving health, but it cannot serve as a method that affects the level of anti-Muller hormone in women in the blood. In any case, any drugs prescribed must be in complex treatment, and they are prescribed only by a specialist.

We talk about anti-Mullerian hormone, what it shows and what it is needed for, what is the norm for women by age. According to socio-statistical studies in 2017, the average age for the birth of the first child among Russian women was 27.5 years. The trend of births in more late age due to financial and psychological aspects. Couples begin to plan for children long in advance and try to find financial independence and independence.

It should be borne in mind that after 31 years of age, a woman’s likelihood of becoming pregnant begins to gradually decrease.

In order to assess the supply of remaining resting follicles that are still capable of fertilization, a test for anti-Mullerian hormone is carried out. The advantage of the analysis is the constant value of the hormone, which does not depend on the phase of the menstrual cycle.

The cost of research for private laboratories starts from 850 to 1200 rubles. Applicable immunological method followed by detection in ultraviolet light. The waiting time for results can be up to 7 days.

What does anti-Mullerian hormone affect in women?

The future sex of the child is determined at the moment of conception and depends on the combination of chromosomes: XX or XY. Until the sixth week of intrauterine development, the baby develops undifferentiated reproductive structures of both sexes, and the Wolffian and Müllerian ducts are formed. The ontogenesis of a child of any sex initially occurs according to the female type: the uterus with appendages develops, and the Wolff's duct is destroyed.

If exposure to suppressive factors occurs, the Müllerian duct atrophies, and the seminal vesicles and vas deferens are formed from the cells of the Wolffian duct.

The generally accepted abbreviation for anti-Mullerian hormone is AMH. This protein substance is produced by supporting cells in the convoluted tubules of the testes during the embryonic stage of development from the seventh week. In women after birth, it is synthesized by granular cells of maturing follicles.

The unique property of the hormone is to interfere with the formation of female internal organs from the Müllerian duct. However, even after birth, AMH in women takes part in the process of final maturation of follicles and their selection for further ovulation.

What does anti-Mullerian hormone show?

The AMH level determines the number of growing follicles, which can be used to estimate the remaining reserve of resting eggs. The study will allow the doctor to determine the approximate age of menopause in a woman.

Determining the ovarian reserve is necessary when preparing a woman for in vitro fertilization(ECO). It has been noted that in patients with low anti-Mullerian hormone, pregnancy occurs when artificial insemination occurs much less frequently.

Before IVF, the ovulation process is stimulated, which results in increased production of eggs, including defective ones. There are cases where the condition was accompanied negative consequences for women's health. In order to assess the risk of ovarian hyperstimulation syndrome, the AMH value is first determined.

In addition, the hormone is a tumor marker for tumors in the ovaries. Average age tumor formation in women is 51 years.

Elevated anti-Mullerian hormone is detected when comprehensive assessment hormonal status patients.

Anti-Mullerian hormone - when is it analyzed and how to take it?

A general practitioner, gynecologist or geneticist can send it to the laboratory for AMH analysis. Indications for the study:

• the need to assess the functional reserve of the ovaries;
• differential diagnosis oncological diseases, polycystic ovary syndrome and intersex disorders;
• preparation for IVF.

In order to get the most accurate results, you need to know the rules for preparing for collecting biomaterial:

• at least 12 hours must pass after the last meal;
• you cannot smoke three hours before your visit to the laboratory;
• alcohol is excluded two days before the study;
• sexual intercourse is excluded for 24 hours;
• reception oral contraceptives and hormonal medications are postponed for 2 days;
• absence of physical or emotional stress for 2 hours.

Important: the phase of the menstrual cycle does not matter for AMH analysis. However, since AMH is taken together with follicle-stimulating hormone, it is recommended to take tests from the fifth to the seventh day of the cycle (sometimes from the third to the fifth).

Table of the norm of anti-Mullerian hormone in women by age

In newborn girls, determining the AMH level is not possible due to its extremely low value. IN puberty There is an increase in the level of the hormone, and after menopause it again reaches minimum values.

Below is a table of AMH norms in women by age, which is used to interpret the results of a study on hormonal status.

It should be noted that a decrease in the value of the indicator to 1 ng/ml indicates a low ovarian reserve in a woman. The norm of anti-Mullerian hormone in women for conception starts at 1.2 ng/ml and above.

Should I stimulate ovulation before IVF or use donor material?

