Written by:Dra. Ashley Eskew MD, MSCI
Edited by:dr Will Haas, MD, MBA
Last update:30. May 2022
Have you ever wondered if there is a way to check your fertility with a simple blood test?
Or what does your anti-Müllerian hormone (AMH) value actually mean?
What if there is a way to increase AMH?
Well you are not alone!
Here's a quick overview of what you'll discover:
- What is AHM?
- What Causes Low AMH?
- Can IVF work with low AMH levels?
- Steps to increase AMH levels
What is Anti-Müllerian Hormone (AMH)?
Anti-Müllerian hormone (AMH) is a glycoprotein produced by granulosa cells, which are tiny cells that line the dormant follicles of the ovary (antral follicles). It is a general indicator of the number of eggs a woman has left.
How do I test the AMH?
AMH can be determined from a serum sample, which can be obtained from a typical blood draw or a drop of blood (fingerstick). Unlike other ovarian reserve markers, AMH can be tested at any time during the menstrual cycle.
Understand your AMH results
Serum levels of anti-Müllerian hormone in adult females correlate with the amount/number of oocytes remaining (hence its use as a marker forovarielle Reserve) and better predicting response to ovarian stimulation with injectable gonadotropins (the injectable drugs used in IVF). Normative values are determined by age and the assay used.
Contrary to popular belief, an AMH test does not predict the likelihood of pregnancy, live birth, infertility, or fertility (but more on that below).
Elevated AMH levels are commonly seen in women with polycystic ovary syndrome (PCOS), or in younger women in general. A higher AMH level is associated with an increased risk of ovarian hyperstimulation syndrome (OHSS), so medication regimens and IVF treatment protocols can be chosen to reduce the risk accordingly. A high AMH level does not mean increased fertility or infertility. Again, it's an egg count marker. Higher doesn't always mean better.
Normal AMH levels indicate a predictable response to injectable gonadotropins (IVF drugs) and that you have an expected egg reserve based on your age. Again, normal AMH does not guarantee fertility or a favorable outcome.
As mentioned above, low AMH levels and lower normal limits are determined by age. In general, the lower limits of normal based on age are as follows (1):
- 0.5 ng/mL every 45 years
- 1 ng/ml every 40 years
- 1.5 ng/mL every 35 years
- 2.5 ng/mL every 30 years
- 3.0 ng/mL every 25 years
Some clinics use an AMH threshold of < 0.7 ng/mL or < 1 ng/mL to be considered “low” in all age groups. Low AMH levels have been associated with earlier age at menopause (2-4), decreased ovarian reserve (OR) (fewer oocytes), poorer response to IVF drugs (5, 6), and higher rates of cycle termination (7 ). Interestingly, it wasn't linked to fertility or the likelihood of conceiving. Women with lower AMH often require more aggressive IVF treatment regimens to achieve a positive response.
How is Follicle Stimulating Hormone (FSH) used with AMH?
Follicle-stimulating hormone (FSH) is the hormone produced by a small area in the brain called the anterior pituitary gland that is secreted at the beginning of the menstrual cycle to recruit a follicle each month. If a serum FSH is measured with a serum estradiol level on day 2 or 3 of the menstrual cycle, this is a good indication of how well the ovary is communicating with the brain.
High FSH early in the menstrual cycle indicates deficient ovarian hormone production as part of a declining number of follicles/ova or reduced ovarian reserve. High estradiol and low FSH can be interpreted similarly.
Unlike AMH, FSH cannot be collected at any point in the menstrual cycle and must also be collected with estradiol for correct interpretation. It is also highly variable from cycle to cycle. And while high FSH (usually > 10 mIU/mL) is a good predictor of diminished ovarian reserve and poor ovarian response to gonadotropins, normal FSH is less predictive.
If an initial FSH is abnormal or inconsistent with the AMH, it is usually repeated due to the high variability mentioned above, which can help confirm which treatment regimen might be best.
Limitations of the AMH
Although AMH levels are highly correlated with ovarian response to gonadotropin stimulation in IVF, it is a poor predictor of non-pregnancy, infertility, or fertility. That said, just having a woman with low AMH doesn't mean she has a lower chance of conceiving (8).
