Before I talk about what an AMH test is, I think it's important for women to understand the basics of female fertility.
Women are born with all the eggs they will ever have (approximately 1-2 million at birth). Throughout your life, beginning with your first menstrual cycle, your body recruits a group of follicles (each with a small immature egg inside) that have the potential to respond to hormones, grow, and ovulate.
Normally, a woman ovulates one egg per month. Eggs that are not selected for ovulation are lysed, and the process is repeated if the woman is not pregnant that month.
The average age of a woman with children in the United States has increased in recent decades. As more women choose to further their education and career, they are delaying starting a family. The result is that more women are having children in their 30s and 40s than ever before.
However, we know that fertility declines with age, so it is important for women to understand their fertility and what current tests and treatments can and cannot do for them.
Only when women are armed with all the knowledge can they make informed decisions about their health!
table of Contents to hide
1. What exactly are AMH levels?
2. What does the AMH measure?
3. What is a normal AMH level? What is the AMH low level range?
4. Does insurance cover an AMH test?
5. Treatment Options for Low AMH Levels
What exactly are AMH levels?
AMH, or anti-Müllerian hormone, is a laboratory test that obstetricians and fertility doctors can use to assess a woman's ovarian reserve or egg count. This hormone is produced by the small follicles in a woman's ovaries. AMH is used as a marker for the number of oocytes.
The essential details about AMH
- AMH, or anti-Müllerian hormone, is a substance produced by the granulosa cells in the ovarian follicles.
- It is first produced in the primary follicles, which emerge from the primordial follicle stage. In these stages, the follicles are microscopic and cannot be seenUltrasonic.
- AMH production is highest in the preantral and small antral (less than 4 mm diameter) stages of development.
- Production slows and then stops as the follicles grow. Almost no AMH is produced in follicles larger than 8 mm.
- Therefore, the levels are fairly constant and AMH testing can be done on any day of a woman's cycle.
What does AMH mean in relation to your fertility?
The AMH is an important fertility test that tells us about the ovarian reserve of a woman today. Higher AMH levels (greater than 1 ng/mL) generally mean that a woman has normal ovarian reserve. Lower numbers (less than 1 ng/mL) may indicate a femaledecreased ovarian reserve(GO DEAD).
We know that a woman's fertility declines as she ages, so we typically also see AMH levels decline as a woman ages. The value of this test is that a woman with low AMH can decide to do something about her fertility now if she wants to have a family in the future.
How can an AMH blood test help diagnose infertility?
Because AMH is only produced in small ovarian follicles, blood levels of this substance have been used to try to measure the size of the pool of growing follicles in women.
- Research shows that the size of the pool of growing follicles is strongly influenced by the size of the pool of remaining primordial follicles (microscopic follicles in "deep sleep").
- Therefore, by reading an AMH blood test, a fertility doctor can determine the size of the remaining egg pool, or "ovarian reserve."
As a woman ages, the size of her remaining pool of microscopic follicles decreases. Likewise, their blood AMH levels and the number of ovarian antral follicles visible on ultrasound also decrease.
Women with many small follicles, such aspolycystic ovaries (PCOS)have high levels of the hormone AMH. Women with few follicles left and those nearing menopause have low levels of anti-Müllerian hormone.
Anti-Mullerian Hormone (AMH) | Philadelphia RMA, Fertility Clinic
What does the AMH measure?
What is AMH:
A great tool to assess a woman's current ovarian reserve. It gives a general picture of how it looks today.
Also, it can help set realistic expectations for the number of eggs that will be retrieved. It can also indicate how you are responding to the medication if you decide to continue with IVF, either for infertility or egg freezing.
What AMH is not:
A predictor of whether a woman can conceive spontaneously in the future.
The only true test of whether a woman can conceive, regardless of her AMH levels, is to conceive naturally. A large cohort study showed that there was NO difference in pregnancy rates in women with normal AMH levels trying to conceive compared to women with low AMH levels (less than 1 ng/mL) trying to conceive.
If you check your AMH today and get a low reading, that doesn't mean you can't get pregnant tomorrow or in 3 months if you try to get pregnant yourself.
The fact that you currently have "normal" AMH levels does not predict that it will remain normal in the future. All women will experience a decline in fertility as they age, and how quickly this decline occurs is different for each woman and cannot be predicted.
Should I get an AMH test?
I am a big supporter of women receiving fertility education so they feel empowered to make decisions about their health. Part of that education is knowing what your ovarian reserve is like at any given time, and once you have that information, what, if anything, do you want to do about it?
