After a period of marriage, many women may start thinking about the reasons for delayed childbearing. When consulting a specialist doctor, he may ask her to conduct a set of basic tests to determine the main cause and treat it as soon as possible. Among these tests, the ovarian reserve analysis is considered one of the most important. In this article,              Dalili Medical, we will answer all questions related to this analysis, the reasons for conducting it, and how to read its results accurately.

What is the normal percentage of ovarian reserve?

 

The normal percentage of AMH hormone level varies according to the woman's age. In general, the normal percentage of this hormone in a 35-year-old woman ranges between 1 and 3.5 nanograms per milliliter.

Can an AMH test be performed at home?

 

Yes, there are home tests available to measure AMH levels using a simple blood sample. However, it is preferable to consult a specialist doctor to interpret the results accurately, as fertility assessment requires comprehensive examinations.

What are the causes of high AMH hormone in the blood?

 

High levels of AMH in the blood may indicate increased fertility, but it may also be a sign of polycystic ovary syndrome. 

Should I fast before an AMH test?

 

No, the AMH test for women does not require fasting before the test.

Does taking birth control pills affect the results of the AMH test?

No, AMH is produced regularly by the ovarian follicles, and the AMH test is not affected by taking birth control pills.

Can diseases affect the results of the ovarian reserve test?

 

Yes, some diseases can affect the level of AMH in the blood and cause fluctuations in its levels. Some diseases may lead to an abnormal increase in this hormone, while other diseases can reduce its levels.

How can I know if my ovarian reserve is weak?

 

There are many symptoms that may indicate that the AMH hormone level is abnormal in the body, including obesity, early menopause, the appearance of pimples and acne on the face, abnormal hair growth on the face and body, in addition to breast shrinkage and other signs.

Does high AMH prevent pregnancy?

 

If the result of the ovarian reserve test shows a high level, this indicates that the woman has a good reserve of eggs. However, an increase in the AMH hormone level above the normal rate is a sign of polycystic ovary syndrome (PCOS), which may negatively affect the woman's reproductive ability and require treatment.

**The best time to perform an AMH test**

 

AMH levels remain relatively stable in the blood throughout the menstrual cycle, unlike the FSH hormone. Therefore, there is no specific date for performing an ovarian reserve test, and women can perform an AMH test on any day of the menstrual cycle. It is also not required to fast before performing this test, and taking birth control pills does not affect the results of the AMH test in any way.

**How ​​to do an AMH blood test**

 

A small amount of blood is drawn in the laboratory using a needle from a vein to perform an AMH test, which helps estimate the ovarian reserve. It is important to note that there are other tests to evaluate the ovarian reserve, and sometimes several tests are performed at the same time based on the recommendation of the infertility specialist, in order to make the final decision in this regard.

What is an ovarian reserve test?

 

An ovarian reserve test is considered one of the basic tests used to determine a woman's fertility level. If the results of this test are good, this is considered strong evidence of increased chances of pregnancy, as it helps to reassure the health of the ovary. This test measures the level of the AMH hormone, which is produced in the reproductive cells and secreted from the ovary, which gives an accurate picture of the ovarian reserve.

**What is the ideal time to perform an ovarian reserve test?**

 

The AMH test does not require any special considerations, as it can be done by drawing a blood sample from the arm at any time of the month, and does not require prior fasting.

**Normal values ​​for ovarian reserve**

The following values ​​represent normal ovarian reserve levels, but it should be noted that these values ​​vary according to age, as hormone levels peak in the twenties and begin to decline with age. The normal range is determined based on the woman's age as follows:

**Normal values ​​for ovarian reserve analysis level**

 

Normal values ​​for ovarian reserve analysis level include the following, according to age and general ratios:

**General ratios** Normal values ​​for ovarian reserve analysis level include the following according to general ratios:

- **Moderate:** Between 1.0 nanograms/ml (ng/mL) to 3.0 nanograms/ml.

- **Low:** Less than 1.0 nanograms/ml.

- **Very low:** 0.4 nanograms/ml.

**Levels by age**

Normal values ​​for ovarian reserve analysis level vary according to age as follows:

- Women in the age group (20-25): 3 nanograms/ml.

- Women aged (25-30): 2.5 ng/ml.

- Women aged (30-35): 1.5 ng/ml.

- Women aged (35-40): 1 ng/ml.

- Women aged (40-45): 0.5 ng/ml.

