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Anti-mullerian hormone (AMH) is an essential player in human reproduction. It shows how many eggs are left in the ovaries. But even if your AMH levels are low, it doesn’t mean you can’t get pregnant. After all, it only takes one good egg to make a baby. Here’s what your AMH levels can and can’t tell you about fertility.
Summary
- AMH is a hormone that reflects your ovarian reserve (your remaining egg supply).
- As you age, AMH levels naturally decrease.
- Younger women have higher AMH levels, more eggs, and tend to get pregnant faster.
- Low AMH levels can indicate that menopause may be nearing.
- AMH levels are higher than normal in PCOS.
- Factors that can affect your AMH levels include BMI, hormonal birth control, vitamin D levels, and conditions like endometriosis and autoimmune disorders.
- Getting an AMH test can help, but it doesn’t tell the whole story about your fertility potential or reproductive health.
What is AMH?
Anti-mullerian hormone is a hormone that both males and females have. Before birth, AMH helps develop the genitals of babies in the womb.
AMH levels change throughout your life, particularly from puberty to menopause. It’s produced in the primary follicles and released by special cells known as granulosa cells. Granulosa cells surround the egg as it develops.
AMH regulates the growth of follicles by affecting how sensitive the follicles are to follicle-stimulating hormone (FSH).
How are AMH Levels Measured?
After the follicles make AMH, it’s released into the follicular fluid and blood vessels. Doctors can measure AMH levels using a simple blood test. They’ll take a small amount of blood from your arm with a needle. Then, the blood sample gets sent out to the lab for testing.
Once your results are ready, your doctor will call to share them with you. Or, they’ll direct you to check them on an online portal and provide information about what your AMH test results mean.
How Important is AMH in Determining Your Fertility?
There are many reasons why people may want to check their AMH levels. But it’s especially relevant for family planning. If you’re a female who wants to get pregnant, AMH testing can give you an idea of how many eggs you have left. This is known as your body’s ovarian reserve.
Generally, a high AMH means you have several eggs left and more opportunity to get pregnant. Low AMH means you have fewer eggs available for fertilization.
AMH measurements are helpful since, compared to other hormones, AMH stays relatively stable throughout the menstrual cycle.
Although AMH plays a role in fertility, it’s not the only factor that matters. The AMH test can indicate early menopause, but it doesn’t show egg quality or the genetic composition of the egg.
You can ask your healthcare provider about testing for other reproductive hormones for a more comprehensive fertility assessment. Even if they find you have a low ovarian reserve, you may have different options, like donor eggs, to explore.
What Your AMH Levels Mean for Fertility
Be careful about depending on AMH levels when assessing your fertility. One meta-analysis found that serum AMH levels aren’t reliable at predicting natural pregnancy, especially in younger and older women. Several other studies have found similar results.
The American College of Obstetricians and Gynecologists (ACOG) recommends against measuring serum AMH or using this value to counsel fertile women on their chances of future pregnancy.
Use of AMH in Vitro Fertilization (IVF)
Low AMH doesn’t necessarily mean you can’t get pregnant. But it could mean you have fewer eggs and should bring up fertility concerns with your doctor sooner. They may suggest other tests or treatments to boost your chances of a successful conception.
Doctors routinely measure AMH levels in women who are undergoing assisted reproduction treatments. AMH helps predict how well the ovaries will respond to stimulation.
In one study, researchers found that AMH levels predicted poor response and cycle cancellation in women having fertility treatments. It also helped predict hyper-response and ovarian hyperstimulation syndrome.
Another study also supported checking AMH before fertility treatment, especially in women over age 36. Women with AMH levels so low that they were undetectable still had a fair possibility of pregnancy.
Other research agreed with these findings. Women with very low (<0.5 ng/ml) AMH levels showed a reasonable chance of pregnancy through IVF, depending on their age. The pregnancy rate was 31% in those under age 35. The rate declined to 10.2% in the 40 to 43-year age range.
Can AMH Predict Menopause?
The ACOG says women shouldn’t use AMH to try to predict menopause. It’s not a standardized measurement that you can depend on for this information.
AMH levels naturally decline with age. Low levels mean that the window for pregnancy is getting shorter and that you may be approaching menopause.
Unfortunately, it can also mean it’ll take longer to get a positive pregnancy test. In a large study on 3,150 women, those with low AMH levels took 20% longer to get pregnant than those with normal levels. This was true regardless of their age and other fertility factors.
While AMH alone doesn’t give enough information about menopause or fertility, it can help paint a clearer picture of what’s happening in your body when paired with other testing.
