What this test measures
The AMH Plus Premium panel measures four reproductive hormones in a single draw:
• Anti-Müllerian Hormone (AMH) — produced by small antral follicles in the ovary, the single best biochemical marker of ovarian reserve. • Follicle Stimulating Hormone (FSH) — the pituitary signal driving follicle growth; rises as ovarian reserve declines. • Luteinising Hormone (LH) — the pituitary surge that triggers ovulation; often raised in PCOS. • Estradiol (E2) — the principal oestrogen made by growing follicles; gives the baseline ovarian activity.
Together, these markers provide both the inputs (FSH, LH) and outputs (AMH, E2) of the female reproductive axis.
Why it matters
Indian women face a real-world infertility prevalence of 10–15% and, demographically, are marrying and trying to conceive later. The AMH Plus panel is the standard "ovarian reserve" workup used at fertility clinics across India because it answers three practical questions at once: how many eggs are left (AMH, antral count), how hard is the pituitary working to recruit them (FSH, LH), and is the basal oestrogen environment normal (E2).
The LH/FSH ratio in this panel is also one of the most useful patient-facing clues to Polycystic Ovary Syndrome (PCOS), which affects 1 in 5 Indian women of reproductive age.
How to prepare
AMH can be tested on any cycle day. FSH, LH and Estradiol are most informative on cycle day 2 or 3 (early follicular phase) — schedule the draw accordingly. Fasting is not required. Stop biotin / hair-skin-nail supplements 48–72 hours before. If you are on hormonal contraception or HRT, tell your doctor — these can suppress FSH/LH and lower the AMH reading slightly. Continue other medications.
Markers & reference ranges
Reference ranges below are typical adult values. Your lab's reported range may differ slightly based on the assay platform and patient demographics — always read your report against the range printed on it.
| Marker | Normal range | If low | If high |
|---|---|---|---|
| Anti-Müllerian Hormone (AMH) (ng/mL)[1] | 1.0 – 4.0 ng/mL (reproductive-age woman; declines with age) | < 1.0 ng/mL suggests low ovarian reserve. < 0.5 ng/mL is severely diminished and typically requires aggressive ovarian-stimulation protocols for IVF. | > 4.0 ng/mL is commonly seen in PCOS and predicts an exaggerated response to ovulation induction — a higher risk of OHSS during IVF. |
| Follicle Stimulating Hormone (FSH) (mIU/mL)[1] | Follicular: 3.5 – 12.5 · Mid-cycle peak: 4.7 – 21.5 · Luteal: 1.7 – 7.7 · Postmenopausal: 25.8 – 134.8 | Low FSH suggests hypothalamic or pituitary disease (functional hypothalamic amenorrhoea from low body weight or stress, pituitary tumour or Sheehan's). | Raised early-follicular FSH (> 10 mIU/mL) suggests diminished ovarian reserve. > 25 mIU/mL with absent periods is consistent with premature ovarian insufficiency or menopause. |
| Luteinising Hormone (LH) (mIU/mL)[1] | Follicular: 2.4 – 12.6 · Mid-cycle peak: 14 – 95 · Luteal: 1.0 – 11.4 · Postmenopausal: 7.7 – 58.5 | Low LH with low FSH suggests hypogonadotropic hypogonadism — pituitary or hypothalamic problem. | An LH:FSH ratio > 2:1 in the early follicular phase is suggestive of PCOS (along with the clinical and ultrasound criteria). Very high LH (> 25) without a recent ovulation is consistent with primary ovarian failure. |
| Estradiol (E2) (pg/mL)[1] | Follicular: 12.5 – 166 · Mid-cycle: 85.8 – 498 · Luteal: 43.8 – 211 · Postmenopausal: < 54.7 | Low E2 in the follicular phase along with low FSH/LH suggests hypothalamic-pituitary disease. Persistently low E2 with high FSH indicates ovarian failure. | Raised baseline E2 (> 80 pg/mL on cycle day 2/3) can falsely suppress FSH and indicates premature follicular recruitment — a marker of declining reserve. |
AMH Plus — common patterns
| AMH | FSH (d2/3) | LH:FSH | E2 (d2/3) | Likely picture |
|---|---|---|---|---|
| Normal (1–4) | Normal (< 10) | < 2 | Normal | Normal ovarian reserve |
| Low (< 1) | High (> 10) | Variable | Normal/high | Diminished ovarian reserve |
| Very low (< 0.5) | Very high (> 25) | Variable | Low | Premature ovarian insufficiency / menopause |
| High (> 4) | Normal/low | > 2 | Normal | PCOS — high reserve, anovulation |
| Normal/low | Low | Low | Low | Hypogonadotropic hypogonadism (stress, low BMI, pituitary) |
Frequently asked questions
When in my cycle should I do this panel?
AMH can be done on any day. FSH, LH and E2 are best on cycle day 2 or 3 (counting day 1 as the first day of full flow). If you do not have regular cycles, your doctor will pick a convenient day and interpret accordingly.
I am planning IVF — why does my clinic want all four together?
IVF clinics use the panel as one snapshot of "ovarian reserve and HPG axis". AMH predicts how many eggs are likely to be retrieved; FSH/E2 confirm the early-follicular environment; LH:FSH ratio flags PCOS, which changes the stimulation protocol and OHSS risk.
What does it mean if my LH/FSH ratio is > 2?
In a woman with irregular periods, acne or hirsutism, an LH:FSH ratio above 2:1 is one of the supportive markers for PCOS. It is not diagnostic on its own — your doctor will combine it with ultrasound and clinical signs.
Will hormonal contraception change my AMH?
Combined oral contraceptive pills can lower AMH by 20–30%. Levels return to baseline 3–6 months after stopping. Mention any hormonal medicines on the requisition.
I am 35 and my AMH is 0.7 — does that mean I cannot have a baby?
No. AMH predicts how the ovary will respond to stimulation, not whether you can conceive naturally. Plenty of women with low AMH conceive spontaneously. It does mean fertility is more time-sensitive — discuss with a reproductive endocrinologist.
How often should this panel be repeated?
Annually if you are planning to delay pregnancy or are in active fertility workup, every 6 months on ovulation-induction cycles, and as your fertility clinic prescribes during IVF.
Why is biotin a problem for these tests?
High-dose biotin (in many "hair, skin and nail" supplements) interferes with the chemiluminescent immunoassays used for AMH, FSH, LH and E2. Stop 48–72 hours before testing.
Related Hormones / Endocrine tests
Tests commonly ordered alongside AMH Plus premium, or that help interpret an unexpected result.
Sources & references
- ESHRE — Ovarian Stimulation for IVF Guideline · accessed 2026-05-30T00:00:00.000Z
- NIH MedlinePlus — AMH Test · accessed 2026-05-30T00:00:00.000Z
- ASRM — Testing and Interpreting Measures of Ovarian Reserve · accessed 2026-05-30T00:00:00.000Z
- NCBI StatPearls — Anti-Mullerian Hormone · accessed 2026-05-30T00:00:00.000Z
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