Anti-Mullerian Hormone (AMH) Test

The Anti-Mullerian Hormone (AMH) test is used to measure the level of anti-müllerian hormone in the body. This hormone is produced by the sex organs, the ovaries in females and the testes in males. It plays an important role in reproductive development and functioning. Before birth, AMH helps in the development of reproductive organs in the developing male baby.

The AMH test, also known as the AMH hormone test, müllerian-inhibiting hormone (MIH), müllerian inhibiting factor (MIF), and müllerian-inhibiting substance (MIS), provides useful information about reproductive health. The AMH test for females is mainly used to evaluate ovarian reserve, which reflects the number of eggs remaining in the ovaries. This helps in assessing fertility, menopause, or conditions like polycystic ovarian disease (PCOD). In male infants, this test can help assess testicular function.

AMH levels vary depending on age and sex and naturally change over time. In women who are in the child-bearing age group, AMH levels are generally high due to a greater availability of eggs in the ovaries. As age increases, the number of eggs decreases, leading to a gradual decline in AMH levels over time. In males, their levels are high until puberty, after which they start to decline.

The AMH test is used in specific situations to support fertility and reproductive health evaluation. The following categories of individuals or clinical situations may require AMH testing:

• Women with difficulty in becoming pregnant or undergoing infertility evaluation
• Women planning or undergoing IVF treatment to guide response to fertility medicines
• Women planning for a late-age pregnancy
• Those having symptoms suggestive of polycystic ovary syndrome (PCOS), such as irregular or absent periods, acne, excess hair growth, weight gain, or hair thinning
• Women with ovarian cancer to monitor if the treatment is working or if the cancer has come back
• Before other cancer treatment (chemotherapy or radiation) in women to check how the ovaries may be affected
• Male infants with undescended testicles
• Babies with unusual sex organ development to check if the sex organs are formed properly

These groups may benefit from AMH testing as part of a broader clinical evaluation.

The AMH test procedure does not require routine repeated testing and is usually performed based on specific clinical needs. The frequency depends on the reason for testing, as shown below:

The AMH test report is used to support the evaluation of certain reproductive and hormonal conditions, such as the following:

• Fertility assessment: Low AMH indicates reduced ovarian reserve, meaning a lower number of remaining eggs compared to what is expected for the age (but note that it can only detect the quantity of remaining eggs, not the quality)
• Polycystic ovary syndrome (PCOS): A hormonal condition where AMH levels may be higher, and the test is used to support assessment
• Ovarian function during cancer treatment: The test helps check how chemotherapy or radiation may affect the ovaries
• Early or premature menopause: AMH may be low when menopause is approaching, but the exact timing of menopause cannot be predicted
• Ovarian response in IVF: The test helps estimate the number of eggs that may be obtained during a treatment cycle
• Undescended testicles: The test helps doctors understand if testicular tissue is present and working in baby boys whose testicles have not come down into the scrotum.
• Atypical genital development: The test, along with other tests, supports assessment and sex determination in babies with underdeveloped sex organs

Note: This test helps in assessment and monitoring but does not diagnose conditions on its own. Results are usually interpreted along with other clinical findings and tests.

What to Expect Before the AMH Test

No fasting is required for a standalone AMH test. You can eat and drink normally. However, if it is part of a broader package that includes fasting tests, your doctor may advise fasting for 8-12 hours. Avoid strenuous exercise for 24 hours before the test, as intense physical activity can temporarily raise AMH levels and affect interpretation. Always inform your doctor about any ongoing medications.

What to Expect During the Blood Collection

A phlebotomist cleans the skin with an antiseptic, then places an elastic band around your upper arm to make the veins easier to access. A small needle is inserted into the vein; you may feel a brief pinch. Blood is collected into a labelled tube in under a minute.

What to Expect After the AMH Test

A small cotton swab and bandage are placed over the site to stop any minor bleeding. You can return to normal activities immediately. Minor bruising is normal and disappears quickly. If dizzy, sit and rest for a few minutes.

This test measures a single key parameter related to reproductive health:

• Anti-Müllerian Hormone (AMH)

The table below presents typical AMH test normal range values based on age groups:

Important Note

• AMH levels remain relatively stable and can be measured on any day of the menstrual cycle, as they do not show significant variation from one cycle to another. This is why it is commonly used to assess ovarian reserve.
• There may be variation in AMH results across different laboratories due to differences in testing methods and reference ranges. Interpretation is generally based on the standards followed by the respective laboratory.
• When comparing AMH levels over time, results from the same laboratory may provide better consistency, as inter-laboratory differences can affect comparability.

The table below shows what different AMH levels in a test report may indicate:1,2

Note:

AMH results are interpreted by comparing them with reference ranges (normal values) provided by the laboratory. Values outside this range may be flagged as high or low; however, this does not always indicate a problem. Interpretation depends on individual factors and should be done by a qualified doctor.

This test is generally considered safe; however, some possible risks and limitations are as follows:

Potential Risks and Complications (Rare)

• Mild pain at the blood draw site
• Slight bruising or bleeding

These effects are usually temporary and resolve on their own.

Understanding AMH Test Limitations

• The test reflects ovarian reserve but does not provide information about egg quality.
• It may not be used alone to estimate the likelihood or timing of pregnancy.
• AMH levels may vary between individuals and are interpreted along with other clinical factors.
• It may support evaluation of menopause status, but it does not determine the exact timing.

If your AMH test results are altered, you may need some additional tests, such as:

• FSH AMH test (Follicle Stimulating Hormone blood test) to assess ovarian reserve, along with AMH
• Oestradiol E2 blood test to evaluate hormone levels related to ovarian function
• Antral Follicle Count (AFC) using ultrasound to estimate the number of developing follicles in the ovaries

These tests are often used together with AMH to provide a more comprehensive assessment of ovarian reserve and reproductive health.

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