How To Increase AMH Levels

Trying to improve your AMH numbers? Learn how to increase anti-mullerian hormone and increase your chances of fertility. 

By OBGYN and fertility expert Dr. Kenosha Gleaton

Your AMH (short for anti-müllerian hormone) levels are a good indicator of ovarian reserve, or how many eggs you have left, and can be especially helpful for those TTC (trying to conceive) that are undergoing IVF. So how do you check your AMH levels, and what can you do to increase them? Let’s talk about it. 

AMH Levels 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. Are you trying to conceive? Check out our TTC kit for a bundle of tests, prenatal vitamins, and more. 

What Does AMH Tell You?

Research shows that AMH levels correlate with the number of oocytes (eggs) retrieved after stimulation and can help predict ovarian response for those undergoing IVF. [1] This tells us that AMH has some association with predicting live birth after IVF, but it’s ability to accurately predict live birth is somewhat poor. [2] 

One study suggested the following general guidelines regarding AMH levels for IVF [3]:

• AMH <0.5 ng/mL predicts difficulty in IVF getting more than three follicles to grow, which in turn reduces the chance for pregnancy with IVF.
• AMH <1.0 ng/mL suggests a limited egg supply and a short window of opportunity to conceive.
• AMH >1.0 ng/mL but <3.5 ng/mL suggests a good response to IVF stimulation.
• AMH >3.5 ng/mL indicates an ample egg supply, and suggests caution should be exercised in order to avoid ovarian hyperstimulation syndrome (OHSS).

AMH can also tell us when to expect menopause. Research shows that AMH is very low or undetectable approximately five years before menopause. [4]

How to Check AMH

Typically, AMH levels are tested using a blood sample from the arm. If you’re getting a full fertility workup, it’s likely that you will also be tested for estradiol and FSH levels, two other hormones that aid in reproduction. 

You can buy an AMH test online and test at home at your convenience. If you want a more comprehensive understanding of your fertility, your OBGYN or REI can order an AMH test as part of a larger fertility workup.

What Can Cause Low AMH Levels?

For the most part, AMH levels are not impacted by medications. However, there have been a few studies that have found potential associations between medications like metformin or hormonal birth control and AMH. 

• AMH and birth control: No proven relationship exists between AMH and birth control, but some studies suggest that taking hormonal birth control pills may decrease AMH levels temporarily. [4] Some researchers found that those on hormonal contraceptives had a lower average AMH level when compared to those not on hormonal birth control. [5] It was observed that these effects were reversed, however, after discontinuation of the oral birth control pills. So, while there’s no proven link between the two, if you’re looking to increase your AMH levels and you’re currently using (or have recently used) hormonal birth control methods, keep in mind the potential that your medication may affect your results. Talk with your OBGYN about how to time testing and medications to obtain the most accurate results.

• AMH and metformin: Another medication that could  impact AMH levels is metformin, a drug used to treat type 2 diabetes due to its interactions with insulin in the body. It may also be useful for some women living with PCOS as it is associated with insulin resistance. [6] 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. [7-8] 

Read more about birth control and AMH levels here, or explore more on the Natalist homepage. 

How to Increase AMH Levels

For those with thyroid dysfunction, supplementation with a certain hormone 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. [9] At the end of the study, the AMH level in 35 patients with Hashimoto's disease increased following LT4 preconception supplementation.

Supplements to Influence AMH Levels

Similarly, it’s unlikely that supplements will have an effect on AMH levels, though there have been a few studies that observed potential associations. 

 One small study researched the effects of selenium and vitamin E supplementation in women with diminished ovarian reserve. [10] 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. We know that vitamin D impacts AMH signaling, FSH sensitivity, and progesterone production and release, but is it associated with AMH concentrations? [11] Studies 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. [12] Another study also concluded that AMH and vitamin D are likely independent of each other. Regardless of its correlation to AMH, vitamin D has many other benefits. [13] 

Foods to Increase AMH Levels

Does diet influence AMH levels? More research is needed on the association between AMH and dietary factors, but research shows there may be a link. 

• A cross-sectional study assessed links 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. [14]
• Another study also found that AMH concentrations were positively associated with a diet high in carbohydrates and inversely associated with a diet high in fats. [15] 
• Dairy has also been studied in relation to AMH levels. [16] Consumption of dairy may regulate AMH levels in regularly menstruating women. The same study found that the odds of rapid AMH decline was reduced with higher intakes of carbohydrates, protein, calcium, and lactose. [16]

Thus, the short answer is yes, diet likely does have a small effect on AMH levels! Try adding in healthy fats, dairy, and carbohydrates, and steer clear of fast food and saturated fats. 

Lifestyle Habits and AMH

Just as lifestyle, diet, and environment can impact overall fertility, certain lifestyle factors may have an effect on AMH levels. 

A cross-sectional study of over two thousand premenopausal women found that women with irregular menstrual cycles have much lower age-specific AMH percentiles than those with regular menstrual cycles. [17] It was also observed that smokers have lower age-specific AMH percentiles; however, low levels associated with smoking are likely reversible. [17] This study also found that higher parity (the number of times a woman has birthed a fetus greater than 24 weeks or more) was associated with slightly higher AMH levels. [18]

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. [19]

These studies concluded that body mass index (BMI), race, height, weight circumference, alcohol consumption, education, physical exercise, and socioeconomic status were all factors that are not significantly associated with age-specific AMH percentiles. [17-19]

Key Takeaways

• AMH is short for anti-müllerian hormone.
• AMH is a good indicator of ovarian reserve, or how many eggs you have left.
• When TTC, AMH levels greater than 1ng/ml are desirable.
• For women undergoing IVF, AMH levels can be helpful for determining how many eggs may be retrieved following stimulation.
• AMH may also indicate when menopause is going to occur.
• AMH is a blood test that is obtained individually or as part of a bigger fertility workup.
• For those with thyroid dysfunction, LT4 may be helpful for increasing AMH concentration.
• For those with diminished ovarian reserve, selenium and vitamin E supplementation may be helpful for increasing AMH levels.
• Some studies indicate there may be an association between AMH levels and lifestyle factors such as age of menarche, parity, smoking, and menstrual cycle regularity.

