AMH: What Does It Really Mean For Your Fertility?

If you’re struggling to conceive or have asked your gynecologist about assessing your egg quality, you’ve likely heard of the Anti-Mullerian Hormone (AMH) test. This ovarian reserve test is often used to gauge egg supply, but it has its limitations. In this post, I’ll clarify what AMH means for fertility, future reproductive potential, and conditions like PCOS.

Understanding Ovarian Reserve

The term “ovarian reserve” can be confusing, as it may refer to egg quantity, quality, or overall fertility potential—each of which is distinct.

• You are born with a finite number of eggs, and you don’t produce new ones.
• Your egg count diminishes with each menstrual cycle, especially after age 35.
• Menopause occurs once your egg supply is depleted.
• There’s no precise way to measure egg quality or quantity, only rough estimates.

Ovarian reserve is often used to predict fertility potential, but it’s not always straightforward.

How Does AMH Relate to Ovarian Reserve?

AMH is produced by the granulosa cells in ovarian follicles (egg sacs) and reflects the number of follicles in your ovaries. A lower AMH level suggests fewer follicles in reserve, while a higher level indicates more.

For women nearing menopause or experiencing premature ovarian aging, AMH levels drop below 1.0 ng/ml. AMH peaks around age 25 and becomes undetectable roughly five years after menopause.

It’s important to note that the number of eggs you have doesn’t necessarily reflect their quality—quantity and quality are separate factors.

What Is a Normal AMH Level?

AMH levels can be tricky to interpret. There isn’t a universally agreed-upon “normal” range. For a 35-year-old woman, here’s a general guide:

• High (likely PCOS): Over 4.0 ng/ml
• Normal: 1.5–4.0 ng/ml
• Low Normal: 1.0–1.5 ng/ml
• Low: 0.5–1.0 ng/ml
• Very Low: Less than 0.5 ng/ml

However, don’t focus too much on these cutoffs! A difference between 1.0 and 0.9 may seem significant, but it rarely has a major impact on fertility. AMH levels fall along a continuum and shouldn’t be used in isolation to assess pregnancy potential.

What Do Studies Say?

Most AMH research focuses on IVF, as these patients are particularly concerned with egg reserves.

• Low AMH Levels:
  • May indicate poor response to IVF induction agents (hormones that stimulate follicle growth for egg retrieval).
  • Do not predict low IVF success rates for women under 35.
  • May predict lower success rates in women over 40.

• High AMH Levels:
  • Lower IVF cycle cancellation rates, meaning a better chance of proceeding with embryo implantation.
  • Higher egg retrieval rates per cycle, and improved live birth rates.
  • Higher pregnancy rates among women of the same age compared to those with low levels.

Importantly, AMH doesn’t provide information about egg quality. It reflects the number of eggs that can be stimulated during an IVF cycle but doesn’t predict who will get pregnant through IVF.

More Predictive for Older Women

The test’s ability to predict pregnancy outcomes improves with age. This is crucial! Many young women with low AMH are wrongly labeled as infertile.

AMH is weakly associated with egg quality when used alone. Low AMH in your 20s doesn’t necessarily mean infertility, and normal levels at 40 don’t guarantee egg quality sufficient for pregnancy. Age remains a more important fertility predictor than AMH alone.

Can AMH Help Diagnose PCOS?

Yes, AMH is a valid indicator of PCOS (Polycystic Ovarian Syndrome). Women with PCOS tend to have unusually high AMH levels—up to three times higher than average.

A cutoff level of 4.7 ng/ml is considered most accurate for diagnosing PCOS, especially when combined with other clinical signs. However, AMH alone is not enough to diagnose PCOS, and a high AMH can be related to other conditions, such as functional hypothalamic amenorrhea (FHA).

AMH: Key Takeaways  

AMH is:

• A reliable marker of ovarian reserve for identifying good IVF candidates.
• A useful tool in diagnosing PCOS.
• Better at predicting egg quality in women over 40 than in younger women.
• Not a stand-alone indicator of fertility or egg quality, especially in women under 35.
• Not accurate enough to exclude women from attempting IVF.

If you’re under 35 with a low AMH, there’s no need to panic. Working with a practitioner who integrates functional and Chinese medicine—like myself—can help you naturally optimize your fertility and improve your chances of success with IVF or other assisted reproductive techniques. Contact me directly to find out more.

Since you’re here reading about AMH, you may be interested in these related posts:

Enhancing a Fertile Follicular Phase: A Holistic Approach

Improving Preconception Health with Functional Medicine

Functional Medicine for Fertility: A Personalized Path to Conception

Questions or insights about AMH? I’d love to hear them in the comments below.