In addition, data have shown that AMH levels are a poor predictor of pregnancy and childbirth when using assisted reproductive technologies (ART) and in vitro fertilization (IVF) (9, 10). This would support the fact that AMH better predicts egg quantity but not egg quality.
What Causes Low AMH Levels?
When interpreting the AMH values, all possible influencing factors should also be taken into account in order to be able to estimate the ovarian reserve or the number of remaining egg cells as accurately as possible.
Women are born with about 2 million follicles, but in their first period, that number drops to about 400,000. The number of oocytes continues to decline over time and somewhat more rapidly in quantity and quality in a woman in her early 30s. The loss of ovarian reserve over time is irreversible and the rate of loss can vary greatly from woman to woman. AMH levels tend to decrease linearly over time, while age is the best predictor of oocyte quality. With increasing age, reduced egg cell quality and a corresponding decrease in fertility is observed, which is why a discussion can be usefulfreeze eggwith your fertility doctor at a younger age.
Genetic disorders such as BRCA1 (11, 12) and Fragile X premutation (FMR1—which is associated with an increased risk of premature ovarian failure) and certain karyotype abnormalities (such as Turner syndrome) are also associated with decreases in AMH like others health concerns. If any of these conditions apply to you, early consultation with a reproductive specialist and considering egg freezing in certain situations can be extremely beneficial.
Previous surgeries on the ovaries, including cystectomy (removal of a cyst) or oophorectomy (removal of an entire ovary), are associated with a decrease in AMH because the destruction or removal of follicles also removes the surrounding granulosa cells that produce AMH.
environmental factors:See AlsoHow to increase AMH level through yoga? (4 best poses)Boost Low AMH Levels Naturally | Clinics in Mumbai, SuratBoost Your AMH Levels With Ayurveda | How To Increase AMH Levels In Ayurveda | Safe and natural solutionsHow to increase AMH levels naturally - Dr. mona dahiya
Environmental factors have been inversely associated with AMH levels, including smoking (13, 14), low vitamin D (15), and elevated BMI (16-18).
Polyzystisches Ovarialsyndrom (PCOS):
As mentioned above, PCOS is usually characterized by a larger number of antral follicles and therefore a higher AMH. And although women with PCOS often have high or normal AMH, medication to induce ovulation is often needed because ovulatory dysfunction is a hallmark of the condition. Thus, normal or high AMH does not correlate with ovulation either.
Use of medication:
Taking certain medications, such as combined hormonal contraceptives (CHC), can suppress AMH levels. However, it is important to realize that this does NOT mean that CHDs will decrease fertility in the short or long term, as AMH levels usually return to baseline within 3-4 months after stopping (19-21).
If a woman checks her AMH while using CHCs and finds that it's low, it may be worth going through a washout period (while continuing to use birth control to avoid unwanted pregnancy) and repeating the AMH to get one to get more accurate picture consider using egg freezing. It also makes sense that CHCs lower AMH since their whole purpose is to prevent pregnancy by suppressing stimulation of the ovaries by the brain's natural hormones to prevent ovulation, or the monthly release of an egg.
Can IVF work with low AMH levels?
IVF and egg freezing can work when AMH levels are low, but it's important to realize that it can take more than one IVF cycle to achieve a live birth, as fewer eggs are typically retrieved per cycle. It's important to have a realistic conversation with your fertility doctor about overall family-building goals and what treatment options may give you the best chance of having a live birth (IVF using your own eggs, ovulation induction or a donated egg, etc.). Account diagnosis, age and ovarian reserve.
Steps to increase AMH levels
As mentioned above, age is the biggest predictor of egg count and quality. But the question remains: is there anything a woman can do to increase her AMH levels?
Luckily, there are some things you can control that will also benefit your overall health.
If you smoke tobacco products, work with your doctor to quit as soon as possible.
If you are overweight or obese, work towards a normal BMI range. Losing as little as 5-10% of body weight can improve response to fertility drugs and improve reproductive outcomes.
