AMH Levels & Fertility: Understanding Tests & the Results
Struggling with your fertility is an all consuming journey and there is no shortage of tips, tricks, and tests to help you understand what’s going on with your body. One test you’re definitely going to want to pay attention to on your fertility journey is your anti-mullerian hormone (AMH) levels.
AMH is an important indicator of female fertility and can tell you a lot about your reproductive health status. Keep reading to discover everything you need to know about your AMH levels and what they have to say about your overall fertility.
What is AMH?
Anti-mullerian hormone, or AMH, is a protein hormone found in both males and females. This hormone is produced in reproductive tissues.
Soon after conception, a baby starts developing reproductive organs aligned with their genes. Males have higher levels of AMH, which keeps female sex organs from developing. In females, AMH levels start low to allow for reproductive organs to develop.
As a female enters puberty, the role of AMH changes. At this point, the ovarian follicles begin making AMH. The more egg cells that are made, the higher the level of AMH.
For females, the level of AMH in the blood can help your doctor estimate the number of follicles in the ovaries and your overall egg count. Thus, your AMH levels are a good indicator of ovarian reserve.
What Are AMH Levels?
Testing the level of AMH in your blood is a reliable indicator of your ovarian reserve. While your AMH levels don’t change much throughout your menstrual cycle, they do change as you age. In females, AMH levels rise throughout childhood and peak right before puberty. As a woman progresses through her most fertile years, her level of AMH gradually decreases alongside her ovarian reserve.
As you enter puberty and your reproductive years, your egg count and AMH begin to drop. After age 25, you begin to lose eggs at a higher rate. Again, at 30 and 35, the loss becomes more rapid until you reach menopause and your egg count reaches zero. As your egg count goes down, so do your AMH levels, making this an important hormone to track if you are trying to conceive.
AMH Changes Over Time
AMH levels are important to monitor over time because they reflect the size of our ovarian reserve, or the number of healthy eggs we have to be fertilized. This is an accurate measure of ovarian function because only healthy, functional follicles produce AMH.
Studies show that AMH correlates well to the number of follicles in the ovaries. Even so, AMH levels vary widely between women and across age groups. Your AMH levels do change over time, though they remain fairly stable throughout most of your menstrual cycle.
In women ages 18-24 with normal AMH levels, this number does not change much from month to month, though it can fluctuate. Women with high AMH levels have been found to have large fluctuations in their AMH measurements over time, while women with low AMH have been found to have smaller fluctuations. Because AMH levels are higher in younger women, this means that younger women may have greater fluctuations in their AMH levels than older women.
The most significant changes in AMH, however, occur as you age. Read on to learn more about how your AMH levels change as you age — and what that means for your fertility.
AMH Levels by Age
We already know that our egg reserves decline as we get older. Correspondingly, research clearly demonstrates that AMH levels decrease steadily as women age. One study of women between the ages of 26 and 45 confirmed that AMH levels were negatively associated with age — and that is just one of many studies we have to support this conclusion.
Normal AMH levels for healthy women by age are estimated to be:
AMH’s Role in Fertility
AMH levels can help you determine the best time to start trying for a baby. Not only do women’s AMH levels vary by age, but they also vary widely between women. Thus, you may already have a low AMH level — and given that your AMH will steadily decline as you age, you may want to start trying to conceive before your biological clock starts ticking away.
AMH & Ovarian Reserve
As we’ve mentioned previously, AMH levels are a relatively accurate reflection of your ovarian reserve — or the number of healthy eggs you have stored in your ovaries. We already know that the number of healthy eggs decreases with age, most significantly after age 35. Thus, you can reasonably expect that your AMH will decline with age, too.
AMH & Infertility
Your doctor may measure your AMH level if you are having trouble getting pregnant naturally to determine if you might be suffering from diminished ovarian reserve or another condition affecting fertility. A normal AMH level for fertile women is 1-4 ng/mL. Levels less than 1 ng/mL or greater than 4 ng/mL might indicate an underlying health condition, which we’ll talk more about later in this article.
AMH & Miscarriages
As we mentioned previously, a low AMH level of less than 1 ng/mL may mean that you are suffering from infertility. Low AMH levels may also increase your risk of having a miscarriage once you are pregnant. One study found that women with an AMH level of 0.4 ng/mL or lower had a higher risk of miscarriage over time. In this study, the most significant increase in risk for pregnant women occurred between six and seven weeks gestation.
Understanding AMH Tests
So, how can you tell what your AMH level actually is? The answer is simple: your doctor can measure your AMH with a simple blood test. Once you get the results, they will interpret them to let you know whether your AMH levels are high, low, or normal. But first, let’s talk more about what the results of an AMH test actually mean.
How do you test for AMH levels?
First, let’s talk about the AMH testing process. An AMH blood test is a simple, low-risk procedure. It requires no special preparation (i.e. fasting) and should take less than five minutes in a trained laboratory. The lab technician will prepare you for the blood test by identifying a vein, cleaning the area with alcohol, and using a tourniquet to temporarily increase blood flow to the area. As with any blood test, you may feel a slight sting when the needle is inserted. Otherwise, the risks are low, including bruising and feeling faint.
What is AMH testing used for?