It is necessary to accurately know the level of anti-Mullerian hormone. The minimum AMH rate for IVF ranges from 1 to 2.5 ng/ml.

What does it mean if anti-Mullerian hormone is elevated in women?

If the patient's hormone level is at upper limit norms, then a conclusion is made about a large ovarian reserve. The onset of menopause and infertility will not occur in the next few years.

However, if anti-Mullerian hormone is elevated above acceptable values, then the patient needs additional diagnostics. Similar condition indicates 2 main pathologies.

Stein-Leventhal syndrome (polycystic ovary syndrome), in which a disorder occurs normal operation ovaries. A woman does not ovulate completely or does not ovulate regularly. In combination with this, there is an increase in female and male sex hormones.

Patients with polycystic disease are at greater risk of developing cancer, diabetes mellitus And cardiovascular pathologies. According to the data modern research Women with polycystic disease are more likely to spontaneous miscarriage or premature birth.

If the doctor correctly selects treatment methods, and the patient strictly follows all the instructions, then she will be able to successfully conceive and give birth to a healthy baby.

Based on the fact that AMH is a tumor marker, its increase may indicate the development of malignant tumors or metastases. More than 70% of all ovarian tumors are primary. Secondary neoplasms are observed when metastases spread from the mammary glands, stomach or large intestine.

Be sure to check:

According to statistics, 220 thousand new cases of ovarian cancer are registered annually, half of them with fatal. The sad statistics are due to the fact that pathology is detected on late stages, When known methods treatments are no longer effective enough.

In the first stages, the tumor does not cause discomfort to the woman, the disease proceeds without pronounced clinical signs. First signs malignant formation similar to inflammation of the ovaries.

Treatment is chemotherapy and surgery to remove or resect the ovary. Based on the fact that the disease most often affects women of reproductive age, removal of the ovaries will lead to their infertility.

If anti-Mullerian hormone is low

Is pregnancy possible with low levels of the hormone in question? Yes, there is a possibility of pregnancy. Anti-Mullerian hormone is reduced against the background of low functional ovarian reserve, but is not 100% proof of its dysfunction.

It should be borne in mind that after menopause, the indicator in question is equal to the minimum values, and pregnancy is impossible.

How to bring the indicators back to normal?

If the AMH deviation was caused by physical or emotional stress, then restoring the patient’s body will allow the indicator to return to normal values.

Premature menopause is more difficult to treat. As a rule, a woman is prescribed medicinal hormonal therapy aimed at increasing the level of female sex hormones.

conclusions

To summarize, it should be emphasized:

• The functional reserve of a woman’s ovaries is determined by the amount of anti-Mullerian hormone. In other words, how long will she be able to successfully conceive and bear a child;
• the minimum level of anti-Mullerian hormone for IVF is 1 – 2.5 ng/ml;

In 2015 at the Institute of Cellular and Intracellular Symbiosis of the Ural Branch of the Russian Academy of Sciences, she completed advanced training in additional professional program"Bacteriology".

Laureate of the All-Russian competition for the best scientific work in the category "Biological Sciences" 2017.

Gynecologists often prescribe anti-Mullerian hormone tests to patients. What it is? A blood test for this substance indicates the condition of a woman’s reproductive system. The hormone is produced from birth and throughout childbearing age, right up to postmenopause.

What is anti-Mullerian hormone?

In gynecology there is such a thing as ovarian reserve. This is the number of eggs that a woman currently has. Certain quantity oocytes are laid in a female fetus during the prenatal period. Each girl is naturally given a certain number of eggs, and it is impossible to increase it. Throughout life, a woman loses oocytes with each menstrual cycle. There are fewer and fewer eggs left in the reserve. For this reason, it becomes more difficult to get pregnant as you age.

Study blood Anti-Mullerian hormone (AMH) is a method for assessing ovarian reserve. At the beginning of the menstrual cycle, follicles begin to develop in the ovaries. Their cells intensively produce AMH. But only the largest (antral) follicles give rise to the future egg. The rest undergo atresia. The more antral follicles there are in the ovaries, the higher the likelihood of conception. Therefore, by the content of the hormone produced in these cells, one can judge a woman’s reproductive health.

The number of antral follicles can also be determined by ultrasound. Typically, women use comprehensive diagnostics. An ultrasound is prescribed to count the number of follicles, an AMH test and an inhibin B test (a marker of decreased ovarian function). However, testing for anti-Mullerian hormone is the most informative method, since when ultrasound examination not all follicles are visible.