Consider getting your vitamin D levels checked and discuss with your doctor whether you should replenish if you are deficient.
Few studies have examined the association between food intake and ovarian reserve markers. From the research carried out:
The Sister Study (22) found that dietary fat intake may be inversely related to AMH concentration - however, specific dietary patterns were not examined (Mediterranean diet versus Western diet), which is a major limitation...
The EARTH study showed no association with dietary habits and AFC, but did not specifically examine associations with AMH levels (23).
In a study I conducted on a grant, AMH was positively associated with increased adherence to a fertility diet in women of childbearing potential with no history of infertility and a BMI > 25 kg/m2 (24).
In short, consume afertility diethigh in fruits and vegetables, high-quality carbohydrates, plant-based or seafood sources of anti-inflammatory proteins and fats, maintaining a healthy weight and not smoking can have positive effects on overall health and fertility.
However, if you tend to search for alternative answers to Dr. Google, beware of anyone or anything that promises to increase your AMH or egg count, lower your FSH, or guarantee you will get pregnant with a magic treatment or a simple diet or lifestyle fix...
Because it's really not that simple.
Final thoughts on AMH and fertility
The AMH is an incredibly useful tool that fertility professionals use to support fertility treatments and general patient counseling, but it's important to understand its limitations and that it cannot be interpreted in a vacuum.
If you have been trying to conceive for some time, the AMH will be part of your basic fertility assessment. And if you're not trying to conceive but just curious, knowing your AMH can be very empowering and informative.
Regardless of your test results, be sure to discuss this with a fertility doctor to get a good understanding of the bigger picture of your overall fertility and family building goals.
with love and strength,
dra Ashley Eskew and Dr. Will Haas
When you're ready, join our FREE training and find out how eating right can increase your chances of conceiving and having a healthy baby!
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Tal R et al. Ovarian reserve test: a user's guide.Am J Obstet Gynecol. 2017before;217(2):129-140.
Broer SL, Eijkemans MJ, Scheffer GJ, et al. Anti-Müllerian hormone predicts menopause: a long-term follow-up study in normovulatory women. J Clin Endocrinol Metab 2011;96:2532-9.
Freeman EW, Samuel MD, Lin H, Boorman DW, Gracia CR. Contribution of anti-Müllerian hormone rate of change to estimating time to menopause for women of late reproductive age. Fertil Steril 2012;98:1254-9. e1-2.
Freeman EW, SammelMD, LinH, GraciaCR. Antimüllerian hormone as a predictor of time to menopause in women of late childbearing age. J Clin Endocrinol Metab 2012;97:1673-80.
Majumder K, Gelbaya TA, Laing I, Nardo LG. The use of anti-Müllerian hormone and antral follicle count to predict oocyte and embryo potential. Eur J Obstet Gynecol Reprod Biol 2010;150:166-70.
Yates AP, Rustamov O, Roberts SA, et al. Anti-Müllerian hormone-adapted stimulation protocols improve outcomes and reduce side effects and costs of in vitro fertilization. Hmm Reprod 2011;26:2353-62.
Seifer DB, Tal O, Wantman E, Edul P, Baker VL. Assisted reproductive technology outcome predictive indicators for ultra-low serum anti-Müllerian hormone cycles: a multivariate analysis of over 5,000 autologous cycles from the Society for Assisted Reproductive Technology Clinical Outcome Reporting System database for 2012-2013. Fertil Steril 2016;105:385-93.e3.
Steiner A et al. Association between ovarian reserve biomarkers and infertility in older women of childbearing potential. JAMA. 2017;318(14)1367-1376.
S. Iliodromiti, TW Kelsey, O. Wu, RA Anderson, SM Nelson. The predictive accuracy of anti-Müllerian hormone for live births after assisted conception: a systematic review and meta-analysis of the literature. Hmm Play Update 2014;20:560-70.
Tal R, Tal O, Seifer BJ, Seifer DB. Anti-Müllerian hormone as a predictor of implantation and clinical pregnancy after assisted conception: a systematic review and meta-analysis. Fertil Steril 2015;103:119-30.e3.