The normal range for anti-Mullerian hormone has been determined to be between 1 and 3 ng/ml, with values ​​greater than 4 or less than 1 considered abnormal.

**What is AMH test?**

 

AMH test is a test used to assess ovarian reserve in women. AMH levels naturally decrease with age, and must be greater than 1 ng/ml to achieve pregnancy naturally. Higher levels than normal may indicate polycystic ovary syndrome.

**What is Anti-Müllerian Hormone (AMH)?**

 

AMH, also known as anti-Müllerian hormone, is a protein hormone produced in females after puberty by the granulosa cells in the primary follicles of the ovary. This hormone is produced by follicles that have passed the primitive stage but have not yet reached a diameter of 6 mm, mmIt reflects the level of ovarian reserve and the percentage of ovarian follicles in the growth phase.

AMH is not secreted by ovarian follicles that exceed 8 mm in diameter, which makes its levels in the blood somewhat constant. The rate of this hormone decreases with age, due to the gradual loss of the ovary's reserve. The level of AMH in the blood also increases in the presence of a large number of ovarian follicles.

***Causes of low egg reserve***

There are many factors that lead to low egg reserve, the most prominent of which are:

- Removal of one or both ovaries.

- The significant effect of radiation therapy on the egg reserve.

- Surgery on one of the ovaries.

- The effect of chemotherapy for tumors on the eggs.

- The presence of an infection inside the uterus.

- Suffering from autoimmune diseases that cause the body to attack the eggs.

- Practicing unhealthy habits such as smoking and drinking alcohol.

- The presence of genetic disorders that affect the eggs.

- Endometriosis.

- Increasing age is considered one of the main causes of low egg count.

What is the role of AMH hormone in fertility?

 

The results of the AMH hormone test provide women with information about the possibility of fertilization and reproductive capacity. Fertilization occurs when the egg is released from the follicle in the ovary and moves to the fallopian tube, where it meets the sperm.

The ovary contains a large number of follicles that contain small sacs, each of which contains immature eggs. The female is born with a specific number of follicles in her ovaries, and a large number of them are destroyed before reaching puberty. After the start of the first menstrual cycle, the ovary begins to produce one mature egg every month, as it exits its follicle and heads towards the uterus through one of the fallopian tubes, at a rate of approximately every 28 days. Pregnancy occurs when the egg meets the sperm and fertilization occurs. If this does not happen, the uterus bleeds menstrual blood after several days, to start a new menstrual cycle.

What are the uses of the AMH test?

 

AMH analysis is performed for women to evaluate and diagnose a range of issues related to the reproductive system and fertility. Some of these uses include:

- Evaluating the overall health of the ovaries, ovarian reserve, and the condition of the ovarian follicles during fertility treatment.

- Diagnosing polycystic ovary syndrome, also known as ovarian laziness.

- Evaluating ovarian cancer and its response to treatment.

- Evaluating problems related to the fetus and determining its sex.

- Predicting the approach of menopause.

- Investigating the causes and factors of early menopause.

- Diagnosing the underlying causes of delayed menstruation until the age of 15 and menopause after that.

- Diagnosing the causes of menstrual disorders in some women.

- Evaluating the performance of the testicles in male newborns.

- Knowing the causes of the disappearance or deficiency of the testicle in male newborns.

- Diagnosing the causes of the appearance of masculine characteristics in females, such as increased hair growth or a deep voice, etc.

**Ovarian Reserve Analysis**

The results of the ovarian reserve analysis can be interpreted in cooperation with a specialist doctor, as each result indicates a specific meaning. For example, if the analysis result ranges between 0.7 and 3.5 nanograms, this indicates that the ovary is functioning properly and producing a normal amount of hormones. If the result is higher than 5 nanograms, it may indicate the presence of cysts on the ovary, or it may be a positive sign that increases the chances of pregnancy. On the other hand, if the result is less than 0.3 nanograms, it may indicate the approaching menopause, or indicate a negative impact on fertility rates and difficulty getting pregnant.

Why does the doctor request an ovarian reserve analysis?

 

An anti-Mullerian hormone (AMH) analysis is usually recommended for women who are under 38 years of age and wish to postpone childbearing. If the AMH test results are very low, the doctor may recommend the need to expedite the decision to have children. As for women over 40, they usually have low levels of AMH, so they are not routinely asked to have an ovarian reserve test.

