AMH Test – Clinical Interpretation and Information
What Is AMH Useful For?
In the assessment of menopausal status, including premature menopause or ovarian failure, including ovarian reserve and ovarian responses as part of an assessment for assisted reproductive options such as infertility and IVF.
- for assessment of ovarian status.
- For the evaluation of ovarian function in patients with polycystic ovary syndrome.
- For the evaluation of infants with unclear genital disorders and other intersex cases.
- For evaluation of testicular function in infants and children.
- Anti Müllerian For monitoring patients with hormone-secreting ovarian granulosa cell tumors.
It is useful.
Clinical Information
Anti-mullerian hormone (AMH), also known as Müllerian inhibitory substance, is a dimeric (discrete) glycoprotein hormone belonging to the transforming growth factor-beta family. It is produced by testicular sertoli cells in males and by ovarian granulosa cells in females. In the development of the male fetus, the expression prevents the mullerian ducts from developing into the uterus (womb) and causes the development of the male reproductive system. In the absence of AMH, the mullerian ducts and structures become the female reproductive system. In males, serum concentrations of amh test rise in males under 2 years of age and then decline gradually until puberty, when there is a sharp decline. In females, AMH is produced from the 36th week of pregnancy by the granulosa cells of growing follicles, when levels are not detectable until menopause.
Because of sex differences in AMH concentrations, changes in circulating concentrations with sexual development, and specificity to Sertoli and granulosa cells, measurement of AMH shows utility as a predictor of sex, gonadal function, fertility, and gonadal tumors. AMH is superior to episodic-released gonadotropins and ovarian steroids as an indicator of ovarian reserve, as it is continuously produced in the granulosa cells of small follicles during the menstrual cycle. Moreover, AMH concentrations are not affected by pregnancy or oral or vaginal estrogen- or progestin-based contraceptives.
Studies in obstetrics clinics have shown that women with higher concentrations of AMH respond better to ovarian stimulation and tend to produce more retrievable oocytes than women with low or undetectable AMH. Women at risk for ovarian hyperstimulation syndrome may have increased AMH concentrations after administration of gonadotropins. Polycystic ovary syndrome can elevate serum AMH concentrations as it is associated with the presence of many small follicles.
AMH measurements are frequently used to evaluate testicular presence and function in infants with intersex conditions or ambiguous genitalia, and to differentiate cryptorchidism (palpable testicles) from anorchia (absent testicles) in males. In minimally virilized phenotypic women, AMH helps to differentiate between gonadal and nongonadal causes of virilization.
Serum AMH concentrations are increased in some patients with ovarian granulosa cell tumors, which account for approximately 10% of ovarian tumors. inhibin A and B (INHA / Inhibin A, Tumor Indicator, Serum, INHB / Inhibin B, Serum, INHAB / Inhibin A and B, Tumor Marker, Serum), estradiol (E2) (EEST / Estradiol, Serum) with AMH and CA-125 (CA25 / Cancer Antigen 125 [CA 125], Serum) may be useful in the diagnosis and monitoring of these patients.
Reference Values
Men | |
| Under 2 years old | 14-466 ng / mL |
| 2 – 12 years | 7.4-243 ng / mL |
| over 12 years old | 0,7-19 ng / mL |
Females | |
| under 2 years old | Should be less than 4.7 ng/mL |
| 2 – 12 years | Should be less than 8.8 ng/mL |
| 18 – 25 years | 0,96 – 13,34 ng / mL |
| 26 – 30 years | 0,17 – 7,37 ng / mL |
| 31 – 35 years | 0,07 – 7,35 ng / mL |
| 36 – 40 years | 0,03 – 7,15 ng / mL |
| 41 – 45 years | 0,00 – 3,27 ng / mL |
| over 45 years old | 0,00 – 1,15 ng / mL |
The normal values specified here are based on general criteria, normal values should be evaluated together with the patient’s clinic.
Interpretation
Menopausal women or women with premature ovarian failure for any reason, including cancer chemotherapy, usually have very low Anti Mullerian Hormone (AMH) levels below the current assay detection limit of 0.1 ng/mL.
While optimal AMH concentrations are currently being established to predict the in vitro fertilization response, AMH concentrations in the perimenopausal menopausal range are considered to indicate low or absent ovarian reserve. Depending on the age of the patient, ovarian stimulation may fail in these patients. Conversely, if serum AMH concentrations exceed 3 ng/mL, they may overreact to ovarian stimulation. Minimal warning is recommended for these patients.
In patients with polycystic ovary syndrome, AMH concentrations may be 2 to 5 times higher than the age-appropriate reference range values. These high levels predict anovulation and irregular cycles.
In children who are intersex (both male and female), an AMH result above the normal female range predicts the presence of testicular tissue, while an undetectable value indicates its absence.
In boys with cryptorchidism, the measurable AMH concentration is an estimate of undescended testicles; an undetectable value is highly suggestive of functional failure of anorcha or abnormally located gonad.
Granulosa cell tumors of the ovary can secrete AMH, inhibin A, and inhibin B. Elevated levels of any of these signs may indicate the presence of such a neoplasm in a woman with an ovarian mass. Levels should drop with a successful treat. Elevation levels indicate tumor recurrence or progression.
Attention
Anti-Müllerian Hormone (AMH) measurement alone, like all laboratory tests, is rarely sufficient for diagnosis and results should be interpreted in the light of clinical findings and other relevant test results such as ovarian ultrasonography (antral follicle count for fertility assessment), abdominal or testicular. Measurements of sex hormones (estradiol E2, testosterone, progesterone), follicle stimulating hormone (FSH), inhibin B (for fertility) and inhibin A and B (for tumor treatment).
Elevated AMH is not specific for malignancy and the assay should not be used to diagnose or exclude an AMH-secreting ovarian tumor alone.
This assay shows no cross-reactivity with Inhibin A, Inhibin B, Activin A, Activin B at concentrations of about 1000 pg/mL.
As with other immunoassays, the AMH assay is sensitive to false-low results at excessive analyte concentrations (hook effect).
Heterophilic antibody interferences unhindered by the blocking regimens of the test may rarely occur, typically false high results. If the test results are not consistent with the clinical picture, the laboratory should be consulted.
AMH Test – Fee Information
Fee Information
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Frequently asked Questions
- Where Can I Get AMH Test? In Istanbul Laboratories, AMH Test is given to SGK members at a discount.
- What is AMH? Explanation Is Above.
- AMH Result (Normal Values Available in Our Article)
- What Day of Menstruation Is The AMH Test Performed? (There is no date range, you can come with a number of pieces)
- Hospitals Laboratories Performing AMH Tests ( Istanbul Laboratory and Imaging Center )
Test Classification
This test was developed and its performance characteristics were determined by Istanbul Laboratories in a consistent manner with CLIA requirements. This test is accredited by our external lab.
Accreditation number: 83520
Clinical References
1. Broer SL, Broekmans FJM, Laven JSE, Fauser BCJM: Anti-Müllerian hormone: ovarian reserve testing and potential clinical implications. Hum Reprod Update Sep-Oct 2014; 20(5): 688-701
2. Dewailly D, Andersen CY, Balen A, et al: Physiology and clinical use of anti-Müller hormone in women. Hum Reprod Upd 2014; 20 (3): 370-385