What is the relationship between PCOS and AMH level?
18 April 2025What is the relationship between PCOS and AMH level?
Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal disorders affecting women of reproductive age, characterized by irregular menstrual cycles, excess androgen levels, and polycystic ovaries. Anti-Müllerian Hormone (AMH) is a crucial biomarker used to assess fertility potential and the severity of PCOS. But what exactly is AMH, and how does it relate to PCOS? This blog explores the connection between AMH levels and PCOS, how AMH is used in diagnosis, its implications for fertility, and potential treatments to regulate AMH levels.
What is AMH and Why is it important?
Anti-Müllerian Hormone (AMH) is a hormone secreted by granulosa cells in the ovarian follicles, particularly by the small, pre-antral and antral follicles that have not yet reached maturity. AMH plays a crucial role in ovarian function by regulating follicle development and inhibiting premature follicle recruitment by follicle-stimulating hormone (FSH).
AMH is widely used as a biomarker for ovarian reserve, helping to estimate a woman’s remaining egg supply. Unlike other hormones like FSH and estrogen, AMH levels remain relatively stable throughout the menstrual cycle, making it a reliable measure of ovarian follicles at any time.
How does PCOS affect AMH Levels?
Women with PCOS (polycystic ovarian syndrome) typically have higher-than-normal AMH levels due to ovarian follicle excess—an unusually high number of small, immature follicles in their ovaries. This happens due to several reasons:
1. Increased follicle count
PCOS is characterized by an abundance of small follicles that fail to mature properly and reach ovulation. Since AMH is produced by these small follicles, its levels tend to be 2-3 times higher in women with PCOS than in those without the condition. Women with PCOS have higher anti-Müllerian hormone (AMH) levels compared to controls. The mean AMH level for women who are having PCOS is approximately 8.63 ng/mL.
2. Hormonal imbalance
Elevated Luteinizing Hormone (LH): High luteinizing hormone LH levels in PCOS prevent normal follicle maturation, causing an accumulation of small follicles that continue producing AMH.
Increased androgen levels: Elevated testosterone and other androgens disrupt normal follicle development, contributing to high AMH levels.
Insulin resistance: A common issue in PCOS (polycystic ovarian syndrome) , insulin resistance leads to hyperinsulinemia, which in turn stimulates ovarian theca cells to produce excess androgens. This can indirectly increase AMH levels by inhibiting follicular maturation.
3. Impaired follicle selection
In a normal menstrual cycle, one follicle is selected for ovulation, while others regress. However, in PCOS, this process is disrupted, leading to persistent high AMH levels because many follicles remain in a premature state.
AMH as a diagnostic tool for PCOS
Due to the strong correlation between PCOS and AMH levels, AMH is often considered a potential diagnostic marker for polycystic ovary syndrome pcos. Some studies report AMH levels in PCOS can be as high as 10.2 ng/mL in certain phenotypes. The standard cut-off value for diagnosing PCOS using AMH is often set at around 4.1 ng/mL or higher.
However, AMH alone is not enough to diagnose PCOS, as elevated levels can also be influenced by age, ovarian function, and other factors. The Rotterdam Criteria, the most widely accepted diagnostic guideline for PCOS, requires at least two of the following:
Irregular or absent ovulation (oligo/anovulation).
Excess androgen levels (elevated testosterone, acne, or hirsutism).
Polycystic ovary morphology (presence of multiple small follicles on ultrasound).
Since not all women with high AMH have PCOS, AMH should be used alongside other clinical and hormonal assessments.
Can AMH levels predict fertility in PCOS (Polycystic Ovarian Syndrome)?
1. High AMH (Anti Müllerian Hormone) and Anovulation
While high AMH indicates a greater ovarian reserve, it does not necessarily mean better fertility. Many women with polycystic ovary syndrome pcos experience anovulation (lack of ovulation), making it difficult to conceive naturally despite having many follicles.
2. Response to ovarian stimulation
Women with high Serum AMH levels often respond more strongly to ovarian stimulation during fertility treatments such as IVF.
However, they also have a higher risk of ovarian hyperstimulation syndrome (OHSS), a condition where the ovaries become swollen and painful due to excessive stimulation.
3. AMH levels over time
As women age, AMH levels naturally decline. However, in PCOS, this decline is often slower than in women without PCOS, meaning that women with PCOS may have a prolonged ovarian reserve despite menstrual irregularities.
Can AMH levels be reduced in PCOS (polycystic ovary syndrome)?
Since high AMH levels in PCOS are linked to an excess of small follicles, regulating ovarian function can help reduce AMH levels over time. Here are some ways to manage AMH levels in PCOS:
1. Lifestyle modifications
- Weight loss: Losing even 5-10% of body weight can improve insulin sensitivity, reduce androgen levels, and help regulate ovarian function.