There are also other cases that require this test, such as:

- Women with a family history of ovarian failure

- Women with autoimmune diseases

- Women receiving chemotherapy

- Women who have undergone previous ovarian surgeries

**How ​​to perform an ovarian reserve test**

 

To obtain the most accurate and best results, the following steps must be followed:

1. It is necessary to draw a sample on the third day of the menstrual cycle to perform an FSH and estradiol test.

2. Clomiphene should be taken on the fifth day of the cycle for up to 5 days, then measure the levels of FSH and estradiol hormones on the tenth day of the start of menstruation.

**Reasons for Ovarian Reserve Test**

 

Ovarian reserve testing is done for two main reasons: to diagnose the causes of infertility in women and to assess the response of the ovaries to treatments used in assisted reproductive technologies.

**Details of reasons:**

1. **Diagnosis of low ovarian reserve:**   Ovarian reserve testing helps determine whether a low egg count is the cause of infertility in women. This test is often done in the following cases:

- If the woman is older than 35 years and has not been able to get pregnant after 6 months or more of trying. 

- If the woman is younger than 35 years and has not been able to get pregnant after 12 months or more of trying. 

- If she suffers from disorders that affect her fertility, such as polycystic ovary syndrome.

***Success of fertility treatment in assisted reproductive technologies**

 

Ovarian reserve testing is done for women who are planning to undergo one of the assisted reproductive technologies, such as artificial insemination (IVF), where fertility drugs are used to stimulate the ovaries.

Having a good supply of eggs is essential for a woman to respond to fertility treatments. Therefore, ovarian reserve testing can help assess a woman’s ability to respond to these treatments, helping in decision-making.Whether it is appropriate for her to undergo assisted reproductive techniques.

In addition, knowing a woman’s response to fertility drugs can help determine the possibility of egg freezing. A number of eggs are extracted from the woman and frozen for preservation, allowing the couple to use them later when they want to have children.

**Things that AMH analysis cannot predict**

 

We discussed the importance of ovarian reserve analysis and its role in assessing ovarian function. However, we must be aware that there are some things that this analysis cannot reveal, such as:

Fertility rate: Ovarian reserve analysis cannot accurately determine your fertility level, as this depends on many other factors. Therefore, it cannot be relied upon alone to know whether you are able to get pregnant or if there are reasons leading to infertility.

Date of menopause: The value of the AMH analysis cannot be used to determine a specific date for menopause, but it gives a general idea of ​​the condition of the ovaries.

Egg quality: The analysis indicates the number of eggs remaining in the ovary, but it does not provide information about the quality of these eggs or their ability to fertilize.

**Tests related to the ovarian reserve examination**

 

The ovarian reserve examination includes a set of tests and examinations, the most prominent of which are:

**Anti-Müllerian hormone analysis** Anti-Müllerian hormone is a hormone produced by the granulosa cells in the ovarian follicles, which are small fluid-filled sacs located in the ovaries. The analysis of this hormone is considered one of the most reliable ways to assess the ovarian reserve, as the hormone levels are related to the number of eggs available in the ovary. Low levels of this hormone indicate a low ovarian reserve. To perform this examination, a blood sample is taken from the woman at any time during the menstrual cycle, and then the sample is sent to the laboratory to measure the level of anti-Müllerian hormone.

As you age, your ovarian reserve decreases, which also leads to lower levels of anti-Müllerian hormone, and these levels may become undetectable at menopause and beyond.

**Follicle Stimulating Hormone**  Follicle stimulating hormone is a key hormone that plays a role in regulating the menstrual cycle and egg production in women, as it is secreted by the pituitary gland. Therefore, an ovarian reserve test may include an analysis of this hormone levels. High levels of follicle stimulating hormone often indicate a decrease in a woman’s ovarian reserve. It is normal for this hormone levels to increase with age, but if the percentage is higher than the normal rates for women in the same age group, this may indicate a decrease in ovarian reserve. Since follicle stimulating hormone levels fluctuate throughout the menstrual cycle, this test is usually performed on the third day of the cycle.

Follicle stimulating hormone testing is an easy and inexpensive test for ovarian reserve, but because its levels change constantly, it cannot be relied upon alone. Therefore, doctors often prefer to perform additional tests, such as an anti-Müllerian hormone test, to obtain a comprehensive assessment.