Anti-Mullerian hormone levels

Typically, a doctor prescribes a blood test for AMH if the patient has persistent infertility. This analysis is mandatory before undergoing reproductive techniques, such as IVF. Most frequent indications to carry out such diagnostics are the following pathology:

IN at different ages Varying amounts of anti-Mullerian hormone are released. Norms for women at different age periods are shown in the table:

However, the amount of AMH is not always directly related to age. There are cases when girls aged 20 - 25 years old have a prematurely depleted ovarian reserve, and in some middle-aged women the reserve of eggs is still quite sufficient for conception.

AMH levels from 2.2 to 4 ng/ml are considered low for women reproductive age and require medical intervention. The maximum permissible level of anti-Mullerian hormone is 7.5 - 8 ng/ml. To carry out the IVF procedure, the concentration of anti-Mullerian hormone must be at least 0.8 ng/ml, otherwise it will be difficult to obtain the required number of eggs.

Reasons for increase and decrease in AMH

Most often, a decrease in AMH is observed in older women during menopause. In such cases it is natural process. However, if the hormone is reduced in women young, then this may be due to the following pathologies:

A decrease in AMH concentration is dangerous for pregnant women. This increases the risk of having a child with characteristics of two sexes, that is, with congenital hermaphroditism. Normally, in girls, the genital organs are formed from the Müllerian duct, and in boys, from the Wolffian canal. If the mother's production of anti-Mullerian hormone is disrupted, the formation of the genital organs in the fetus may be disrupted.

Elevated AMH levels may occur with the following: pathologies:

• ovarian tumors;
• infertility associated with lack of ovulation;
• lack of ovulation for several cycles;
• polycystic ovary syndrome;
• congenital defects of AMH receptors;
• delayed puberty;
• increased physical and psycho-emotional stress;
• disruption of the production of follicle-stimulating hormone (FSH).

If high levels of anti-Mullerian hormone are detected, additional diagnosis and treatment are necessary.

How to get tested?

Many women are interested in the question of when to take anti-Mullerian hormone. The analysis must be taken on days 3 - 5 of the menstrual cycle. It is during this period that the production of the hormone remains unchanged, and the results of the study will be the most reliable. Diagnosis is made using a blood sample taken from a vein. Before taking the test, you must adhere to the following: rules:

Typically, analysis results are ready in 2 - 3 days. Sometimes AMH can be increased or decreased due to random reasons. In this case, you need to take the test again. If the results still deviate from the norm, then consultation with a gynecologist, reproductive specialist or endocrinologist is necessary.

The effect of AMH on fertility

Often the anti-Mullerian hormone is reduced in the results of studies. Is it possible to get pregnant with such indicators? This question worries many women.

An AMH level of less than 0.2 mg/nl is considered critically low, and the concentration of the hormone from 0.2 to 1 ng/l is assessed in medicine as low. To further evaluate the functioning of the ovaries, a blood test for follicle-stimulating hormone (FSH) is prescribed. Is it possible to get pregnant with reduced AMH but normal FSH? The likelihood of pregnancy exists even with low AMH, if the concentration of follicle-stimulating hormone remains normal. It may be that additional drug stimulation ovulation. However, a low AMH level indicates that a woman planning a pregnancy should hurry up, as the ovarian reserve is coming to an end.

If the level of AMH reaches critically low levels in women over 30 - 35 years old, and at the same time a high level of FSH is observed, then this indicates the approach of menopause. To date, there are no methods of therapy that would increase ovarian reserve and increase AMH. Anti-Mullerian hormone levels decline steadily with age.

Is it always low level anti-Mullerian hormone indicates approaching menopause? In some cases this may be due to overweight. If a decrease in AMH in young women is caused by obesity, then treatment of the underlying disease is required. After weight loss hormonal background comes back to normal.

What to do if a middle-aged woman is planning a pregnancy, but at the same time she has low AMH due to approaching menopause? It is necessary to contact a gynecologist-endocrinologist. The patient may be prescribed a replacement hormone therapy. This will allow you to extend the childbearing period for some time, during which pregnancy is possible.

There are cases when a young woman’s AMH level is extremely low, and menopause has already occurred. What to do in such situations if the patient is planning a pregnancy? An IVF procedure is used using donor eggs. This technique helps older women or young patients with early menopause become pregnant.