Besides identifying your current egg count, AMH levels can also be used to diagnose or predict several conditions:
- The reasons behind early menopause
- The causes for amenorrhea
- Help diagnose polycystic ovary syndrome (PCOS)
- Monitor the health of women suffering from certain ovarian cancers
- Predict the start of menopause
Testing for AMH levels is very common when working with a fertility specialist. If your levels are found to be lower than what is considered appropriate for your age group, you will be considered to have diminished ovarian reserve. Your doctor may recommend egg freezing if you aren’t ready to get pregnant, or other fertility treatments if you are currently trying to conceive.
Knowing your AMH levels can help understand your chances at successfully using assisted reproductive technology (ART) for conception. For example, if you have normal levels for your age, there is a higher chance that a larger number of eggs will be retrieved for freezing or IVF. Understanding your AMH levels is only one piece of the puzzle, but it gives you important information to help make your fertility plan.
Remember, your AMH levels give you a picture of what your current ovarian reserve looks like. It cannot be used to indicate what it will look like in the future or how quickly the number of eggs available will change. However, it is a great starting point for conversations with your doctor about your fertility plans.
Low AMH: What it means
Your AMH levels are a representation of your ovarian reserve. Because AMH levels naturally decrease as you age, your doctor should interpret your results by comparing them to the average numbers for your age group.
If your AMH levels are lower than your doctor would expect for your age, it may mean that you have fewer eggs than other women in your age group. This condition — known as diminished ovarian reserve — can create challenges with infertility.
High AMH: What it means
You might think that high AMH is a good thing. After all, doesn’t that mean you have more eggs in your ovarian reserve? If your AMH levels are higher than expected for your age group, that may be true: high AMH may mean you have more time to get pregnant since your ovarian reserve is greater. But in some cases, dramatically high AMH levels can indicate a condition called polycystic ovarian syndrome (PCOS), which causes many follicles to grow on the ovaries.
Despite high AMH levels, women with PCOS often struggle with infertility. This is because mature follicles, those that are capable of releasing an egg, produce AMH. Women with PCOS have more mature follicles than other women. However, because not all of these follicles can release an egg, the extras often become ovarian cysts instead. Thus, while a woman with PCOS may have higher AMH, these levels do not necessarily mean she has a higher ovarian reserve.
We’ve talked a lot about AMH, including how your AMH levels are measured, what high and low levels mean, and how AMH impacts fertility. Still, you may have lingering questions about AMH and what it means for your journey toward conception. Here, we answer your burning FAQs about AMH.
Can I get pregnant with low AMH?
You can get pregnant with AMH, but you may need help from ART to do so. It is possible to get pregnant naturally with low AMH, but it’s less likely. Those that have low AMH are more likely to need fertility treatments to conceive and your AMH levels can be used as an indicator for your chances of success with treatments such as IVF.
If you already have fewer eggs to retrieve for treatments, your chances of successfully using those eggs are lower than if you had a large number of eggs. That being said, every woman is different. For some women with low AMH, it’s still possible to get pregnant without any intervention.
How can you increase your AMH levels?
As of right now, there is no proven way to increase your AMH levels. Some studies suggest that consuming more vitamin D and DHEA, whether through food or supplements, can help raise your AMH. However, there is no indication that increasing your AMH level will actually help you get pregnant. There is no way to completely stop your eggs from aging (besides freezing them), though you can slow the process through healthy lifestyle choices. Once your eggs are gone, however, there is no way to get them back. Thus, increasing your AMH levels won’t necessarily increase your ovarian reserve or make you more likely to get pregnant.
What are the causes of low AMH?
Diminished ovarian reserve most often happens with age, but it can occur earlier than expected in some women. Some reasons why a woman may begin to lose eggs at a higher rate in her 20s or 30s include:
- Genetics. Your genes could play a part in why you are losing eggs at a faster rate than the average population.
- Medical conditions. Chronic illnesses such as endometriosis and some autoimmune disorders can lead to lower ovarian reserve.
- Surgery on the ovaries. Surgery on the ovaries for certain reproductive health conditions can occasionally lead to scarring or damage, resulting in diminished ovarian reserve.
Should you get an AMH test?
You will likely get an AMH test if you decide to visit a fertility specialist for assistance getting pregnant. Women who are under 35 and have been trying to get pregnant naturally for one year, or women over 35 who have been trying for six months, should see a fertility specialist if they do not have success.
Your doctor might also want to test your AMH if you are having symptoms of perimenopause or menopause. AMH levels can be used to predict when you are approaching and/or entering menopause, indicating that you are no longer fertile.
✔️ Medically Reviewed by Banafsheh Kashani, MD, FACOG
Banafsheh Kashani, M.D., FACOG is a board-certified OB/GYN and specialist in reproductive endocrinology and infertility at Eden Fertility Centers, and has been treating couples and individuals with infertility since 2014. Prior to joining Eden Centers for Advanced Fertility, she was practicing as a top fertility specialist at Kaiser Permanente in Orange County and Reproductive Fertility Center. Dr. Kashani has received numerous awards throughout her years of study and medical training.
Dr. Kashani has conducted extensive research in female reproduction, with a specific focus on the endometrium and implantation. Additionally, Dr. Kashani has authored papers in the areas of fertility preservation, and fertility in women with PCOS and Turners syndrome. She also was part of a large SART-CORS study evaluating the trend in frozen embryo transfers and success rates.
Dr. Kashani is a fellow of the American Congress of Obstetricians and Gynecologists. In addition, she is a diplomat of the American Board of Obstetrics and Gynecology and an active member of the American Society of Reproductive Medicine (ASRM) and Pacific Coast Reproductive Society (PCRS). She is also a member of the Society of Reproductive Endocrinology and Infertility (SREI).