**Estradiol Test** An ovarian reserve test may include an estradiol test, as high levels of estradiol are an indicator of a woman’s low ovarian reserve. Since estradiol levels fluctuate throughout the menstrual cycle, it is usually best to perform this test on day 3 of the cycle, in conjunction with an FSH test. However, it should be noted that high estradiol levels can mask normal FSH results, meaning that the level of this hormone cannot be relied upon to accurately determine ovarian reserve. Therefore, doctors often use an estradiol test in combination with an FSH test and other types of ovarian reserve tests to get a comprehensive picture of a woman’s fertility.

**Antral Follicle Count** Antral Follicle Count is performed using transvaginal ultrasound to measure the number of follicles in the ovaries during the early follicular phase. In general, a high follicle count indicates an increased egg reserve.

The antral follicle count is considered one of the best tests for detecting poor ovarian response during fertility treatments, compared to other tests such as measuring ovarian volume, FSH, or estradiol.

**Clomiphene Citrate Challenge Test**

In the Clomiphene Citrate Challenge Test, a woman’s FSH and estradiol levels are measured before and after she is given clomiphene.

The steps for performing this test for ovarian reserve include:

1. Taking a blood sample from the woman on day 3 of her menstrual cycle to measure FSH and estradiol levels.

2. Administering a 100 mg dose of clomiphene.

Retaking a blood sample on day 10 to measure both FSH and estradiol levels.

An increase in FSH levels, whether before or after taking clomiphene, or both, indicates a low ovarian reserve, which means that the ovaries will be less responsive to fertility treatments.

**Ovarian Reserve Test** Ovarian reserve testing helps determine a woman’s fertility and provides important information about the optimal time to try to conceive.

There is no set range for a normal AMH level, but an AMH level of less than 0.5 nanograms per milliliter is considered very low, meaning that it may be difficult to find more than two or three ovarian follicles in this case.

AMH levels between 0.5 and 1 nanogram per milliliter indicate that the ovaries have minimal reserve, allowing for a limited number ofEggs.

AMH levels ranging from 1 to 3.5 nanograms indicate a natural ovarian reserve, which enhances the response to treatment better.

When AMH levels are high, i.e. exceeding 3.5 nanograms, this indicates an over-response of the ovaries to stimulation and fertility medications. Therefore, it is necessary to follow the doctor's instructions regarding the appropriate dosage, as they vary based on the woman's age and health condition.

The appearance of male signs in women may be a result of excessive production of the AMH hormone, which may result from the presence of a tumor in the body or other conditions.

**Treatment of low ovarian reserve**

 

When there is a decrease in ovarian reserve, it may become difficult, if not impossible, to find treatment or medications to increase the number of eggs in women. However, if it is found that the woman suffers from a weak ovarian reserve and wants to have children, doctors begin to develop a treatment plan to achieve pregnancy, such as using medications to stimulate the ovaries. Treatment of low ovarian reserve is related to several factors, including:

- The couple's desire to get pregnant.

- Their available budget.

- The number of children they want to have.

Artificial insemination is one of the most prominent treatments for cases of weak ovarian reserve, despite its high cost. The success of this procedure often depends on the woman's age, in addition to the reasons for the low number of eggs and their response to fertility treatment. Although ovarian reserve analysis is not the only factor that determines a woman's fertility and the possibility of pregnancy, it is an important factor that guides the rest of the examination and treatment steps. Therefore, its results must be accurate and correct. Delta Laboratories provides the latest devices and the best doctors to ensure the best and most accurate results.

**Ways to protect ovarian reserve**

 

After discussing how to increase ovarian reserve, we now present some strategies that contribute to protecting the egg reserve inside the ovary:

1. **Providing oxygen to the body's cells**: By treating anemia, the body's oxygen supply can be improved.

2. **Eating foods rich in omega-3**: These fatty acids play an important role in maintaining general health. It is recommended to consume between 1000 and 2000 milligrams of omega-3 daily.

3. **Maintain a healthy weight**: Obesity negatively affects the number of eggs, so it is important to maintain an appropriate weight.

4. **Follow a balanced diet and exercise**: It is preferable to exercise regularly, at a rate of no less than three times a week.

5. **Prevent sexually transmitted diseases**: These diseases can greatly affect the number of eggs, so the necessary precautions must be taken.

6. **Conduct periodic examinations**: to follow up on any possible infections with sexually transmitted diseases.

7. **Practice relaxation techniques**: such as meditation, to help reduce stress and anxiety.

8. **Take vitamin A**: as it enhances the health of the ovaries and contributes to maintaining fertility.