AMH, Ovarian Reserve, & Continued Follicle Production

AMH, Ovarian Reserve, & Continued Follicle Production

Among the many hormone tests performed to determine infertility, there is a blood test that measures the levels of AMH (Anti-Mullerian Hormone) also known as MIS (Mullerian Inhibiting Substance). Why are doctors wanting to know what AMH level you have? AMH levels are tested to help doctors determine ovarian reserve.

AMH is produced directly by the granulosa cells in the follicles. AMH is first made in the primary follicles as they advance from the primordial follicle stage. AMH levels continue to rise and AMH production is highest in preantral and small antral stages (less than 4mm diameter) of development. Past this point of growth AMH levels decrease and eventually stops as the follicle continues to grow. Follicles over 8mm diameter produce almost no AMH.

A woman’s body contains millions of follicles at birth, but over time the number of follicles may decline. Doctors use this test to measure the amount of growing follicles in the ovaries. Women with low levels of AMH indicate low levels of follicles and produce lower levels of immature eggs. It is very normal for an older woman to have a lower AMH level, because it is a known fact that both the health of the follicles and the number of follicles declines over time.

Women with many small follicles, typical in women with PCOS, usually have higher levels of AMH. A test result of high AMH may indicate PCOS and is also used to determine excessive or poor response to ovarian hyperstimulation (hCG trigger shot/IVF preparation).

Low levels of AMH in women under the age of 40 may also indicate Premature Ovarian Failure. Premature Ovarian Failure (POF) is also known as Ovarian Hypofunction and is defined as a loss of normal ovarian function before the age of 40.

Anti-Mullerian Hormone Test Results = Chance of Conception
Doctors use this test result to determine if you are a good candidate for IVF. It may help them to determine if they should go forward with IVF or not. It may also be used to determine if you may be able to conceive naturally on your own.

    High (often PCOS) = Over 3.0 ng/ml
    Normal = Over 1.0 ng/ml
    Low Normal Range = 0.7 – 0.9 ng/ml
    Low = 0.3 – 0.6 ng/ml
    Very Low = Less than 0.3 ng/ml

I am never one to take a test result that sounds negative and allow it to define my life. If you have a low AMH level, there is still a chance you will go on to have a baby! No one can know for sure if you will have a child or not. You can choose to have a positive outlook. It is important to realize that this type of test is relatively new and not completely understood by the doctors themselves. Do not worry about the cut off values of the above table, these are general guidelines. For example, the difference between a 0.6 and a 0.7 ng/ml test result puts a woman in a “different range” in this table, but there is very little difference in her fertility potential.

There are other tests that can be used in combination with the AMH test to help determine if in fact ovarian reserve may be low. According to the studies I am going to share below, the word reserve in relation to the ovaries may become obsolete in the future.

Research Shows Human Females Produce Eggs Throughout Their Reproductive Years

It is extremely important to protect your egg count and health now. It is possible to increase the health of your eggs, which may help protect egg die off, which may help to sustain egg count.

Studies on mice have shown that female mammals can produce egg cells throughout life. The studies showed that follicles may not originate in the ovaries themselves, but within the bone marrow. Scientist gave mice with diminished ovarian reserve bone marrow transplants and they began producing follicles once again. These studies are hopeful for the future of infertility, especially POF.

In a follow-up study performed by Massachusetts General Hospital, lead by Jonathan Tilly, PhD, director of the Vincent Center for Reproductive Biology in the MGH Vincent Department of Obstetrics and Gynecology pointed out, “The discovery of oocyte precursor cells in adult human ovaries, coupled with the fact that these cells share the same characteristic features of their mouse counterparts that produce fully functional eggs, opens the door for development of unprecedented technologies to overcome infertility in women and perhaps even delay the timing of ovarian failure.”

These follow-up studies give hope for the future of female infertility, as well as how to treat it. While bone marrow and/or blood transfusions used to restore follicle production is not currently being practiced, the advancement of the this technology over the years is exciting and hopeful!

How Does Egg Health and Count Decline?
AMH levels are not thought to determine the quality of the eggs, which is good. So how can someone with a low AMH level increase the amount of follicles they have or support the health in maintaining the ones you currently have?

As we age the health of our eggs is affected by environmental toxins, poor food choices, circulation, free-radicals, stress, hormonal balance, illness, injury, genetic factors, autoimmune disorders, ect. It is very normal for the health of our cells to decline as we age, but we can also work to protect and support long-term health, which includes our egg health. To learn the full scope of the best ways to improve egg health naturally please read over our complete Increase Egg Health Guide because increasing egg health may help you to sustain the follicles you currently have. Supporting overall health will also help to support egg production over time because the health of the body directly impacts reproductive health.

