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Low AMH Levels: What Do They Really Mean For Fertility?

Low AMH Levels: What Do They Really Mean For Fertility?

Low AMH Levels: What Do They Really Mean For Fertility?Women often reach out to us concerned when tests reveal they have low levels of Anti-Mullerian Hormone (AMH). But what does this test really mean and are AMH tests reliable? New research suggests AMH test interpretation may need updating. Additionally, your lifestyle, where you are at in your menstrual cycle, and other factors can affect your AMH levels. While knowing your AMH levels is important if you are struggling with infertility, a single AMH test does not reveal your whole fertility-health picture.

AMH testing is part of the gold standard for modern fertility tests. AMH is a protein produced by cells in ovarian follicles. AMH testing developed in 1990 after research on women undergoing IVF found a positive correlation between AMH levels and the number of eggs retrieved after ovarian stimulation.

Most fertility doctors now believe that low AMH levels by themselves should not exclude a woman as a good candidate for IVF. In some cases, women with low AMH levels may have reduced egg quantity (ovarian reserve), but still have good egg quality and a good chance for a healthy pregnancy.

AMH by the Numbers

  • Normal AMH levels (1.5 to 4.0 ng/ml) are associated with increased fertility and better response rates to fertility treatments.
  • Low–Normal AMH levels (1.0 to 1.5 ng/ml) are associated with decreased ovarian reserve but chances can still be good for pregnancy outcomes.
  • Very low AMH levels (below .5 ng/ml) suggest diminished ovarian reserve and fertility concerns.

What affects AMH levels?

AMH levels are regulated by gonadotropin hormone, and are the highest during the early stages of follicle development (when the follicle measures less than 4 mm). AMH production stops or slows down as a follicle grows larger. Some research finds there is almost no AMH production when follicles reach 8mm.

Natural fluctuations in circulating AMH levels are critical to our understanding of what they mean in relation to fertility. They also reveal the potential limitation of interpreting a single measurement of AMH in relation to egg quantity or egg quality.

Low AMH Levels

Aging is the primary reason for low AMH levels. Early ovarian aging due to stress, poor food choices, low circulation to the ovaries, hormonal imbalance, illness, injury, genetic factors, autoimmune disorders and even lifestyle factors (shared in detail below) can all impact AMH levels and ovarian function.

Low AMH levels in younger women (35 and under) can signal they are at risk for early menopause. In these situations, natural and/or medical measures may be needed to help preserve and enhance fertility.

What about High AMH Levels?

Some research links high AMH levels to increased breast cancer risk in premenopausal women. High AMH levels (over 4 ng/ml) can also be a sign of PCOS. Women with PCOS often have many small follicles (cysts) and therefore test high in AMH. If this sounds like you, be aware that women with high AMH levels are at a greater risk for OHSS (ovarian hyper-stimulation syndrome) if they pursue medical fertility treatments. Work with your doctor to reduce your risk factors if you’re concerned.

AMH & Menopause: AMH levels decline naturally with age. Women in menopause typically have low AMH (see previous list) and high follicle stimulating hormone (FSH) levels (above 15). This is a normal change we see as the reproductive years come to a close.

Can Lifestyle Factors Impact AMH levels?

Yes! Excessive exposure to toxins can affect ovarian reserve and decrease your AMH levels.

  • Heavy smoking (20 plus cigarettes a day) is linked to low AMH levels and early menopause.
  • Long-term exposure to sources of environmental smoke, like that from indoor heating (artificial fire logs, burning wood at least 10 times a year), is linked to low AMH levels in recent tests.
  • Drug treatments like chemotherapy can cause AMH and ovarian reserve to drop significantly. If you have cancer, ask your doctor about fertility sparing options that may be available.

Hope for the Future

If you have tested low in AMH and are worried, please keep in mind that a single AMH test does not offer a complete view of your fertility. New testing approaches for AMH levels may evolve that offer more insight, particularly for healthy, young women with low AMH where current tests may be unreliable. Using natural methods like charting your cycle and monitoring cervical mucus can also give you more information on your fertility cycle.

Additionally, following a natural Egg Health Program and using fertility herbs can provide benefits to your egg health and may help support normal AMH levels. We encourage you to pursue follow up testing to see if your AMH or egg health changes over time with natural or medical therapies.

Explore all of your options and don’t give up hope after one test. In many cases, women with low AMH levels may go on to have successful pregnancies, particularly if they don’t have other fertility concerns.

