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Anti-Müllerian hormone: what all nulliparous girls should know about it
Its indicators most clearly reflect the health of the reproductive system. If you plan to give birth only after 35 years, it is simply necessary to be tested for this hormone.
Anti-Müllerian hormone is a very important indicator. This is a substance that allows the doctor to assess a woman’s reproductive potential and possible changes in the work of the ovaries.
leading gynecologist-reproductologist of the network of centers of reproduction and genetics “Nova Clinic”
The anti-Müllerian hormone – AMG – is also present in the male body. In the process of early intrauterine development, it is he who determines the development of the male embryo. In adulthood, in the male body, anti-Müllerian hormone continues to be secreted by certain cells in the testicles, and the assessment of the level of this hormone helps in the diagnosis of severe forms of male infertility.
In the female body, anti-Müllerian hormone is secreted by cells located in the ovarian follicles. The number of follicles varies throughout life and is limited. It will be maximum at the stage of intrauterine development.
Unfortunately, if the number of follicles is reduced, you cannot force the body to produce additional ones. When supplies run out, menopause will come. This is a natural process of the extinction of reproductive function, when the normal functioning of the organ and the rhythm of the menstrual cycle becomes impossible.
At the beginning of each menstrual cycle, a certain number of follicles enter into active growth in the ovary. The younger the woman, the more of them can be in one cycle: at 20-25 years old to 20-30, at 40 – only 2-5. These follicles, which have already begun to grow, are clearly visible on ultrasound. They look like small bubbles 3-6 millimeters in size.
These follicles are selected from the ovarian reserve. The reserve is the reserve of all follicles. And the selection process is called recruiting. It’s easier to imagine this as a cash account in a reliable bank, from which a certain amount is debited every month. The lower the amount of funds on the account, the lower the amount that will be spent this month. That is why, with age, with a natural decrease in the ovarian reserve, the number of follicles entering into growth in a given cycle decreases. This is clearly visible on ultrasound.
The fate of these selected follicles is predetermined. One of them will become dominant, in the process of ovulation, an egg will be released from it, in order, possibly, to give rise to pregnancy. Others will stop developing, undergo atresia (in fact, reverse development, replacement with connective tissue).
Why AMG is called a litmus test of women’s health
The anti-Müllerian hormone is secreted by the cells of those follicles that are in reserve. Why is it important? Since it is the main advantage of this indicator over other hormones and counting the number of follicles on an ultrasound scan.
The number of follicles, like the indicators of other hormones, can vary from cycle to cycle. This may be due to the peculiarities of the size of the follicles, the duration of the cycle, preceding hormonal therapy. But the anti-Müllerian hormone will remain relatively stable and independent. It will reflect the true state and the number of follicles not for this particular cycle, but for the ovarian reserve as a whole. This is a convenient and important indicator. A decrease in ovarian reserve is associated with a decrease in anti-Müllerian hormone levels, and it is a decrease in these indicators that most often worries us.
When to assess the level of AMH
Heredity… If on the female line (mother, grandmother, sister) there were menstrual irregularities, infertility, early menopause, then this may be an alarming signal and indicate a hereditary predisposition to premature depletion of the ovarian reserve.
Operations on the pelvic organs, especially on the ovaries. The AMG level will help to understand the state of the reserve and sometimes change the tactics of the operation. After any intervention on the ovaries, the reserve will decrease. The AMH level will help determine the prognosis and reproductive plans.
Menstrual irregularities… Irregular or, on the contrary, regular, but persistently shortened menstrual cycle is also a reason to donate blood for AMG. The first signs of an imperceptible decrease in the reserve just look like a decrease in the duration of the cycle (less than 26 days).
Delayed motherhood… Guided by an active social life, modern girls postpone pregnancy to an older age. The female reproductive system begins to experience biological difficulties with conception after 35 years. In this case, many problems can be avoided by knowing in advance the state of the ovarian reserve. Sometimes it makes sense to vitrify oocytes. This is a medical procedure that allows you to preserve your eggs by bypassing the natural decline in ovarian reserve that cannot be stopped. Any difficulties with conceiving or planning a pregnancy after 35 years are indications for assessing the level of AMH.
How to prepare for an AMG test
A blood test for anti-Müllerian hormone can be performed on any day of the menstrual cycle. As a rule, AMG is donated along with other female hormones, which must be watched at the beginning of the cycle (on days 2-5).
Before taking AMG, it is recommended to refrain from excessive physical activity and smoking. By the way, there are many studies confirming the extremely negative effect of smoking on the state of the ovarian reserve and a decrease in AMH levels.
There is also something that can have a positive effect on the concentration of anti-Müllerian hormone. According to some reports, compensation for vitamin D deficiency leads to an increase in AMH levels. It is worth immediately stipulating the point that it is impossible to increase the real state of the ovarian reserve, that is, the number of follicles. Unfortunately, there is currently no way to do this, as the supply of eggs in the ovaries is limited.
What do the decrease and increase in AMH levels indicate?
Normal condition ovarian reserve at different ages is considered on average to be from 2 to 4 ng / ml.
Decreased ovarian reserve the AMH level is 1,2 ng / ml. The reproductive prognosis with a decrease in AMH less than 0,5 ng / ml becomes very serious, and in some situations this may indicate the need for IVF with donor cells. Here, timely access to a doctor and planning for conception is extremely important.
There are situations when AMH is increased. Levels greater than 6,8 ng / ml may be associated with polycystic ovary syndrome (PCOS) or multifollicular ovary syndrome. A significant increase in AMH above 13 ng / ml requires additional examination and exclusion of oncological pathology, but it is most often found in certain types of PCOS.
Whatever the level of AMH, only a doctor can give a full assessment of the condition. If the indicator is lowered, first of all, you should seek the advice of a specialist.