AMH Levels in Polycystic Ovary Syndrome (PCOS)
If your AMH levels are too high and you’re struggling to get pregnant, you might have another problem that’s affecting your fertility. High AMH can signal a hormonal disorder called Polycystic Ovary Syndrome (PCOS). PCOS can lead to fertility issues, but treating the condition can make pregnancy possible.
Women with PCOS have many small follicles, which increases AMH levels. AMH testing is a useful way to help diagnose PCOS. One study on women in a fertility clinic found that over 97% of women with ultrahigh AMH levels (>10 ng/mL) had PCOS. Doctors may combine AMH testing along with checking for other signs of PCOS (like irregular periods) to get a more accurate diagnosis.
Normal AMH Levels by Age
Egg count naturally declines with age. So it’s normal to expect lower AMH levels as you get older.
Age-appropriate serum reference values for AMH are as follows:
Age | Normal lower limit of AMH (ng/mL) |
25 | 3.0 |
30 | 2.5 |
35 | 2.0 |
40 | 1.5 |
45 | 1.0 |
Remember, these numbers are estimates. You should always discuss your test results with your doctor to understand what they mean for you.
Other Factors That Could Affect AMH Levels
- Body mass index (BMI):
In addition, body mass index (BMI) may affect AMH levels. One study measured AMH levels in women with and without infertility. Some of the participants also had PCOS. They found that BMI was a significant factor in everyone’s AMH levels in the study. Higher BMI meant lower AMH levels. Researchers weren’t sure exactly why, but they think it could have something to do with leptin, a hormone related to appetite and body fat.
- Hormonal birth control
Hormonal birth control seems to influence AMH levels, too. A review of several studies found that AMH levels decreased by up to 55% in women who were on it for at least a year. But this effect may be reversible after stopping birth control.
- Health conditions
Health conditions that can cause low AMH levels include endometriosis and autoimmune disorders.
- Vitamin D
Researchers have also wondered if vitamin D and AMH are connected. Vitamin D is called the sunshine vitamin. Levels naturally go up in the summer season when your skin is exposed to more sunlight. Interestingly, the same seasonal fluctuations are seen with AMH levels.
In one study, AMH levels were 18% lower during wintertime. Vitamin D supplements rapidly increased women’s AMH levels. You can ask your doctor if they think your vitamin D levels should be checked. If you have low vitamin D, they may recommend starting a supplement.
- Cancer
High AMH is also a possible sign of ovarian cancer. But your doctor will need to run other tests before making a diagnosis. Women with a history of ovarian cancer may get AMH levels tested to monitor if the cancer comes back. AMH is also checked during cancer treatment to see if the treatment is working.
Is AMH a Reliable Sign of Fertility?
AMH can estimate how many eggs you have left. It’s also a good way to help screen for ovarian conditions like PCOS. However, it doesn’t tell the whole story about fertility.
For example, knowing your ovarian reserve is one piece of information. But the quality of your eggs (not just the quantity) also matters. Unfortunately, AMH can’t tell you how healthy your remaining eggs are. It also can’t predict if your eggs will lead to a healthy pregnancy.
Nonetheless, experts have said that AMH is the best available test to check ovarian reserve. As women in general are having children later in life than in the past, AMH levels become more relevant. Not only can AMH help gauge your “biological clock,” but it can also help predict how well your body will respond to fertility treatments, if needed.
How to Balance AMH Levels
Living a healthy lifestyle is a good start to improve fertility and balance your hormones, including AMH.
Not smoking and maintaining a healthy body weight could help with AMH levels. If you have low vitamin D levels, follow your doctor’s advice on taking a supplement. Since high or low AMH levels can signal another health condition, treating any underlying issues is key.
A Note on AMH Levels in Men
There’s not a lot of research on AMH testing in men. Some research suggests that AMH might help diagnose problems that cause male infertility. One study shows that low AMH levels are linked to low sperm count in men, but measuring AMH levels isn’t a common practice in men’s healthcare.
FAQs
AMH levels decline with age naturally. You can increase low AMH levels only if they’re low because of something you can change. For example, there’s no way to increase your egg count or delay menopause. However, if you have low AMH because of high BMI, hormonal birth control, or a vitamin D deficiency, fixing those issues should help boost AMH back to the normal range.
Normal to high AMH levels are generally best for getting pregnant (assuming there’s no PCOS or other issue affecting your levels). A high AMH level is equal to or more than 5.5 ng/mL. A normal AMH level is less than 5.5 ng/mL and may be as low as 1.0 ng/mL.
Vitamin D supplements and healthy weight loss (if you’re overweight) can boost your AMH levels. Your healthcare provider will need to check your levels and screen for other factors before deciding the best way to boost AMH.
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