AMH (Anti Mullerian Hormone)

Anti Mullerian Hormone (AMH) is secreted from the Sertoli cells in the testes in men and is secreted throughout life, and ensures normal development of the sexual organ in the early period. In women, it starts to be secreted from the granulosa cells in the ovaries after birth, increases during the fertility periond, and decreases towards menopause, reaching undetectable levels with menopause. AMH plays a very important role in tissue development and differentiation of the fetus. It facilitates the regression of the Mullerian duct, which forms the fallopian tubes and upper vagina sections in the male fetus, and provides the formation of male genital organs and the regulation of spermatogenesis, ie sperm production. In women, it also plays a role in regulating folliculogenesis, or which egg will develop.

What is the AMH test?

AMH test is a blood test to measure the ovarian reserve in women. AMH, which is found in both men and women, starts to be secreted in the mother's womb, and is secreted until menopause. With meopause, it is reduced to undetectable levels.

AMH is a hormone secreted from the granulosa cells of eggs that begin to grow in women. AMH determines which egg will develop at what rate. AMH test is a very important test that gives information about the ovarian reserve, as it is secreted from small cells that cannot be seen even with ultrasound. The AMH level is directly correlated to the number of eggs in the ovaries.

FSH hormone test, which was the predecessor of the AMH test, could be misleading because it could only be measured in certain periods of mensturation and varied greatly from month to month. However, since AMH is directly secreted from ovaries and its level does not vary during the cycle, AMH test consistently gives accurate information about the ovarian reserve.

With women getting older, the AMH value decreases along with the number of eggs. AMH reaching very low levels is an idication that menopause is approaching. A low AMH level at a young age is an indication that a patient should hurry. A low AMH level, especially under the age of 35, indicates that attention should be paid to `early menopause`. We recommend our patients in this situation to get pregnant as soon as possible if they wish for a child at the moment. If they do not wish to have a child at the time, we recommend them to freeze their eggs.

Sometimes, AMH can be detected in very high levels in patients with polycystic ovary syndrome (PCOS).

In IVF treatment applications, AMH is an important marker showing the response to treatment. It guides the hormone levels to be used before treatment. The information that a small number of eggs can be collected at low AMH levels is shared with the patient before the treatment. It is necessary to adjust the drug doses more carefully, as although a lot of eggs can be collected at very high AMH levels, high AMH levels risks overstimulation of the ovaries (Overian Hyperstimulation Syndrome, OHSS).

How is the AMH test done?

AMH test, similar to other hormone tests, is a blood test. AMH is a test done with blood taken from a vein. The AMH test can be performed at any time of the cycle. For the AMH test, it is not necessary for the patient to have menstruation or to be on a certain day after menstruation similar to FSH hormone tests. You can have the AMH test done at our clinic at any time by giving blood.

Why is an AMH test requested?

  • The most common use of the AMH test is to determine the ovarian reserve in women. AMH is currently the most important marker in the determination of ovarian reserve.
  • It is used in diagnosis and follow-up of granulosa cell tumors (ovarian cancer).
  • It is used to determine the risk of poor response or hyperstimulation (OHSS) in IVF treatment.
  • It is used for differential diagnosis in patients with genital anomalies.
  • It is a test applied in the detection of menopause.
  • It is a recommended test for the diagnosis of Polycystic Ovary Syndrome (PCOS).

What are the normal AMH levels?

AMH is at a level of 1.5-4 ng/ml during puberty. It decreasees with age and reaches undetectable levels during menopause. Your AMH value must be evaluated by our doctors. Since low AMH value indicates early menopause under 35 years of age, our patient should hurry to have a child. Each patient should be evaluated separately and personalized treatment should be applied.

  • High (AMH > 4 ng/ml)
  • Normal (AMH 1.5-4 ng/ml)
  • Low (AMH < 1.5 ng/ml)
  • Very low (AMH <0.5 ng/ml)

What is the difference between FSH test and AMH test?

  • FSH hormone is secreted from the pituitary gland in the brain, while AMH is secreted directly from the granulosa cells in the ovary.
  • FSH can be done at a certain time of the menstrual cycle, whereas AMH can be done at any time of the cycle.
  • FSH varies a lot during menstrual cycle periods and menopause periods. The AMH value is always constant.
  • AMH is not affected by birth control drugs.
  • AMH is a direct test that shows the ovarian reserve in a woman.
  • For the AMH test, hunger does not make a difference.

How is the AMH test evaluated?

Your AMH result should be evaluated together with all your examination findings after meeting with our doctor. You should remember that the AMH value gives information about the number of eggs in your ovary, but not about your egg quality. In very low AMH values, you should not worry immediately but make good use of the remaining time. With a very low AMH value, you should not forget that good quality eggs can still develop, even if they are few in number, and pregnancy is still possible. In our embryology lab we are accustomed to working with a small number of eggs, and we will obtain the best quality embryos for you.

What is the treatment for low AMH values?

While men can produce sperm every day throughout life, women are born with a limited ovarian reserve. Women use a certain amount of eggs from this reserve every month. The AMH value shows the remaining number of eggs in the ovary, and since new eggs can not be produced in women, it is not possible to treat a low AMH value. We recommend our patients with low AMH value to hurry if they want to have a child, since AMH value can not be increased.


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