While exploring your options, here are three resources to help you learn more about AMH in relation to fertility health:
AMH, Ovarian Reserve, & Continued Follicle Production
Fertility Q&A Part 1: The Chance of Natural Conception with Low AMH Levels
Fertility Q&A Part 2: The Chance of Natural Conception with Low AMH Levels

References

  • White, A., Sandler D., D’Alosio, A. (2016, Sept.). Antimüllerian hormone in relation to tobacco and marijuana use and sources of indoor heating/cooking. Fertility and Sterility. Retrieved from: http://www.fertstert.org/article/S0015-0282(16)61282-7/fulltext
  • Anderson, R. (2016, Oct.). Towards improving analysis and interpretation of antimüllerian hormone in women. Fertility and Sterility. Retrieved from: http://www.fertstert.org/article/S0015-0282(16)61392-4/fulltext
  • Sherbahn, R. (2016). Anti-Mullerian Hormone Testing of Ovarian Reserve. Retrieved from: http://www.advancedfertility.com/amh-fertility-test.htm
  • AMH (Anti-Mullerian Hormone): What is AMH and What Does It Mean For Your Fertility (2016). Retrieved from: https://www.createhealth.org/fertility-treatments-services/fertility-diagnosis/amh
  • Faye, S. (2014). Anti-Mullerian Hormone and Its Significance in Women’s Fertility. Retrieved from: http://www.mlo-online.com/anti-mllerian-hormone-amh-and-its-significance-in-womens-fertility.php
  • Eliassen AH, Zeleniuch-Jacquotte A, Rosner B, Hankinson SE. (2016, May). Plasma Anti-Müllerian Hormone Concentrations and Risk of Breast Cancer among Premenopausal Women in the Nurses’ Health Studies. Cancer Epidemiology. 25(5):854-60. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26961996

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  1. Hello, if someone can guide me, please?
    I went for the hormone examination and my anti mullerian hormone is low.. it is 1.080
    Could you please advise honestly is there any chance that I will be pregnant or it is not possible ?? and what to do in my case

  2. Hi, I’m so very concern and wonder if i can ever become a mommy. Last year in June 2017 when i checked my AMH it was 2.24 ng/ml and everything was normal. We keep trying for the baby naturally but i was never getting pregnant. Finally, i did laparoscopy and found out both fallopian tubes are damaged. My doctor suggested IVF. so i went for AMH test and the result came down to 0.86 ng/ml. Can you please suggest what i should do to increase my AMH and if there is chances of getting pregnant through IVF. Thanks for your help in advance.

    • Dear Juliana,

      As suggested here a great place to start is by learning about a natural egg health program. Click this link: How to Increase Your Egg Health in 90 Days to learn more.

      Many do have great chances of becoming pregnant through IVF, but do talk through all of your questions and concerns with an IVF specialist. I can not quantify chances of success. If you choose to try IVF, know that there is natural support for this as well, which includes egg health support. We share more in our guide How to Increase Your IVF Success Rate Naturally.

      Try to stay positive and hopeful! My best!

  3. Hi,
    I was under the care of a fertility specialist for about 6 months. We were diagnosed with “unexplained infertility” and Dr. recommended we start with an IUI. We did 3 failed IUIs! Dr. suggested we meet again to discuss our next steps/options. I could not go back. The whole experience was just too much to handle, both physically and mentally. About 2 months ago I requested my medical records and took them to my Ob/gyno. She went through them and said everything looked good expect my AMH levels. She said the levels were extremely low! My husband and I are both 38 and have been trying for years. Is there any way to increase the AMH levels?

  4. Hi

    I have just been diagnosed with a low AMH of 1.3 by my fertility clinic, they said my success rate for IVF is 5% to 10%. Just wondering where to go from here any advice welcome.

    • Dear Sab,

      Thanks or reaching out to us!

      The focus largely becomes working to protect and support long-term health, including the health of the remaining eggs you have. 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. It is also important to support overall health which directly impacts reproductive health – daily exercise, a clean wholefood diet, managing stress, timing ovulation – and will help to support your chances of conception.

  5. Hi! I had 3 kids naturally. I basically sneezed and got pregnant. My youngest is just over 1 now. I went to get my AMH tested and it was very low! I couldn’t believe it. It was tested on day 26 and I just stopped breastfeeding. Could this have anything to do with it? I want more children and now I’m anxious! The doctor didn’t seem so positive 🙁 .

    • Hi Sara!

      I’m sorry this is concerning! Anything that disrupts the hormones involved in the development of follicules and AMH secretion can cause low AMH. Breast-feeding through the stimulus of the baby suckling suppresses fertility by nature for a varying amount of time for each woman who breastfeeds. The high steroid levels of pregnancy first suppress fertility and after birth, there is often that period of inhibited ovarian activity associated with limited follicle growth (sure to breastfeeding). Given that we know that AMH is the hormone secreted by the antral follicles during a “regular” menstrual cycle and follicle growth is likely to be suppressed while breastfeeding and perhaps for a bit of time after, this could be part of why your AMH test levels came back low. To be honest, it may be best to give your body some time to readjust now after stopping breastfeeding, and after having seen several “normal for you” cycles in a row, consider a retest.

  6. I was diagnosed with undetectable AMH (15). One doctor told me again that my chances were less that 1% after my only IVF round was canceled. However, my tenth IUI (using Menopur) worked, and I am three months pregnant with my second child as I approach 39. My advice: Just keep trying if you are getting a decent response from clomid and/or Menopur. Contrary to what doctors tell you, all you need is one good egg.