By OBGYN and fertility expert Dr. Kenosha Gleaton
You may have heard about one of the most popular hormones on the block, AMH (short for anti-müllerian hormone). Perhaps you even got your AMH tested at your clinic, or at home. In this guide, we’ll review what this hormone can (and can’t) tell you and share the latest research on the topic.
What is AMH?
AMH is a hormone expressed by granulosa cells of the ovary during a woman’s reproductive years. A gradual increase in AMH levels is observed in girls from the first day of life, with maximum levels observed in women at around the age of 25. In adult women, AMH levels gradually decline as the primordial follicle pool declines with age, becoming undetectable at menopause.
What AMH can’t tell you
There is no single test that can tell you with certainty your likelihood of getting pregnant.
To understand ovarian reserve (the reproductive potential based on number and quality of eggs), a number of screenings may be utilized, but no single test is highly reliable for predicting pregnancy potential. In addition to AMH, your doctor will likely look at day 3 FSH, day 3 estradiol, antral follicle count, and more.
No single test is highly reliable for predicting pregnancy potential.
Multiple studies show that AMH doesn’t correlate with how likely you are to get pregnant. Getting pregnant depends on many different factors, and AMH does not assess egg quality, the quality of the ovaries, sperm quality, or the health of the womb.
One study tracked 981 women aged 30 to 44 years. The women had their ovarian reserve tested using three hormones (AMH, FSH, and inhibin B) and were followed for a year. The study showed that there was not a correlation between a woman’s ovarian reserve and her ability to conceive, and that a low ovarian reserve was not associated with reduced fertility. The researchers concluded: "These findings do not support the use of urinary or blood FSH tests or AMH levels to assess natural fertility..."
What AMH can tell you
For women undergoing IVF, research shows that AMH levels correlate with the number of oocytes (eggs) retrieved after stimulation and can help predict ovarian response. However, while AMH has some association with predicting live birth after IVF, its ability to predict live birth is poor.
One study suggested the following general guidelines for AMH values and IVF:
- 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 is also a strong predictor for the timing of menopause. Research shows that AMH is very low or undetectable approximately five years before menopause. Other research indicates that the time of menopause may be predicted via a mathematical model on the basis of a single AMH measurement and the age of the patient.
What is a good AMH level?
For every woman, AMH levels will decrease with age and there’s not a lot we can do about that. However, I encourage you not to stress about your AMH level! As stated earlier, AMH is just one measurement your doctor looks at to assess overall ovarian reserve. Your AMH level is not predictive of your chances of conceiving naturally, and certainly does not define your fertility.
Your AMH level is not predictive of your chances of conceiving naturally, and certainly does not define your fertility.
In general, a typical AMH level for a woman of reproductive age is 1.0–4.0 ng/ml.
Median AMH levels at every age
One study looked at the median AMH levels (ng/mL) in 2,741 women:
- Under 25 = 5.13
- 25 = 5.42
- 26 = 4.91
- 27 = 4.12
- 28 = 4.96
- 29 = 3.87
- 30 = 3.53
- 31 = 3.59
- 32 = 3.44
- 33 = 2.70
- 34 = 2.49
- 35 = 2.58
- 36 = 2.28
- 37 - 1.85
- 38 = 1.66
- 39 = 1.72
- 40 = 1.27
- 41 = 1.26
- 42 = 1.20
- 43 = 0.81
- >43 = 0.72
The following chart shows the average AMH (in pmol/l) for women by age. Please note: this table should not be compared to the numbers above (in ng/mL) as they are measured in different increments.
How can I increase my AMH?
I am often asked what someone can do to increase their AMH levels. While there are no definitively proven ways to increase your AMH levels, there are ways to increase your chances of getting pregnant.
Can AMH go up and down month over month?
In general, AMH is considered a stable hormone that doesn’t fluctuate greatly month over month. However, according to studies on AMH fluctuations, AMH can go up and down slightly for young women. The studies report that the lowest AMH levels were observed during the very early luteal phase, directly after ovulation for young women. However, for older women, the range of AMH level fluctuation over a menstrual cycle was very low.
Beware of comparing your AMH level to others
Because there is no international standard for AMH levels, interpretation of AMH levels is laboratory assay-dependent, meaning it can vary from lab to lab and test to test. Your clinician should give you the laboratory's reference ranges. If you have AMH tested in one lab one year, and another the next, talk to your doctor before comparing the numbers to ensure it’s apples to apples.
Be informed, but don’t over worry
For every woman, AMH levels will decrease with age and there’s nothing we can do about that. I encourage you not to stress about your AMH level! AMH is just one measurement your doctor looks at to assess overall ovarian reserve. Your AMH level is not predictive of your chances of conceiving naturally, and certainly does not define your fertility. At Natalist, we’re here to support you every step of the way as you embark on this journey!