References:
1. http://en.wikipedia.org/wiki/Ovarian_hyperstimulation#cite_note-11
2. Anti-Mullerian Hormone Testing of Ovarian Reserve Richard Sherbahn MD: http://www.advancedfertility.com/amh-fertility-test.htm
3. “Harvard researchers have found new evidence that female mammals can produce egg cells throughout life”, Harvard University Gazett.2005 http://www.news.harvard.edu/gazette/2005/08.25/99-eggs.html
4. Egg-Producing Stem Cells Isolated from Adult Human Ovaries ScienceDaily (Feb. 26, 2012) http://www.sciencedaily.com/releases/2012/02/120226153641.htm

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[-] 19 Comments
  1. I am hoping to help some of you on here. I am not a Dr., but spent years researching and going through infertility to get my kids. I just had my second child 15 weeks ago. I was diagnosed with a low AMH. 0.3. I did not do IVF. I did six months worth of acupuncture and 13, yes 13 IUI’s and have a perfect little boy. I was told to throw in the towel. Use Donor Eggs or Adopt. After six months of acupuncture my score went up to 1.0. Not sure how this can happen but it did. I also got my blood tested for MTHFR gene (blood clotting Disorder). Turns out was double homozygous. Women with this have trouble having a baby. Depletes all Folic Acid.

  2. Hi,

    How is it possible to have a low AMH level, but a normal number of follicles? Are the two not correlated?

    We have been trying to conceive for over 2.5 years and all test results were good with the exception of AMH. Our doctor told me not to worry about this, but I am confused.

    Thanks

    • Dear Lisa,

      The AMH test is used to determine the number of healthy, growing follicles in the ovaries. As a woman ages the number of growing follicles and follicle health may decline. This happens at a different rate for each woman and may even happen when a woman is young depending one hormone balance and ovarian health and function.

      I am curious what your doctors answer to your question is. Have you asked?

      I hope to have been helpful!

  3. Hi Elizabeth,
    I am 30 years old and I have been trying to conceive for nearly four years now. I have never been successful. My periods are never on time. I had a blood test done in January this year in India. The doctor said that I had a hormonal imbalance and advised me to take Normoz tablets twice a day for six months. I also had a blood test done for AMH and its <0.30. He advised that I visit a IVF clinic asap. I found out that IVF is very expensive and am looking for a natural way to increase AMH level.
    I am really confused and wonder if ever I will be able to conceive. I would highly appreciate if you could kindly advise.

    • Dear Chandra,

      I am sorry you have to deal with this challenge.

      AMH levels are not thought to determine the quality of a woman’s eggs. As women age, the health of our cells decline and the health of eggs is affected by a variety of things – environmental toxins, unhealthy food choices, lack of circulation to the reproductive organs (ovaries), free-radicals, stress (from work, the conception journey, families, etc.), hormonal imbalances, genetic factors, autoimmune disorders and illness, etc.

      There are ways to work to protect and support egg health. To learn what we feel are the best ways to support and improve egg health naturally, please read over our complete Increase Egg Health Guide. We have learned that increasing egg health may help to sustain the follicles a woman currently has, as well as overall reproductive health.

      I hope this is helpful!

  4. Good Morning,
    I’ve been TTC for nearly 5yrs, without success. I am 34yrs old now. I’ve been told that I’m in the intermediate level for Fragil X, last FSH 17 and AMH 0.21 (July results). In 2012, both fallopian tubes were open, but now right tube is blocked (Dec/2014 HSG result). I’ve been taking good vitamins for years and did acupuncture for one year straight without success. Currently I’ve been taking for 3 months: FertileAid for women, FertilCM, OvaBoost, Omega-3, CO-Q10, Vitamin B as directed on bottle. For last month: FertileDetox, Myo-Inositol for women, Maca and Vitamin D all as directed on bottle. I think I eat a decent diet filled with lots of non organic fruits and vegetables.
    What do you suggest I try for a change or not?

    • Dear Sam,

      I am sorry for your struggles! We are more than happy to work with you and help you know what to change in your program or not! The very best way to receive a full plan designed specifically for your fertility health needs is to have a Fertility Consultation.

