A high AMH (anti-Müllerian hormone) level is a condition in which the AMH level in the blood is above the upper limit of the reference range (Fig. 1). High AMH levels are associated with several pathological conditions, particularly polycystic ovarian syndrome (PCOS) and granulosa cell tumors, which significantly affect female fertility.
Anti-Müllerian hormone or Müllerian inhibitory hormone is a glycoprotein hormone that plays a key role in embryonic growth, differentiation, and in the regulation of folliculogenesis (growth and development of ovarian follicles).
In women, AMH is secreted by the granulosa cells of the small follicles of the ovary. Serum levels are barely detectable in infancy and then rise rapidly with the onset of puberty, reflecting the initial recruitment of primordial follicles (the smallest form of ovarian follicle, small collections of cells, each containing a oocyte). AMH is produced in growing follicles until they reach a stage where the dominant follicle separates from a cohort of antral follicles (more mature stage of ovarian follicles).
Measurement of serum AMH levels during a woman's reproductive life provides an ideal tool to assess ovarian follicular reserve (the number of ovarian follicles that are still capable of inducing ovulation). The advantage of AMH over ovarian steroid hormones is that serum levels do not vary significantly throughout the menstrual cycle. The strong correlation of AMH with the number of growing follicles is supported by the fact that its levels are very high in ovarian tumors and polycystic ovaries, while undetectable levels are found in postmenopausal women (women after menopause, the end of natural part of the menstrual cycle). ) and Turner syndrome (a genetic syndrome that affects only women and causes infertility) in patients without gonadal tissue. As the number and quality of oocytes decline during a woman's reproductive life, serum AMH concentrations gradually decline and fall below detectable levels during menopause (the definitive end of a woman's menstrual cycle).
It has been reported that in PCOS, AMH levels increase two to three-fold (Fig. 2), reflecting stress on the growing follicles. This correlation with follicular growth implies the power of AMH as a marker of the severity of ovarian dysfunction and hyperandrogenism (elevated levels of male sex hormones) in women with anovulatory PCOS. AMH has also been identified as a marker of ovarian tumors of granulosa cell origin. Because it is secreted exclusively by granulosa cells (a type of cell that surrounds the egg in the ovarian follicle), it is a reliable marker for diagnosis and for monitoring tumor recurrence (repeated spikes of activity). Elevated levels have been found in 76 to 93% of women with granulosa cell tumors. In addition, an increase in AMH is observed up to 16 months before the clinical recurrence of the tumor itself, suggesting that it is a useful marker of granulosa cell activity.
A high level of AMH is only detected biochemically by measuring the serum concentration of circulating AMH. Other symptoms that can occur in patients with high AMH levels depend on the underlying condition.
In granulosa cell tumors, elevated AMH levels may precede any perceptible clinical signs and symptoms in the patient and, in tumor recurrence, serve as a sensitive marker of tumor activity. When clinically manifested, symptoms are variable: abdominal pain (30 to 50%), abdominal distension related to mass effects, and hormonal events (41%) such as irregular menstruation, breakthrough bleeding, postmenopausal bleeding, or amenorrhea (cessation of the menstrual cycle). . Endocrine manifestations are observed in 66% of patients. These manifestations are related to the secretion of estrogens from the tumor. This explains why granulosa cell tumors are often associated with endometrial hyperplasia (4–10%) or with endometrial adenocarcinoma.
In PCOS patients, who often have very high AMH levels, the most common symptoms of PCOS are amenorrhea or oligomenorrhea (infrequent or light menstruation), abnormal uterine bleeding, androgenization (development of masculine characteristics due to elevated levels of sex hormones). male) These include hirsutism (facial hair growth), acne, oily skin, and the characteristic finding of polycystic ovaries on ultrasound (Fig. 3), with or without enlargement of the ovaries. Patients with PCOS also often appear obese.
