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. In fact, serial measurements of AMH, along with other biomarkers such as FSH and Inhibin-B may provide useful information, but a single value is almost meaningless.
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 but his has not been substantiated conclusively in longitudinal studies. In these situations, natural and/or medical measures may be needed to help preserve and enhance fertility. Family history of early menopause and other genetic factors play a significant role and consideration for testing in high risk women may prove beneficial.
What about High AMH Levels?
Research out of Brigham and Women’s Hospital and Harvard Medical School 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. PCOS and higher AMH levels lead to increase chance of pregnancy and live births, according to one 2014 study published in the American Journal of Obstetrics & Gynecology that evaluated IVF outcomes.
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) on day 3 of their cycle. 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 (Fertility and Sterility).
- 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 a low AMH level 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
- 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
- Tal R, Seifer DB, Khanimov M, Malter HE, Grazi RV, Leader B. (2014 Jul). Characterization of women with elevated antimüllerian hormone levels (AMH): correlation of AMH with polycystic. 211(1):59.e1-8. doi: 10.1016/j.ajog.2014.02.026. Epub 2014 Mar 2. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/24593938
- 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