Wang ET, Pisarska MD, Bresee C, et al. BRCA1 germline mutations can be associated with reduced ovarian reserve. Fertil Steril 2014;102:1723-8.
Phillips KA, Collins IM, Milne RL, et al. Serum anti-Müllerian hormone concentrations in women with germline BRCA1 or BRCA2 mutations. Hum Play 2016;31:1126-32.
Freour T, Masson D, Mirallie S, et al. Active smoking affects the outcome of in vitro fertilization and impairs the ovarian reserve. Reproduced from Biomed Online 2008;16:96-102.
Plante BJ, Cooper GS, Baird DD, Steiner AZ. The influence of smoking on anti-Müllerian hormone levels in women aged 38 to 50 years. Menopause 2010;17:571-6.
Dennis NA, Houghton LA, Jones GT, van Rij AM, Morgan K, McLennan IS. Serum anti-Müllerian hormone levels correlate with vitamin D status in males and females, but not in boys. J Clin Endocrinol Metab 2012;97:2450-5.
Sahmay S, Usta T, Erel CT, et al. Is there a link between AMH and obesity in premenopausal women? Arch Gynecol Obstet 2012;286:661-5.
Halawaty S, ElKattan E, AzabH, ElGhamryN, Al-Inany H. Effect of obesity on ovarian reserve parameters in premenopausal women. J Obstet Gynaecol Can 2010;32:687-90.
Steiner AZ, Stanczyk FZ, Patel S, Edelman A. Anti-Müllerian hormone and obesity: Perceptions in women oral contraceptive users. Contraception 2010;81:245-8.
Bentzen JG, Forman JL, Pinborg A, et al. Ovarian reserve parameters: comparison between users and non-users of hormonal contraception. Reproduce Biomed Online 2012;25:612-9.
Kallio S, Puurunen J, Ruokonen A, Vaskivuo T, Piltonen T, JS. tapanains. Anti-Müllerian hormone levels decrease in women using combined contraception, regardless of the route of administration. Fertil Steril 2013;99:1305-10.
Johnson LN,Collection MD, Dillon KE, Lechtenberg L, Schanne A, Gracia CR. Anti-Müllerian hormone and antral follicle counts are lower in female cancer survivors and healthy women using hormonal contraceptives. Fertil Steril 2014;102:774-81.e3.
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AMH test: what it is, full form, why it's done, cost in india, normal range and more - MyHealth
February 15, 2022
[...] AMH levels begin to decline after a certain age, but there are some steps every woman can take to naturally increase her AMH levels. These stages […]
Research has proved that acupressure or acupuncture can help boost AMH levels by improving egg quality and embryo quality. It also helps in balancing hormones, endometrium lining, male infertility, managing PCOS symptoms, reducing endometriosis and also increases IVF success chances.Can you get pregnant naturally with very low AMH? ›
You can get pregnant naturally if you're having low levels of AMH as it fluctuates every month. However, it is possible for you to get pregnant naturally with your eggs or with donor eggs if you have a low AMH level. Your low AMH level will not decide your fertility and there are other ways to improve your fertility.What can I take to increase AMH? ›
The AMH level is just a reflection of the number of eggs in your ovary. There are no medications that you can take to increase this number. Increasing your AMH level does not increase your eggs in the ovary.Can low AMH be reversed? ›
Treatment of Low AMH:- Usually there is no specific treatment for low AMH, however with life lifestyle management, vitamins and supplements pregnancy outcome may be improved. Lifestyle: The person must have proper nutritious diet, low in calories and high in protein. Diet should contain fresh fruits and vegetables.Can your AMH level go up? ›
AMH levels increase and decrease slightly from one cycle to another, so in one cycle you may be considered low and very low in another. Living a healthy lifestyle and getting the necessary nutrients such as Vitamin D may also increase your AMH levels. You can learn more about fertility supplements here.How many eggs left low AMH? ›
Usually, when the Anti-Müllerian hormone level is less than 1, we should obtain a low number of eggs — around 3.What is the minimum AMH to get pregnant? ›
If you're having AMH levels between 1.0-4.0 ng/ml, it is considered as a good or normal AMH level to get pregnant. AMH levels below 1.0ng/ml result in low egg count and are an indication of diminishing ovarian reserve.Can stress affect AMH? ›
When a stimulus is perceived as stressful, the HPA axis and SAM pathway may be activated . As a result, growing follicles are lost due to the oxidative damage of ovarian follicle cells, which leads to a decrease of AMH level.Is IVF the only option for low AMH? ›
A: Yes, it is possible to conceive with low AMH levels, but it may be more challenging. Women with low AMH levels may require fertility treatments such as IVF, donor eggs, or ovarian stimulation to increase their chances of getting pregnant.Can CoQ10 increase AMH? ›
The mean level of AMH in patients with PCOS showed that Q10 significantly decreased the AMH (2.2 ± 10.36 vs. 1.4 ± 8.57, p value = 0.02). Conclusion: The effect of Q10 intake as an inexpensive and effective therapy significantly reduced the level of AMH in patients with PCOS.
