Having trouble with fertility? One fertility marker to keep in mind is AMH. Read on to learn about the symptoms of low AMH and how to combat it.
By OBGYN and fertility expert Dr. Kenosha Gleaton
Fertility testing and hormone levels can give us some insight into fertility. While anti-Mullerian hormone (AMH) levels don’t tell us all we need to know, they can be predictive of someone’s response to fertility treatments. Here’s what to know and what to look out for when it comes to your AMH levels.
AMH and fertility
AMH is a hormone released by cells in the ovary during a woman’s reproductive years. A gradual increase in AMH levels occurs in girls from birth until about 25, where maximum levels are observed. After this peak, AMH levels gradually decline as the primordial follicle pool declines with age, becoming undetectable at menopause.
When and why to monitor AMH
AMH can be especially useful for women going through fertility testing and treatments as it is typically the earliest indicator of ovarian function. While it can’t tell us everything we need to know about fertility, AMH can help predict someone’s response to fertility treatment.
When it comes to IVF, research shows that AMH levels correlate with the number of eggs retrieved after stimulation. This tells us that AMH has some association with predicting live birth after IVF treatment, but it’s ability to accurately predict live birth is somewhat poor.
AMH can also tell us when to expect menopause. Research shows that AMH is very low or undetectable approximately five years before menopause.
There is no uniform timeline for how often AMH levels should be tested, but we do have a general idea. A team of doctors studied women undergoing IVF and performed repeat testing of AMH levels to determine how often significant changes occurred. The study concluded that quarterly AMH level assessments (≤1 per three months) may be beneficial for patients seeking fertility treatments for conveying additional diagnostic and potential prognostic assessments.
Symptoms of low AMH
There are no specific symptoms that immediately signal low AMH levels, but there are three signs that may indicate a woman has low AMH. These include:
- Short menstrual cycles
- Irregular menstrual periods
- Permanent cessation of the menstrual cycle (typically menopause or premature menopause)
Again, these symptoms are very general and may not be associated with AMH levels at all, and some women may have low AMH and none of these symptoms. If you notice any of these signs and are concerned about your ovarian reserve, bring them up for discussion with your OBGYN at your next visit. If you’re curious about your AMH, the best way to know your level is to get a test done. Use an at-home testing kit to measure other vital fertility hormones, or read up some more on fertility and pregnancy on the Natalist homepage.
What causes low AMH?
For the most part, AMH levels are not impacted much by outside factors. However, there have been a few studies that have found potential links to AMH levels.
- AMH and birth control pills: No proven relationship exists between AMH and birth control, but some studies suggest that taking hormonal birth control pills may decrease AMH levels temporarily. Luckily it was observed that these effects were reversed after discontinuation of the oral birth control pills.
- AMH and metformin: Another medication that could be impacting AMH levels is metformin, a drug used to treat type 2 diabetes due to its interactions with insulin in the body. Two studies observed the effects of metformin and AMH levels and concluded that when used to treat PCOS, metformin showed a decrease in AMH concentration.
- AMH and diet: A cross-sectional study assessed linkages between diet and AMH levels in 200 adult women and found that a higher diet of fast foods and saturated fats was associated with lower AMH concentrations.
- AMH and menstrual cycles: A cross-sectional study of over two thousand women found that those with irregular menstrual cycles have much lower age-specific AMH percentiles than those with regular menstrual cycles. Another cross-sectional study of over 600 premenopausal women found that AMH concentrations are lower in women with an earlier age of menarche (the age of first menstrual period) and women older than 35.
Why do AMH levels drop?
In general, a typical AMH level for a woman of reproductive age is between 1.0–4.0 ng/ml. For every woman, AMH levels will decrease with age as the primordial follicle pool declines (a normal part of aging), and there’s not much any of us can do about that, so it’s best not to stress about your level!
Treatment for low AMH levels: medication and supplements
For those with low AMH and thyroid dysfunction, supplementation with hormone LT4 may actually be beneficial in increasing AMH levels. A study aimed to determine whether levothyroxine (LT4) supplementation could increase ovarian function in women found that for those with Hashimoto’s, LT4 has significant effects. At the end of the study, the AMH level in 35 patients with Hashimoto's disease increased following LT4 preconception supplementation.
Another small study assessed the effects of selenium and vitamin E supplementation in women with diminished ovarian reserve. The results concluded that after 12 months of vitamin E and selenium supplementation, AMH as well as antral follicle count and mean ovarian volume was increased in women with OPOI (occult premature ovarian insufficiency).
The effects of vitamin D on AMH levels have also been studied, and the results are inconclusive. A meta-analysis found that supplementing vitamin D increased AMH levels for women without PCOS, but decreased AMH levels for women with PCOS. Another study also concluded that AMH and vitamin D are likely independent of each other.
Diet, nutrition, and AMH
As many of us know, a healthy diet is beneficial for many facets of our health. Multiple studies focused on the association between diet and AMH levels have found that a diet low in fast foods and saturated fats, and high in dairy, may help increase or maintain AMH levels in regularly menstruating women. To treat low AMH concentrations, try adding in healthy fats, dairy, and carbohydrates, and steer clear of fast food and saturated fats.
Many women ask what they can do to increase their AMH levels. The truth is, there are no definitively proven ways to increase your AMH levels, but there are ways to increase your chances of getting pregnant (like tracking your ovulation to time sex for conception and opting for fertility-friendly lube).
- AMH is often the earliest indicator of ovarian function and can predict someone’s response to fertility treatments
- Studies show that testing your AMH once every three months should be often enough to measure any noticeable changes
- There are no specific symptoms that point to low AMH, but irregular, short, and permanent cessation of menstrual cycles may be indicators of low AMH concentrations
- Vitamin E, selenium, LT4, and vitamin D may be helpful in increasing AMH levels for certain populations
- Maintaining a healthy diet is helpful for overall fertility and for maintaining AMH healthy levels.