Assessing fertility
In adult women serum levels are related to the number and activity of follicles and low levels correlate with declining ovarian reserve with aging, especially though the perimenopausal transition.
AMH levels vary little throughout the natural menstrual cycle and can be interpreted regardless of the time of collect (however, levels do fall during the follicular phase of FSH-induced cycles). This stability of AMH contrasts with other hormones such as FSH and inhibin sometimes used to assess ovarian reserve and which should be measured on day 3 of the menstrual cycle.
In females levels are undetectable at birth, and remain during childhood. They rise rapidly during puberty, fall slowly through adulthood as ovarian follicle numbers decline, and are typically undetectable after menopause or bilateral oophorectomy.
| fertility potential | AMH (pmol/L) | AMH (ng/mL) |
|---|---|---|
| optimal fertility | 28.6 - 48.5 | 4.0 - 6.8 |
| satisfactory fertility | 15.7 - 28.6 | 2.2 - 4.0 |
| low fertility | <15.7 | <2.2 |
| high level: possible PCOS or granulosa cell tumors | >48.5 | >6.8 |
Other rare uses
AMH is present in about 75% of granulosa tumours and can be used in detection and monitoring after surgery or chemotherapy. Even extremely high levels usually fall to normal days to weeks after surgery (serum half-life about 30 hr). It is also secreted by some sex chord tumours and Sertoli-Leydig cell tumours.
Levels may also be helpful in the evaluation of boys with cryptorchidism and possible intersex states, where a positive result suggests presence of testicular tissue and a high level may indicate disorders of testosterone synthesis and androgen resistance (complete/partial androgen insensitivity).
Use of this test should be reserved for specialist settings.
Ref: Lane AH. Diagnostic utility of Mullerian inhibiting substance determination in patients with primary and recurrent granulose cell tumors. Gynecol. Oncol. 1999; 73:51-55
Conversion factor : pmol/L = ng/mL x 7.14
Emails to chemicalpathologist@adhb.govt.nz will receive priority attention from the on-call chemical pathologist.
If the query concerns a specific patient please include the NHI number in your email.
If email is not a suitable option, please contact the on-call chemical pathologist via Lablink (Auckland City Hospital ext. 22000 or 09-3078995).
Individual chemical pathologists may be contacted but will not be available at all times.
After-hours : contact Lablink (Auckland City Hospital ext. 22000 or 09-3078995) or hospital operator for on duty staff after hours.
Dr Samarina Musaad (Clinical Lead) : SamarinaM@adhb.govt.nz ext. 22402
Dr Cam Kyle: CampbellK@adhb.govt.nz ext 22052
Dr Weldon Chiu: WeldonC@adhb.govt.nz ext. 23427
Dr Campbell Heron: CHeron@adhb.govt.nz ext. 23427
Dr Sakunthala Jayasinghe: Sakunthala@adhb.govt.nz ext. 23427
Instructions
SST or Plain
Minimum volume 250 uL
Separate and freeze at -20
o
C
(samples can be kept at 2-8
o
C for up to 48 hours
but this is not recommended)
Specimen Collection
Specimen
Transport
Send frozen aliquot
.