Anti Mullerian Hormone Test in Infertility
AMH is a glycoprotein Originally known as Mullerian Inhibiting Substance(MIS) Appears in females at puberty Produced by granulosa cells of pre-antral and small antral follicles of 4-6 mm AMH is not expressed in atretic follicles and theca cells.
AMH does not change during your menstrual cycle, so the blood sample can be taken at any time of the month - even while you are using oral contraception.
Women are born with their lifetime supply of eggs, and these gradually decrease in both quality and quantity with age.
An AMH test gives us some insight into the remaining quantity of eggs and number of fertile years you may have, but it cannot tell us much about the quality of those eggs.
The AMH test is useful if:
- you have been trying to conceive for over six months, and want to check your ovarian reserve is appropriate for your age
- you are considering IVF or other fertility treatments, as low levels of AMH could indicate a potentially poor response to IVF Conversely, a high level may indicate an exaggerated response to the IVF medication
- you have had chemotherapy or ovarian surgery and want to know if it has affected your future fertility
- you would like to conceive in the future, and just want to understand your current position
- Menopause prediction & AMH Prediction of at menopause by assessing AMH at a relatively young age may enable screening and prevention programs with reference to osteoporosis, breast cancer, congnition and Alzheimer disease, cardiovascular disease and stroke
- Infertility and AMH BENEFITS OF ORT IN SUBFERTILE COUPLE ORT guides in prognosticating outcome in individual cases by Pre-treatment counselling Choice of infertility treatment AMH helps to predict fecunity and accurate ovarian reserve
- Factors influencing AMH concentrations are Overweight - Ethnicity - Vitamin D status - Polymorphisms of AMH and its receptor - Smoking and Alcohol intake - Genetic variants across the genome
- AMH as predictor of ovarian response Value of AMH (ng/ml) Ovarian response <0.4 Extremely poor response and cycle should be cancelled 0.4 – 1 Poor response 1 – 2 At risk of poor response and short stimulation protocols should be used 2 – 3.5 Response adequate 3.5 – 6 Chances of hyper stimulation. Caution to be applied > 6 High chances of severe OHSS
- IT is the earliest marker to change with age It shows the least intercycle and intracycle variability It can be randomly measured during the cycle
- Anti mullerian hormone (AMH) alone or best in combination with antral follicular count (AFC) is the BETTER INDICATOR of ovarian reserve than any other hormonal or sonographic markers available at present.
Blog reviewd by: Dr. C S Manjunath
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