Deep Dive into AMH

What is AMH?

AMH stands for Anti-Mullerian Hormone. As a female enters puberty the ovarian follicles start making AMH. The more egg cells that are made the higher the level of AMH. You can expect the highest levels of AMH when you hit puberty and the lowest when approaching menopause.

It can be a helpful lab that can be used to estimate the number of follicles in the ovaries or your “ovarian reserve” when you are TTC.

I frequently use this lab in clients who have lost their period (amenorrhea), to help diagnose PCOS, who have irregular cycles, low sex hormones, or for women that want help with family planning or timing of fertility treatments like IVF.

Keep in mind this isn't a number you NEED to know or may even want to know, it all depends on your goals.

Ideal Ranges

Below is a chart that shows ideal AMH ranges.

False Reading?

AMH is not always accurate. In fact, if it’s out of range and you are TTC I would have it rechecked to confirm before making any big decisions.

AMH decreases with age because the more times you ovulate, the less eggs you will have. It does NOT measure egg quality or indicate pregnancy rates. 

An elevated AMH can point toward PCOS. It can also be skewed by things like nutrient deficiencies and correcting those can increase your AMH number, but it is not technically increasing the amount of eggs you have left, just the lab value. 

(So yeah, as you can see labs aren't always straight forward and it always takes a skilled provider to interpret fertility related labs.)

Causes of Low AMH

There are various causes of low AMH. They include:

Age

As women we start with X amount of eggs and we can never make more of them. Therefore, as we age we diminish the total reserve, and AMH decreases.

Genetics

I see this one a lot! Your genes (that you are born with) can play a part in the rapid decline of eggs compared to the average population.

Medical conditions (like endometriosis, and autoimmune disorders)

Studies have shown that endometriosis and some autoimmune disorders can cause a lower ovarian reserve.

Surgery

Surgery on the ovaries may lead to scarring or damage or losing an ovary due to endo, ectopic pregnancy, cyst, etc. All of these cause a lower AMH.

Premature ovarian insufficiency

This is early menopause, and I'm seeing it more and more in my practice in women that are in their 20's and 30's.

A lab error

When it comes to a lab value like this (which can change over the course of someone’s life depending on the situation), I always recommend re-testing before making any life altering decisions (such as freezing eggs or jumping into IVF right away)

Options for low AMH?

AMH does NOT impact egg quality at all. If you’re still having regular cycles then it honestly does not mean much, but if you are trying to have multiple children in the future and you have a very low AMH then freezing embryos or eggs may be a good idea as the point of AMH is to help understand a ROUGH timeline of your fertility!