Women often have their AMH (anti-mullerian hormone) levels tested as part of a fertility work-up; when AMH value rises above the normal range (0.9-3.5 ng/ml) women may be told that this is a sign of good ovarian reserve, often, no further attention is paid to the out-of-range AMH value. However, another view of high AMH values is unfolding which could lead to more effective fertility treatment.
Research is highlighting how higher AMH values may be diagnostic for PCOS (poly-cystic ovarian syndrome) and studies suggest that the higher the AMH number, the greater the severity of PCOS in the patient. High levels of AMH can in fact disrupt normal ovarian function; AMH is produced primarily from immature antral follicles which are present upon the ovarian surface and can be seen with ultrasound imaging. The more antral follicles you have, the more AMH they will naturally produce; women with PCOS often have a greater-than-average number of tiny antral follicles all pumping out AMH. AMH is also derived from the granulosa cells within the ovary which produce progesterone.
When an ovarian follicle becomes dominant, matures and prepares for ovulation the AMH levels within the mature follicle dip dramatically. It is thought that perpetually high AMH levels - typical of PCOS - interfere with this process by preventing the dip in AMH levels which is necessary for a dominant follicle to develop. In this way follicle development and ovulation is arrested. A British study (1) published in the medical journal Reproduction, 2010, from St George's University, London, states that
"To conclude, AMH appears to have a major inhibitory role during folliculogenesis, which may contribute to anovulation in PCOS."
Perhaps the reason why many reproductive endocrinologists do not take heed of this new turn in PCOS diagnostics, is that their treatments for anovulation - whether due to PCOS or other causes - are often the same: Clomid...followed by gonadotropin injections...followed by IVF if pregnancy is still elusive. The 'cause' of anovulation sometimes seems almost irrelevant.
By using high AMH values as a diagnostic test for polycystic ovarian syndrome, may women who have been diagnosed with unexplained anovulation or unexplained infertility may find themselves re-tagged with a different label: PCOS. Labels aside, an accurate diagnosis can help to eventuate more specific, targeted treatments. PCOS is often accompanied by various metabolic imbalances which if targeted and treated can increase the likelihood of pregnancy success. An accurate diagnosis can be especially important when natural fertility treatments are being used, either alone, or alongside conventional care. Acupuncture for instance can very effectively induce ovulation in many women when PCOS is the diagnosis.
If the AMH-PCOS link is a new concept for you, you may enjoy reading some snippets from studies on the links between higher AMH values and PCOS, you may find this information of special interest if you have been diagnosed with unexplained infertility and have a high AMH value.
A Finnish study published in the medical journal Human Reproduction, 2005 on 44 healthy women and 65 women with PCOS (aged 16-44 years) states that:
"Serum AMH levels were 2- to 3- fold higher in PCOS women than in healthy women."
"Serum AMH levels, the number of antral follicles and ovarian volume decreased significantly during metformin treatment."
"Serum AMH levels decreased with age both in healthy women and in women with PCOS, although they were always 2- to 3-fold higher and remained elevated until 40 years of age in PCOS subjects."
"Thus, since serum AMH levels correlate well with antral follicle count and serum androgen levels, the measurement of AMH could be used as a tool to assess ovarian ageing, to diagnose polycystic ovaries/PCOS and to evaluate treatment efficacy."
A further study (3) from the Netherlands, published in the Journal of Clinical Endocrinology and Metabolism, 2004, states that:
"In 106 patients presenting with polycystic ovaries... AMH levels were elevated...compared with 22 patients without PCOs."
"In conclusion, serum AMH concentrations are elevated in WHO 2 women ( women with anovulation), especially in those patients exhibiting PCOs. Because AMH concentrations correlated well with other clinical, endocrine, and ultrasound markers associated with polycystic ovary syndrome, AMH may be used as a marker for the extent of the disease."
"A less pronounced AMH decrease over time in these women may suggest retarded ovarian aging. The latter hypothesis, however, should be confirmed by longitudinal studies."
An Italian study(4) published in Clinical Endocrinology (Oxf), 2006, states that:
"AMH has been shown to be a good surrogate marker for polycystic ovary syndrome (PCOS)."
A French study (5) published in the Journal of Clinical Endocrinology and Metabolism, 2003, also found that AMH levels were significantly increased in women with PCOS and states that:
"In conclusion, the assay of the serum AMH may represent an important breakthrough in the diagnosis and in the understanding of PCOS."
Yet another study(6)from Italy, on 236 women, published in 2011 states that:
"In clinical practice it is common to encounter patients who turn to medicine in search of a cure for female infertility. In our experience, AMH two or three times the normal amount (10 ± 2.28 ng/mL), is a good indication of PCOS and infertility."
So, suffice to say, a higher-than-norm AMH value may indicate that you might want to ask your physician about the possibility of PCOS. There are many natural approaches to treating PCOS - employing acupuncture, diet changes, exercise and nutritional supplements - which may help to resolve PCOS naturally or augment conventional fertility treatments.
This article is for purely informational purposes and is not intended to diagnose or to replace medical or dietetic advice for which you should consult a physician or dietitian.
(1) Reproduction. 2010 May;139(5):825-33. doi: 10.1530/REP-09-0415. Epub 2010 Mar 5.
Anti-Müllerian hormone and polycystic ovary syndrome: a mountain too high?
Pellatt L, Rice S, Mason HD.
(2) Hum reprod. 2005 Jul;20(7):1820-6. Epub 2005 Mar 31.
Serum anti-Müllerian hormone levels remain high until late reproductive age and decrease during metformin therapy in women with polycystic ovary syndrome.
Piltonen T, Morin-Papunen L, Koivunen R, Perheentupa A, Ruokonen A, Tapanainen JS.
(3) J Clin Endocrinol Metab. 2004 Jan;89(1):318-23.
Anti-Müllerian hormone serum concentrations in normoovulatory and anovulatory women of reproductive age.
Laven JS, Mulders AG, Visser JA, Themmen AP, De Jong FH, Fauser BC.
(4) Clin Endocrinol (Oxf). 2006 Jun;64(6):603-10.
Anti-Müllerian hormone (AMH) in female reproduction: is measurement of circulating AMH a useful tool?
La Marca A, Volpe A.
(5) J Clin Endocrinol Metab. 2003 Dec;88(12):5957-62.
Elevated serum level of anti-mullerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest.
Pigny P, Merlen E, Robert Y, Cortet-Rudelli C, Decanter C, Jonard S, Dewailly D.
6) Int J. Gen Med. 2011;4:759-63. doi: 10.2147/IJGM.S25639. Epub 2011 Nov 2.
Serum anti-Müllerian hormone as a predictive marker of polycystic ovarian syndrome.
Parco S, Novelli C, Vascotto F, Princi T.