AMH levels can help you determine if you want to do something about your fertility NOW. Remember, AMH tells you what your ovarian reserve is now. You cannot predict how quickly your ovarian reserve will decline in the future, and you cannot predict whether you will be able to conceive spontaneously on your own.
What is a normal AMH level? What is the AMH low level range?
Interpretation of antimüllerian hormone levels
There are some inconsistencies to be aware of when interpreting the results of an AMH blood test. Since the AMH test has not been used routinely for many years, the values that are considered "normal" have not yet been clarified or agreed upon by experts. Furthermore, not all current commercial assays provide equivalent results.
The following table provides guidelines for interpreting AMH from the fertility literature. Check your AMH result with your fertility doctor. The chart below is just a guide.
For example, the difference between the test result of 0.6 and 0.7 ng/mL places a woman in a "different box" on this table. In reality, there are very few real differences in fertility potential. It's actually a continuum, and not something that can be categorized well.
At extremely low levels, an undetectable level of AMH is possible.
AMH blood levels
|Very high AMH levels (often an indicator ofSOP)||Above 3.0 ng/mL|
|Normal AMH levels||More than 1.0ng/mL|
|Normal low AMH levels||0,7 – 0,9 ng/ml|
|Low AMH levels||0,3 – 0,6 ng/ml|
|Very low AMH levels||Less than 0.3 ng/mL|
The graph below shows the average AMH level for women who do not have trouble conceiving, by age.
PLEASE NOTE: the table above, blood AMH values (in ng/ml)should not be comparedthe graph below (measured in pmol/L) as they are measured at different steps.
You will learn more about antimüllerian hormone levels and results. As we continue to use the AMH fertility test, we explore the relationship between AMH hormone levels, fertility, and ovarian responsiveness.
Can AMH levels fluctuate?
Actual studieshave shown that there is significant variation across a variety of disorders and should be taken into account when interpreting AMH results. However, the fluctuations in the menstrual cycle were small, so AMH can be measured regardless of cycle phase.
Is the AMH test covered by insurance?
Some insurance companies adopt the AMH test as a basic diagnostic test.
It is best to check with your health insurance company or your family doctor. Otherwise you can pay in cash and this price varies depending on the clinic or laboratory you use.
The test can range from $20 to a little more for a single AMH test. you can see theinsurance planswhich all RMA offices here accept.
Treatment Options for Low AMH Levels
The most beneficial treatment for low AMH is in vitro fertilization (IVF).
Depending on your diagnosis, your doctor will recommend IVF with your own eggs or with donor eggs.
Low AMH levels mean you have a low egg reserve, making it difficult to conceive, but that doesn't mean you can't conceive naturally. It only takes one healthy egg to get pregnant. It means that it can be very difficult for you to achieve a pregnancy on your own.
AMH levels rise and fall slightly from cycle to cycle, so it can be considered low in one cycle and very low in another.
Living a healthy lifestyle and getting necessary nutrients like vitamin D can also increase your AMH levels. You can learn more about itfertility supplementsHere.
What questions should women ask their doctors about AMH levels?
Women should talk to their doctor about ordering an AMH if they want more information about their fertility and current status.
If you find that your AMH is lower than expected, you should see a doctor.fertility doctorto discuss egg freezing options if you are not ready to start a family now.
AMH values for IVF
Women with higher AMH levels tend to respond better to ovarian stimulation.IVF (in vitro fertilization), recovered with more eggs. Women with lower AMH levels have lower antral follicle counts and produce a lower number of oocytes (eggs).
AMH levels probably do not reflectegg quality. Having more eggs during IVF egg retrieval provides the opportunity for more eggs to be fertilized and develop into embryos. More eggs do not always mean more embryos. The quality of the oocytes plays a role in the fertilization and development of the embryos. The ultimate goal is to transfer at least one healthy embryo to the uterus.
How to Increase AMH Levels
A low AMH level means that a woman has a low ovarian reserve (egg supply).
A low AMH level means you have low ovarian reserve, but it doesn't mean you can't conceive naturally. Unfortunately, there are no proven ways to increase your AMH levels. Although some research has shown that vitamin D and DHEA can help increase AMH levels.
Test methods for ovarian reserve
Anti-Müllerian hormone is only one possible test for ovarian reserve. Fertility specialists often use a combination of fertility tests to better estimate a woman's ovarian reserve. These tests include a transvaginal ultrasound to count the number of antral follicles and blood tests to determine hormone levels.
How do FSH and AMH levels affect pregnancy?