References:

1. Zheng H, Chen S, Du H, et al. Ovarian response prediction in controlled ovarian stimulation for IVF using anti-Müllerian hormone in Chinese women: A retrospective cohort study. Medicine (Baltimore). 2017;96(13):e6495. doi:10.1097/MD.0000000000006495
2. Iliodromiti S, Kelsey TW, Wu O, Anderson RA, Nelson SM. The predictive accuracy of anti-Müllerian hormone for live birth after assisted conception: a systematic review and meta-analysis of the literature. Hum Reprod Update. 2014;20(4):560-570. doi:10.1093/humupd/dmu003
3. Toner JP, Seifer DB. Why we may abandon basal follicle-stimulating hormone testing: a sea change in determining ovarian reserve using antimüllerian hormone. Fertil Steril. 2013;99(7):1825-1830. doi:10.1016/j.fertnstert.2013.03.001
4. Kruszyńska A, Słowińska-Srzednicka J. Anti-Müllerian hormone (AMH) as a good predictor of time of menopause. Prz Menopauzalny. 2017;16(2):47-50. doi:10.5114/pm.2017.68591
5. Bernardi LA, Weiss MS, Waldo A, et al. Duration, recency, and type of hormonal contraceptive use and antimüllerian hormone levels. Fertil Steril. 2021;116(1):208-217. doi:10.1016/j.fertnstert.2021.02.007
6. Wiweko B, Susanto CA. The Effect of Metformin and Cinnamon on Serum Anti-Mullerian Hormone in Women Having PCOS: A Double-Blind, Randomized, Controlled Trial. J Hum Reprod Sci. 2017;10(1):31-36. doi:10.4103/jhrs.JHRS_90_16
7. Foroozanfard F, Samimi M, Almadani KH, Sehat M. Effect of metformin on the anti-Müllerian hormone level in infertile women with polycystic ovarian syndrome. Electron Physician. 2017;9(12):5969-5973. Published 2017 Dec 25. doi:10.19082/5969
8. Johnson NP. Metformin use in women with polycystic ovary syndrome. Ann Transl Med. 2014;2(6):56. doi:10.3978/j.issn.2305-5839.2014.04.15
9. Kuroda M, Kuroda K, Segawa T, et al. Levothyroxine supplementation improves serum anti-Müllerian hormone levels in infertile patients with Hashimoto's thyroiditis. J Obstet Gynaecol Res. 2018;44(4):739-746. doi:10.1111/jog.13554
10. Safiyeh FD, Mojgan M, Parviz S, Sakineh MA, Behnaz SO. The effect of selenium and vitamin E supplementation on anti-Mullerian hormone and antral follicle count in infertile women with occult premature ovarian insufficiency: A randomized controlled clinical trial. Complement Ther Med. 2021;56:102533. doi:10.1016/j.ctim.2020.102533
11. Irani M, Merhi Z. Role of vitamin D in ovarian physiology and its implication in reproduction: a systematic review. Fertil Steril. 2014;102(2):460-468.e3. doi:10.1016/j.fertnstert.2014.04.046
12. Moridi I, Chen A, Tal O, Tal R. The Association between Vitamin D and Anti-Müllerian Hormone: A Systematic Review and Meta-Analysis. Nutrients. 2020;12(6):1567. Published 2020 May 28. doi:10.3390/nu12061567
13. Wong HYQ, Li HWR, Lam KSL, et al. Independent association of serum vitamin D with anti-Mullerian hormone levels in women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 2018;89(5):634-641. doi:10.1111/cen.13816
14. KaboodMehri R, Sorouri ZZ, Sharami SH, Bagheri SE, Yazdipaz S, Doaei S. The association between the levels of anti-Müllerian hormone (AMH) and dietary intake in Iranian women. Arch Gynecol Obstet. 2021;304(3):687-694. doi:10.1007/s00404-021-06098-4
15. Anderson C, Mark Park YM, Stanczyk FZ, Sandler DP, Nichols HB. Dietary factors and serum antimüllerian hormone concentrations in late premenopausal women. Fertil Steril. 2018;110(6):1145-1153. doi:10.1016/j.fertnstert.2018.06.037
16. Moslehi N, Mirmiran P, Azizi F, Tehrani FR. Do dietary intakes influence the rate of decline in anti-Mullerian hormone among eumenorrheic women? A population-based prospective investigation. Nutr J. 2019;18(1):83. Published 2019 Dec 2. doi:10.1186/s12937-019-0508-5
17. Dólleman M, Verschuren WM, Eijkemans MJ, et al. Reproductive and lifestyle determinants of anti-Müllerian hormone in a large population-based study. J Clin Endocrinol Metab. 2013;98(5):2106-2115. doi:10.1210/jc.2012-3995
18. Gaillard R, Rurangirwa AA, Williams MA, et al. Maternal parity, fetal and childhood growth, and cardiometabolic risk factors. Hypertension. 2014;64(2):266-274. doi:10.1161/HYPERTENSIONAHA.114.03492
19. Jung S, Allen N, Arslan AA, et al. Demographic, lifestyle, and other factors in relation to antimüllerian hormone levels in mostly late premenopausal women. Fertil Steril. 2017;107(4):1012-1022.e2. doi:10.1016/j.fertnstert.2017.02.105