- Exercise & Diet: A low-carb, high-protein diet combined with regular physical activity can balance hormones and improve ovulation.
2. Medications to regulate ovarian function
- Birth control pills: Regulate the menstrual cycle and reduce the number of small follicles producing AMH.
- Metformin: Helps manage insulin resistance, indirectly improving ovarian function.
- Ovulation Induction Drugs (Letrozole, Clomiphene Citrate): Can help women with PCOS ovulate regularly and improve fertility.
3. Ovarian Drilling (Surgical Option)
In rare cases, laparoscopic ovarian drilling (LOD) may be performed to reduce the number of follicles, leading to lower AMH levels and improved ovulation. However, this is usually considered only after other treatments fail.
Conclusion
AMH levels are significantly elevated in women with PCOS due to an increased number of immature ovarian follicles. While high AMH can indicate greater ovarian reserve, it is also linked to anovulation and fertility challenges in PCOS. Although AMH is a valuable tool in assessing ovarian function, it should not be used as the sole diagnostic marker for PCOS.
Understanding AMH levels can help in diagnosing PCOS, predicting fertility, and tailoring treatments to improve reproductive health. If you suspect you have PCOS or are concerned about your AMH levels, consult a fertility specialist to determine the best course of action based on your individual needs. Book a consultation today with a fertility expert to discuss personalized solutions!
Author bio
Dr. Parth Bavishi
Dr. Parth Bavishi, MD in Obstetrics and Gynecology, brings over 12 years of invaluable work experience to his role as Director of Bavishi Fertility Institute, leading a group of IVF clinics committed to helping couples realise their dreams of parenthood.
Bavishi Fertility Institute is dedicated to providing customised and personalised treatments which are simple, safe , smart and successful. Bavishi Fertility Institute works with success and satisfaction for all at heart. Providing an ideal blend of professional treatment and personalised care.
Dr Parth had special training in infertility at Bavishi fertility Institute, the Diamond Institute, USA, and the HART Institute, Japan.
Dr. Bavishi is a distinguished expert in his field. In addition to his clinical practice, Dr. Bavishi is the author of the acclaimed book, ‘Your Miracle in Making: A Couple’s Guide to Pregnancy,’ offering invaluable insights to couples navigating the complexities of fertility. He loves to empower patients to make the correct choice by education both online and offline.
His exceptional contributions have earned him the prestigious Rose of Paracelsus award from the European Medical Association. Dr Parth has been an invited faculty at many national and international conferences.
Beyond his professional endeavors, Dr. Bavishi is an avid traveller who finds solace in exploring new destinations. He also enjoys engaging his mind with brainy puzzles, always seeking new challenges and solutions outside of the medical realm.
FAQs
Yes, while high AMH is common in PCOS, some women with PCOS may have normal or even low AMH levels, especially as they age or if they have ovarian dysfunction.
No, while AMH is a useful biomarker, ultrasound remains an important tool for assessing polycystic ovarian morphology and overall ovarian health.
Yes, elevated AMH can also be seen in ovarian hyperstimulation, granulosa cell tumors, and some cases of primary ovarian insufficiency.
Pregnancy can temporarily lower AMH levels due to hormonal changes, but they typically return to pre-pregnancy levels postpartum.
AMH can provide some insight into ovarian reserve, but PCOS women may experience menopause later than average due to a slower decline in ovarian function.
While lifestyle changes can improve ovarian function and ovulation, they may not directly lower AMH levels but can help regulate menstrual cycles.
Serum anti-Müllerian hormone (AMH) levels are often elevated in PCOS patients due to the presence of multiple small follicles. Because AMH reflects the number of these follicles, high levels can be a useful biomarker in predicting PCOS, even before other clinical symptoms appear.
PCOS diagnosis typically involves a combination of clinical symptoms, blood tests, and imaging. Two of the most important tools are measuring serum AMH levels and ovarian ultrasonography. Elevated AMH and the presence of multiple cyst-like follicles on ultrasound are strong indicators in diagnosing polycystic ovarian syndrome phenotypes.
Yes, varying PCOS phenotypes can affect diagnosis accuracy. While some PCOS patients show classic signs like irregular periods and high androgens, others may only present with elevated serum anti-Müllerian hormone levels or polycystic ovaries on ovarian ultrasonography. Accurate PCOS diagnosis requires evaluating all these factors together.
Yes, AMH levels vary, but women with PCOS often have consistently high serum antimullerian hormone levels due to polycystic ovary morphology. This elevated AMH concentration reflects the number of small follicles.
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