Polycystic ovary syndrome (PCOS)
Polycystic ovarian syndrome is a condition that results from increased levels of androgens (male sex hormones) in women. One of the most notorious symptoms in patients with PCOS is oligomenorrhea or amenorrhea, which is caused by the lack of ovulation in the ovaries. As a result, women with PCOS are very likely to be infertile and possibly develop endometrial hyperplasia (abnormal thickening of the lining of the uterus) due to continued secretion of estrogen without ovulation.
Furthermore, recent evidence suggests that around 50-70% of PCOS patients have insulin resistance (the need for higher levels of insulin because of its effects on peripheral tissues), regardless of their body weight or mass index. body (BMI). Consequently, compared to the general population, women with PCOS are at increased risk of developing several common metabolic disorders. In addition, many PCOS patients show symptoms of increased androgen levels or hyperandrogenism, leading to hirsutism (Fig. 4), alopecia (previous hair loss), and acne. In women with PCOS, increased growth of ovarian follicles without subsequent ovulation results in a two- to three-fold increase in AMH blood levels.
Granulosa cell tumors are very rare malignant ovarian tumors; they represent 2 to 3% of all ovarian carcinomas. Unlike ovarian epithelial tumors, they occur in young women and are usually detected at an early stage. The mainstay of treatment is complete surgery (hysterectomy with bilateral salpingo-oophorectomy) with staging for early stages and debulking surgery (removal of as much tumor mass as possible) for advanced stages or recurrent disease. Fertility-sparing surgery with unilateral salpingo-oophorectomy is an option in young patients with early stages of tumor growth. The available data showed that there is not a large difference in survival between conservative management and radical surgery (97% and 98%, respectively). Although granulosa cell tumors generally have a good prognosis, they tend to come back late.
- abnormal uterine bleeding
- irregular menstruation
- Family history of PCOS or insulin resistance
Medical conditions associated with elevated AMH levels can lead to female infertility. PCOS usually causes infertility related to anovulation, and therefore the presence of ovulation indicates the absence of infertility. For patients with granulosa cell tumors, particularly those that are advanced, treatment includes bilateral salpingo-oophorectomy (surgical removal of the fallopian tubes and ovaries), leaving the patient infertile.
It has been reported that in PCOS, AMH levels are elevated two to three times, reflecting stress on the growing follicles. This correlation with follicular growth implies the power of AMH as a marker of the severity of ovarian dysfunction and hyperandrogenism (elevated levels of male sex hormones) in women with anovulatory PCOS. Although the exact cause of PCOS is still unknown, there are certain ways to reduce the risk of developing the condition. If the patient has a family history of PCOS or increased insulin resistance (obesity, type 2 diabetes, and related conditions), certain steps can be taken to reduce the risk of developing PCOS, or at least prevent many of the complications of PCOS. health associated with it. . These steps include regular exercise, walking or running for 20 to 30 minutes a day to increase insulin sensitivity, and cutting carbohydrate-rich and processed foods from your diet. If the patient notices irregular menstrual periods, acne, or facial hair, she should consult her physician.
