Anti-Müllerian Hormone (AMH) plays a crucial role in assessing a woman’s fertility potential. It serves as a reliable indicator of the number of eggs remaining in the ovaries, known as the ovarian reserve [1]. By understanding AMH levels, women and their doctors can gain insights into ovarian reserve and potential response to fertility treatments.
Let’s delve deeper into what AMH is and how it relates to fertility.
What is AMH and What Does it Measure?
AMH is a hormone secreted by the granulosa cells found in the ovarian follicles. It provides valuable insights into a woman’s ovarian reserve by measuring the number of small, growing follicles (primordial and preantral) in the ovaries [2]. Unlike many other hormones that fluctuate throughout the menstrual cycle, AMH levels remain relatively stable, offering a consistent and reliable measure of the remaining egg supply [3]. This measurement primarily helps assess a woman’s reproductive lifespan and is a key factor in guiding fertility treatment discussions with doctors. Now, let’s explore what constitutes a typical AMH level.
What is a Good AMH Level to Aim for?
A good AMH level generally indicates a healthy ovarian reserve. However, it’s important to note that AMH measures the quantity of eggs, not the quality, which is primarily linked to age.
Typical AMH Ranges and Interpretation:
- High Ovarian Reserve: Levels above 3.5 ng/mL may suggest a robust ovarian reserve but could also be associated with conditions like Polycystic Ovary Syndrome (PCOS) [4].
- Optimal Response Range: Levels between 1.0 and 3.5 ng/mL are often considered optimal for a good response to controlled ovarian stimulation (COS) during treatments like IVF [5].
- Diminished Ovarian Reserve (DOR): Levels below 1.0 ng/mL are indicative of a diminished ovarian reserve and may necessitate more proactive or aggressive fertility protocols [3].
- Severely Diminished Reserve: Levels less than 0.5 ng/mL suggest a significantly reduced ovarian reserve. Pregnancy is still possible [6], although the expected number of eggs retrieved during treatments may be lower.
It’s crucial to understand that AMH levels naturally decline with age.
Normal AMH Levels by Age
As women age, their ovarian reserve naturally declines, and consequently, their AMH levels decrease.
- In younger women, typically in their early 20s to early 30s, AMH levels are generally higher, often exceeding 3.0 ng/mL [2].
- With increasing age, especially in the late 30s and 40s, levels tend to decline, often falling below 1.0 ng/mL, indicating a diminished ovarian reserve and generally lower fertility potential [2].
- This age-related decline in AMH helps predict the timing of reproductive aging but does not definitively determine a woman’s ability to conceive naturally [7].
AMH Levels and Conception: Key Insights
AMH levels are primarily a tool for assessing ovarian reserve and planning fertility treatments; they are not a direct predictor of natural conception success.
The Role of AMH in Natural Pregnancy
- AMH does not predict natural conception: While high AMH levels suggest a large pool of eggs, they do not guarantee natural conception. Similarly, low AMH levels do not preclude natural conception, especially if other fertility factors are favorable [7].
- Critical Factors: Factors such as age, the quality of the eggs (which declines with age), regularity of ovulation, and overall reproductive health have a more substantial influence on natural pregnancy than AMH levels alone [7].
- Implication of Low AMH: A low AMH level simply suggests a shorter reproductive window. Women with low AMH who are trying to conceive naturally may be advised to seek fertility assistance sooner rather than later to maximize their chances.
Low AMH Levels and Assisted Reproductive Technology (ART)
Although low AMH levels can indicate a reduced ovarian reserve, pregnancy is still achievable through ART, such as IVF. The main implication of low AMH in IVF is that it predicts a lower yield of eggs during the retrieval process, which can impact the number of viable embryos available [5]. Fertility protocols can be tailored to maximize the response in women with low AMH [3].
What Happens if AMH Levels are Too High?
Elevated AMH levels, often above 4.0 ng/mL, may indicate a very high ovarian reserve.
- PCOS Association: High AMH levels are strongly associated with Polycystic Ovary Syndrome (PCOS), a condition that can cause hormonal imbalances and irregular ovulation, affecting natural fertility [4].
- OHSS Risk: During fertility treatments (e.g., IVF), individuals with high AMH levels must be monitored closely, as they are at an increased risk of Ovarian Hyperstimulation Syndrome (OHSS), a potentially serious complication resulting from an excessive response to ovarian stimulation medications [5].
AMH Testing and What to Expect
AMH testing involves a straightforward blood draw to measure the level of AMH in your bloodstream. No specific dietary restrictions or fasting are required [3]. The test results allow healthcare providers to evaluate your ovarian function and, combined with other factors like age and Antral Follicle Count (AFC), tailor a treatment plan to your specific needs [1]. Only a healthcare professional can interpret AMH results accurately in the context of overall fertility health.
Can AMH Levels Be Improved?
