Test ID: AMH
Antimullerian Hormone (AMH), Serum
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Assessment of menopausal status, including premature ovarian failure
Assessing ovarian status, including follicle development, ovarian reserve, and ovarian responsiveness, as part of an evaluation for infertility and assisted reproduction protocols such as in vitro fertilization
Assessing ovarian function in patients with polycystic ovarian syndrome
Evaluation of infants with ambiguous genitalia and other intersex conditions
Evaluating testicular function in infants and children
Diagnosing and monitoring patients with antimullerian hormone-secreting ovarian granulosa cell tumors
Method Name A short description of the method used to perform the test
Immunometric Assay
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Mullerian-inhibiting hormone (MIH)
Mullerian-inhibiting substance (MIS)
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Specimen Volume: 0.2 mL
Forms: If not ordering electronically, submit a General Request Form (Supply T239) with the specimen.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross reject acceptable to 1,000 mg/dL |
| Lipemia | Mild OK, Gross needs to be spun |
| Icterus | Mild OK, interpret with caution; Gross reject |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum | Refrigerated (preferred) | 7 days |
| Frozen | 90 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Antimullerian hormone (AMH), also known as mullerian-inhibiting substance, is a dimeric glycoprotein hormone belonging to the transforming growth factor-beta family. It is produced by Sertoli cells of the testis in males and by ovarian granulosa cells in females. Expression during male fetal development prevents the mullerian ducts from developing into the uterus and other mullerian structures, resulting in normal development of the male reproductive tract. In the absence of AMH, the mullerian ducts and structures develop into the female reproductive tract. AMH is also expressed in the follicles of females of reproductive age and inhibits the transition of follicles from primordial to primary stages. Follicular AMH production begins during the primary stage, peaks in the preantral and small antral stages, and then decreases to undetectable concentrations as follicles grow larger.
AMH serum concentrations are elevated in males under 2 years old and then progressively decrease until puberty, when there is a sharp decline. By contrast, AMH concentrations are low in female children until puberty. Concentrations then decline slowly over the reproductive lifespan as the size of the pool of remaining microscopic follicles decreases. AMH concentrations are frequently below the detection limit of current assays after natural or premature menopause.
Because of the gender differences in AMH concentrations, its changes in circulating concentrations with sexual development, and its specificity for Sertoli and granulosa cells, measurement of AMH has utility in the assessment of gender, gonadal function, fertility, and as a gonadal tumor marker. Since AMH is produced continuously in the granulosa cells of small follicles during the menstrual cycle, it is superior to the episodically released gonadotropins and ovarian steroids as a marker of ovarian reserve. Furthermore, AMH concentrations are unaffected by pregnancy or use of oral or vaginal estrogen- or progestin-based contraceptives.
Studies in fertility clinics have shown that females with higher concentrations of AMH have a better response to ovarian stimulation and tend to produce more retrievable oocytes than females with low or undetectable AMH. Females at risk of ovarian hyperstimulation syndrome after gonadotropin administration can have significantly elevated AMH concentrations. Polycystic ovarian syndrome can elevate serum AMH concentrations because it is associated with the presence of large numbers of small follicles.
AMH measurements are commonly used to evaluate testicular presence and function in infants with intersex conditions or ambiguous genitalia, and to distinguish between cryptorchidism (testicles present but not palpable) and anorchia (testicles absent) in males. In minimally virilized phenotypic females, AMH helps differentiate between gonadal and nongonadal causes of virilization.
Serum AMH concentrations are increased in some patients with ovarian granulosa cell tumors, which comprise approximately 10% of ovarian tumors. AMH, along with related tests including inhibin A and B (#81049 Inhibin A, Tumor Marker, Serum; #88722 Inhibin B, Serum, #86336 Inhibin A and B, Tumor Marker, Serum), estradiol (#81816 Estradiol, Serum), and CA-125 (#9289 Cancer Antigen 125 (CA 125), Serum), can be useful for diagnosing and monitoring these patients.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Males
<24 months: 14-466 ng/mL
24 months-12 years: 7.4-243 ng/mL
>12 years: 0.7-19 ng/mL
Females
<24 months: <4.7 ng/mL
24 months-12 years: <8.8 ng/mL
13-45 years: 0.9-9.5 ng/mL
>45 years: <1.0 ng/mL
Interpretation Provides information to assist in interpretation of the test results
Menopausal women or women with premature ovarian failure of any cause, including after cancer chemotherapy, have very low antimullerian hormone (AMH) levels, often below the current assay detection limit of 0.25 ng/mL.