Is it possible to get pregnant with high AMH level? ›
No. The AMH test does not provide any information about a woman's chance to conceive at the moment. This will depend on many other factors, including the quality of the partner's sperm, the condition of the fallopian tubes, and if ovulation is occurring. The AMH level alone cannot predict anybody's fertility.What if AMH level is very high? ›
High levels may mean you may have more eggs available and will respond better to treatment. Low levels of AMH mean you may have fewer eggs available and may not respond well to treatment. You may also need an AMH test if you are a woman with symptoms of polycystic ovary syndrome (PCOS).Can I ovulate with high AMH? ›
These results suggest that high serum AMH is associated with a reduced response to ovulation induction among women with PCOS. Women with higher AMH levels may require higher doses of medication to achieve ovulation.Does high AMH mean poor egg quality? ›
First of all, your AMH level tells you only how many eggs you have left—and nothing about the quality (or genetic health) of those eggs, which is actually much more important when it comes to getting pregnant. There's no test for egg quality, but it declines with age in a predictable way.Does high AMH always mean PCOS? ›
Studies have shown that the level of circulating AMH is two- to three-fold higher in women with PCOS than in healthy women of childbearing age, probably due to increased follicular mass associated with PCOS [8–9]. However, women without PCOS who have high AMH levels are commonly very fertile.Can AMH be too high for IVF? ›
Conclusions. High AMH levels correlate with low cancellation rates, retrieval of more eggs, higher live birth rates and a high chance for cryopreservation. Couples should not be excluded from attempting IVF due to low AMH values alone because the live birth rates were reasonable.Does high AMH mean late menopause? ›
For example, AMH is significantly correlated with the number of antral follicles, and further evidence shows that AMH is a stronger predictor of late menopausal transition than age, antral follicle count, or ovarian volume (6).Does good AMH mean good egg quality? ›
An AMH test is not a measure of egg quality – and our best estimation of quality and potential of eggs to become a baby is a woman's age. AMH is a measure of quantity – and can infer how many eggs can be expected to develop in a fertility treatment cycle.Is there a correlation between AMH and egg quality? ›
The level of AMH is positively correlated with the number of antral follicles and small follicles in the ovary. Studies have shown that AMH can not only reflect the number of antral follicles but also the quality of oocytes (1, 2).Does high ovarian reserve mean good egg quality? ›
A woman diagnosed with poor ovarian reserves is more likely to have lower quality eggs. But a woman with good ovarian reserves may not have quality eggs retrieved. In other words, it's possible to retrieve a good number of eggs during IVF, but then have few to none of those eggs fertilize.
What is a good AMH for age 39? ›
In general, a typical AMH level for a woman of reproductive age is 1.0–4.0 ng/ml.Does high AMH mean twins? ›
Higher AMH levels may indicate a higher chance of having twins. An older study shows that AMH concentrations were 1.4 times higher in females with twins compared with those with one baby.What is the best AMH level for pregnancy? ›
A typical AMH level for a fertile woman is 1.0–4.0 ng/ml; under 1.0 ng/ml is considered low and indicative of a diminished ovarian reserve.Can you have high AMH levels and not have PCOS? ›
Wiweko et al. reported that patients with a mean AMH level ≥ 4.45 ng/ml have a 9.35 times higher likelihood of developing PCOS . However, high levels of AMH have also been found in non-PCOS patients.What should a 35 year old follicle count be? ›
For women between 25 to 34 years, the normal antral follicle count is between nine to twelve. For 35 to 40 years, it is around five to nine, whereas, for 41 to 46 years, less than five is also considered normal.How can high AMH improve egg quality? ›
Research has proved that acupressure or acupuncture can help boost AMH levels by improving egg quality and embryo quality. It also helps in balancing hormones, endometrium lining, male infertility, managing PCOS symptoms, reducing endometriosis and also increases IVF success chances.Do people with PCOS have higher egg reserve? ›
Women with PCOS have an increased ovarian follicle and oocyte count, increased ovarian reserve and/or a slower rate of follicle atresia.Does CoQ10 really help egg quality? ›
Emerging research shows that taking supplemental CoQ10 as a form of “mitochondrial energy nutrition” for the egg, can help improve egg quality and potentially lead to a better chance of achieving a healthy pregnancy. CoQ10 is fat-soluble nutrient.Does CoQ10 help with fertility? ›
CoQ10 supplementation has been shown to improve egg quality, sperm quality, and pregnancy rates. Sperm and eggs both take about 90 days to develop. For best results, fertility specialists recommend taking CoQ10 and other fertility supplements for 90+ days if possible.What is the first indicator of egg quality? ›
The most reliable indicator of good egg quality is high survival, through egg hatching and the yolk sac stage of larval development before exogenous feeding is required.