Dra. Marcy Maguire, one of RMA's reproductive endocrinologists, recently explainedFSHand AMH at length in an episode ofthis is infertility, a new podcast exploring what it's like to be infertile in the United States.
You can listen to the full episode in the audio player below, or listen to Dr. Lee at Maguire below.
What is premature ovarian aging, premature ovarian failure or decreased ovarian reserve?
All of the above terms forpremature aging of the ovariesthey mean essentially the same thing: the ovaries contain fewer eggs than they should given the woman's age. The decrease in ovarian reserve does not equate to the aging of the whole body; it does not mean that the woman herself is aging prematurely, it just means that her total egg count is lower than it should be for her age.
What are the symptoms of premature aging of the ovaries?
The two most common symptoms are infertility and irregular or absent menstrual cycles.
How can a fertility specialist diagnose premature ovarian aging?
The best diagnosis comes from the levels of FSH and AMH and after an ultrasound; all three may be markers for a lower egg count.
What is FSH?
FSH or follicle stimulating hormone is a hormone produced by the pituitary gland. The pituitary gland is an organ in the brain that stimulates the follicles and eggs to grow and mature each month. If heFSH levelit starts to increase, usually many times over number, which means the brain is trying to stimulate the ovaries to make eggs, but it's having a hard time getting the ovaries to listen. Essentially, when FSH levels rise, they become stronger to tell the ovaries to listen. Since there are not many eggs left, the ovaries have a harder time producing.
What is AMH?
Anti-Müllerian is a hormone produced by granulosa cells, which care for a woman's eggs. The more eggs a woman has, the more granulosa cells she has and the higher her AMH. We like to use AMH as a marker for a woman's total egg count. If AMH is above 1.2, we feel relatively calm. If the AMH level is below 1.2, that's more of a concern. Of course, this also correlates with the woman's age, so a 30-year-old woman with a low AMH of less than 1.2 is of great concern, while women in their 40s are more likely to have AMH. low.
How are FSH and AMH tested?
Ablood testwill identify a woman's FSH and AMH levels.
What are the fertility options for women with high FSH and low AMH?
If a woman has a reduced ovarian reserve, which means a lower egg count overall, she may still have the ability to have children with her own eggs, it just depends on her relative egg count. If there are some that we can access, we would normally do IVF.(FIV)to get them back. A woman can also store some of the retrieved eggs. The stored eggs are then cryopreserved or "frozen" and can be used in future IVF cycles.
What if a woman can't use her own eggs at all?
When a woman's egg store is so low that she is in the early stages of menopause, fertility treatments usually cannot help a woman use her own eggs, but they candonor eggs(both from known and anonymous donors) are available and the woman can carry the pregnancy herself.
Can my AMH results be wrong? ›
Concerns About the AMH Test
Therefore, if a relatively healthy ovarian population is assessed for ovarian deficiency, it may result in a false number of women testing positive for diminished ovarian reserve. Very low levels of AMH (less than 0.4) can affect the outcome of IVF cycles.
- 1) Polycystic ovary syndrome. Polycystic ovary syndrome (PCOS) is one of the most common ovulatory disorders. ...
- 2) History of ovarian surgery. ...
- 3) Chemotherapy. ...
- 4) Oral contraception. ...
- 5) Obesity. ...
- 6) BRCA mutations. ...
- 7) Vitamin D deficiency.
The patients with AMH between 1 and 3 ng/ml are normal responders obtaining 10-15 eggs during the ovarian stimulation. The ones with AMH below 1 ng/ml are poor responders (with less than 3 eggs per stimulation) and those with AMH over 3 ng/ml are characterised by a high response to the treatment (even over 15 eggs).What AMH level indicates infertility? ›
|Interpretation (women under age 35)||AMH Blood Level|
|High (often PCOS)||Over 4.0 ng/ml|
|Normal||1.5 – 4.0 ng/ml|
|Low Normal Range||1.0 – 1.5 ng/ml|
|Low||0.5 – 1.0 ng/ml|
The average yearly decrease in the median AMH value was 0.2ng/mL/year through age 35 and then diminished 0.1 ng/mL/year after age 35. The rate of decline in mean AMH values was 0.2 ng/mL/year through age 40 and then diminished to 0.1ng/mL/year thereafter.Can AMH levels change month to month? ›
with a very small sample size (n = 20), serum AMH levels were shown to fluctuate throughout the menstrual cycle 23 . Women with low AMH levels had small fluctuations, while women with high AMH levels exhibited relatively high fluctuations throughout the menstrual cycle.