While the optimal AMH concentrations for predicting response to in vitro fertilization are still being established, it is accepted that AMH concentrations in the perimenopausal to menopausal range (0-0.6 ng/mL) indicate minimal to absent ovarian reserve. Depending on patient age, ovarian stimulation is likely to fail in such patients and most fertility specialists would recommend going the donor oocyte route. By contrast, if serum AMH concentrations exceed 3 ng/mL, hyper-response to ovarian stimulation may result. For these patients, a minimal stimulation would be recommended.
In patients with polycystic ovarian syndrome, AMH concentrations may be 2 to 5 fold higher than age-appropriate reference range values. Such high levels predict anovulatory and irregular cycles.
In children with intersex conditions, an AMH result above the normal female range is predictive of the presence of testicular tissue, while an undetectable value suggests its absence.
In boys with cryptorchidism, a measurable AMH concentration is predictive of undescended testes, while an undetectable value is highly suggestive of anorchia or functional failure of the abnormally sited gonad.
Granulosa cell tumors of the ovary may secrete AMH, inhibin A, and inhibin B. Elevated levels of any of these markers can indicate the presence of such a neoplasm in a woman with an ovarian mass. Levels should fall with successful treatment. Rising levels indicate tumor recurrence/progression.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Like all laboratory tests, antimullerian hormone (AMH) measurement alone is seldom sufficient for diagnosis and results should be interpreted in the light of clinical findings and other relevant test results, such as ovarian ultrasonography (in fertility applications, this would include an antral follicle count), abdominal or testicular ultrasound (intersex/testicular function applications) and measurements of sex steroids (estradiol, testosterone, progesterone), follicle-stimulating hormone (FSH), inhibin B (for fertility), and inhibin A and B (for tumor workup).
Elevated AMH is not specific for malignancy, and the assay should not be used exclusively to diagnose or exclude an AMH-secreting ovarian tumor.
This assay demonstrates no cross reactivity with transforming growth factor beta-1, activin A, inhibin A or B, luteinizing hormone alpha or beta, FSH, thyroid-stimulating hormone, or insulin-like growth factor-1. However, although unlikely, there might be cytokines that have not been evaluated for cross reactivity that do cross react, resulting in false-elevations.
As with other immunoassays, the AMH assay can be susceptible to false-low results at extremely high analyte concentrations (hooking effect) or in the hypothetical scenario of the presence of anti-AMH autoantibodies in a patient serum specimen.
Heterophilic antibody interferences that are not blocked by the assay’s blocking regents may also rarely occur, causing typically false-high results. If test results are incongruent with the clinical picture, the laboratory should be contacted.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. La Marca A, Broekmans FJ, Volpe A, et al: ESHRE Special Interest Group for Reproductive Endocrinology-AMH Round Table. Anti-Mullerian hormone (AMH): what do we still need to know? Hum Reprod 2009 Sep;24(9):2264-2275
2. Broer SL, Mol BW, Hendriks D et al: The role of antimullerian hormone in prediction of outcome after IVF: comparison with the antral follicle count. Fertil Steril 2009 Mar;91(3):705-714
3. Rey R: Anti-Mullerian hormone in disorders of sex determination and differentiation. Arq Bras Endocrinol Metabol 2005 Feb;49(1):26-36
4. La Marca A, Volpe A: The Anti-Mullerian hormone and ovarian cancer. Hum Reprod Update 2007 May-Jun;13(3):265-273
Method Description Describes how the test is performed and provides a method-specific reference
This test is performed by enzymatically amplified 2-site immunoassay using the Beckman Coulter Generation II kit. Samples, controls, and calibrators are incubated in microtiter wells coated with anti-antimullerian hormone (anti-AMH) antibody. After incubation and washing, biotin-labeled anti-AMH antibody is added. Streptavidin-horseradish peroxidase is added after a second incubation and wash. After a third incubation and wash, the substrate tetramethylbenzidine is added. Dual wavelength absorbance measurement at 450 nm and between 600 and 630 nm is directly proportional to the concentration of AMH in the sample.(Package insert: Beckman Coulter, Inc., Fullerton, CA, 2009)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday; Varies
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
83520
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 89711 | Antimullerian Hormone, S | 38476-8 |
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