      Through a Fertility Consultation, you will submit your comprehensive intake form including fertility health history, your three detailed questions and your overall goal for your fertility. Then, within five business days one of our Master Herbalists will review, layout and explain each step of your consultation. Once completed, your Fertility Consultation will be emailed to you as a PDF and you get a live link to an audio recording to save and review as often as you need. You also receive the opportunity to continue your relationship with your herbalist through follow-up email correspondence for a few weeks after receiving your consultation, with any questions you may have regarding your consultation.

      I hope you will consider this invaluable guidance1

  5. I am 46 and single. For 2 years I have suffered from Hypothyroidism. I am 5ft tall and 62 kg weight, period is not regular. Now, as I wanted to go for single parenthood through surrogacy, my doctor asked me to go for AMH test. I did and the result is not good, <0.05(ng/ml). So my query, do I have any chances naturally or through medication and diet.
    Thanks

    • Dear Paromita,

      Thyroid health can impact fertility, but has also proven to be easily impacted by dietary changes, herbs and nutritional supplement. Consider taking time to refer to Every Woman’s Guide to Hypothyroidism and Fertility. We have also worked with women who have committed to achieving hormone balance and increasing AMH levels who have been successful.

      I think given the challenges you are faced with, we would be most beneficial to you to consider working one on one with a fertility herbalist who can help create a natural fertility program for you honing in on the most beneficial ways to support your fertility health. We offer this through a Fertility Consultation.

      I hope you will consider this invaluable experience!

  6. I am now 31 years old and I was recently (2014) diagnosed with low amh 0.6. I was told by the RE that the only way that I may be able to have another child (I have a 13 year old girl) is by I.U.I. However all of the other test were normal. I genuinely believe that I can increase my chances of having a child naturally by taking the natural route. I am just confused on what products may be best for me. Can you help me please?

    • Dear Norma,

      We have worked with women who have committed to supporting healthy AMH levels and hormonal balance and succeeded. Thank you for reaching out to us! The very best way to eliminate confusion and receive a full plan designed specifically for your fertility health needs is to have a Fertility Consultation. Through a Fertility Consultation, you will submit your comprehensive intake form, including fertility history, your 3 detailed questions and overall goal for your fertility and within 5 business days one of our Master Herbalists will review, layout and explain each step of the program that was created specifically for you. Learn more about a Fertility Consultation here…

      I hope you will consider this invaluable experience!

  7. I am 32 years old and have never pregnant. I have been trying to conceive for a year but have been unsuccessful. I recently went to the fertility specialist where they did major blood work to check on my hormones because I had a missed period in November and June of 2014. Yesterday, I got a call from the fertility specialist my AMH level is .03!!!!! Is there a chance for me to get pregnant with my own eggs? I am both shocked and devastated to find this out. my whole life I have had two missed periods to find out my AMH level is .03 is a shock to me!! I am so confused and getting too emotional while the rest of my blood work is being processed!!? Any advise or support is greatly appreciated.

    • Dear Zheyan,

      I am so sorry you are going through this! Being emotional, confused and devastated are understandable. Honor these emotions, cry if you need to, and then take a deep breath. Okay, now take another and now another.

      We have clients who have committed to naturally supporting their AMH levels, and ovarian and egg health with great success. Consider reading their stories as you work to educate yourself and find hope. Here are two links to client’s testimonials, Angella and RL, Age 39, TTC 4 years. We also have a member of our Natural Fertility Community who has worked very hard to support her fertility health and hormone levels. Read her story here…

      While this article through which you contacted us offers important guidance and suggestions, consider also working one on one with our fertility herbalist through a Fertility Consultation if you wish for a personalized program designed for your specific fertility health needs. She is happy to work with you!

      Take one more deep breath!

      I send you peaceful, positive energy as you move forward with the best plan for your needs.

    • Hi Elizabeth,

      Thank you for your kinds words and compassion, I am very thankful I have found this great website for support. I plan on seeking a second opinion then follow the natural treatments including vitamins and cleansing kits.

    • Greetings Zheyan!

      You are very welcome! We are glad you found us as well!

      All the best!

  8. Update 2014 – We are back! We have been away for a while and we sure have missed all of your wonderful questions and thoughts on our articles. Moving forward, one of our staff herbalists will be here to respond to comments! We look forward to connecting with our readers once again!

  9. Hi I’m Planning to have my IVF now (today is my first period day), I was taking improve egg kit for almost 3 months. My question now is Can Clomid be combined with herbs for fertility? and what about other IVF medications
    Thank you