The scientific consensus suggests that AMH is a reflection of the existing number of follicles (ovarian reserve) and cannot be significantly increased [3]. However, focusing on overall health may optimize the function of the remaining follicles:
- Lifestyle: Maintaining a healthy weight, managing chronic stress, and engaging in regular, moderate physical activity are recommended for promoting overall reproductive health [8].
- Nutrition: Consuming a balanced diet rich in antioxidants, Omega-3 fatty acids, and essential nutrients may support ovarian health.
- Supplements: Some healthcare providers may suggest supplements like Vitamin D or Coenzyme Q10 (CoQ10) for their potential benefits in egg quality or ovarian function, though their direct, conclusive impact on AMH levels is not established [8]. Always consult with your doctor before starting any new supplement regimen.
Conclusion
AMH levels are a crucial biomarker for assessing ovarian reserve and predicting a woman’s likely response to fertility treatments. While high levels suggest a good quantity of eggs, and low levels indicate a reduced reserve, AMH alone does not determine the ability to conceive naturally. Fertility success depends on a complex interplay of factors, including age, egg quality, and ovulation regularity. Consulting with your healthcare provider is essential for accurately interpreting your AMH results and exploring the comprehensive fertility options available to you.
Disclaimer: This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional, such as an OB-GYN or Reproductive Specialist, for personalized diagnosis and treatment plans.
Frequently Asked Questions (FAQs)
What is the normal range for AMH levels?
Normal AMH levels typically range from 1.0 to 4.0 ng/mL in women of reproductive age. However, the interpretation is highly dependent on the woman’s age and overall clinical picture [2].
Can I get pregnant with low AMH?
Yes, pregnancy is possible even with low AMH levels. Low AMH indicates a smaller egg supply (lower ovarian reserve) but does not mean the remaining eggs are non-viable.
What does it mean if my AMH levels are high?
High AMH levels (often above 4.0 ng/mL) suggest a large ovarian reserve and are commonly seen in women with Polycystic Ovary Syndrome (PCOS) [4].
Is AMH the only test for fertility?
No, AMH is not the only test for fertility. It is a key indicator of ovarian reserve, but other essential tests include Antral Follicle Count (AFC) via ultrasound, and hormone tests for FSH, Estradiol, and Progesterone [1].
Can AMH levels change over time?
Yes, AMH levels naturally and predictably decrease with age [2]. They do not typically fluctuate significantly month-to-month but reflect the gradual, age-related decline in ovarian reserve.
References
[1] Deadmond, A., Koch, C. A., & Parry, J. P. (2020). Ovarian reserve testing. In Endotext. MDText.com, Inc. https://www.ncbi.nlm.nih.gov/books/NBK279058/
[2] Moolhuijsen, L. M. E., & Visser, J. A. (2020). Anti-müllerian hormone and ovarian reserve: Update on assessing ovarian function. The Journal of Clinical Endocrinology and Metabolism, 105(11), 3361–3373. https://doi.org/10.1210/clinem/dgaa513
[3] Cedars, M. I. (2022). Evaluation of female fertility—AMH and ovarian reserve testing. The Journal of Clinical Endocrinology & Metabolism, 107(6), 1510-1519. https://academic.oup.com/jcem/article-abstract/107/6/1510/6518212
[4] Gowkielewicz, M., Lipka, A., Zdanowski, W., Waśniewski, T., Majewska, M., & Carlberg, C. (2024). Anti-Müllerian hormone: biology and role in endocrinology and cancers. Frontiers in Endocrinology, 15, 1468364. https://doi.org/10.3389/fendo.2024.1468364
[5] La Marca, A., Sighinolfi, G., Radi, D., Argento, C., Baraldi, E., Artenisio, A. C., Stabile, G., & Volpe, A. (2010). Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Human Reproduction Update, 16(2), 113–130. https://doi.org/10.1093/humupd/dmp036
[6] Shrikhande, L., Shrikhande, B., & Shrikhande, A. (2020). AMH and its clinical implications. Journal of Obstetrics and Gynaecology of India, 70(5), 337–341. https://doi.org/10.1007/s13224-020-01362-0
[7] Iwase, A., Asada, Y., Sugishita, Y., Osuka, S., Kitajima, M., Kawamura, K., & from the subcommittee “Survey of AMH measurement in Japan” in Reproductive Endocrinology Committee, Japan Society of Obstetrics and Gynecology, 2021-2022. (2024). Anti-Müllerian hormone for screening, diagnosis, evaluation, and prediction: A systematic review and expert opinions. The Journal of Obstetrics and Gynaecology Research, 50(1), 15–39. https://doi.org/10.1111/jog.15818
[8] Bedaiwy, M. A., & Al-Nasr, I. (2014). Nutrition and lifestyle changes for improving fertility and reducing the risk of assisted reproductive technology complications. Reproductive Biology and Endocrinology, 12, 118. https://doi.org/10.1186/1477-7827-12-118