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.Does low AMH mean poor egg quality? ›
Does having a low AMH mean you have poor egg quality? Important point here: low AMH does not mean that you have bad quality eggs. Age is the important factor when it comes to egg quality. The younger you are when you freeze your eggs, the higher chance that they will lead to healthy embryos and a baby.What causes AMH to drop? ›
In healthy females of childbearing age, higher levels of AMH mean that the ovaries have a larger supply of eggs. As females age, the number of eggs decreases, which causes AMH levels to decrease. At menopause, no eggs are left, and AMH levels drop to zero.Do people with low AMH ovulate? ›
If you have low AMH and your cycle is regular, which is considered between 21 and 35 days long, you are likely going through ovulation.Is low AMH ovarian failure? ›
Anti-Müllerian hormone (AMH) is now recognized as the most reliable marker of ovarian reserve status [1,5,6]. Decreased serum AMH levels are a reflection of decreased ovarian reserve, and very low or undetectable AMH levels in women with amenorrhea strongly suggest ovarian failure [1,3,7].How long does it take to get AMH levels back? ›
Your AMH result takes around one week to come through following your test.How quickly does AMH change? ›
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.What should I eat if I have low AMH? ›
- Foods That Increase AMH Levels Naturally.
- Green Leafy Vegetables. Certain leafy vegetables like arugula, broccoli, kale, etc. ...
- Almonds. Different dry fruits especially almonds are one of the well-known foods increasing AMH levels naturally. ...
- Pumpkin Seeds. ...
- Garlic. ...
Of women who had low AMH levels, defined as less than 0.7 ng/mL, 65% conceived within six menstrual cycles, and 84% conceived within 12 cycles.What is a good AMH for age 39? ›
|Age||Median AMH levels|
The median AMH values were 4.23 ng/mL in 20–25 years' age group, 3.48 ng/mL in women aged 26–30 years, 2.43 ng/mL in women aged 31–35 years, 1.28 ng/mL in women aged 36–40 years and0. 52 ng/mL in 40–44 years' age group.Can low vitamin D affect AMH? ›
Vitamin D was shown to have a direct effect on AMH production, and women with higher vitamin D concentrations maintained their ovarian reserve for longer. In another study, lower serum 25(OH)D levels have been accompanied by higher serum FSH levels.What is the average AMH level at 40? ›
30 years old: 2.5 ng/mL. 35 years old: 1.5 ng/ mL. 40 years old: 1 ng/mL. 45 years old: 0.5 ng/mL.What are the signs of low AMH? ›
Symptoms of Low AMH Levels
Generally Low AMH does not have any specific symptoms, but if you see any general symptoms like irregular periods, short cycles, or premature menopause, then you should consult with a doctor.
Treatment of Low AMH
There is no low AMH treatment, but there are ways through which a woman can improve her AMH before considering ART as an option, so that quantity and quality of eggs improve before IVF treatment.
Serum AMH was significantly decreased following vitamin D supplementation in polycystic ovarian syndrome (PCOS) women (standardized mean difference (SMD) −0.53, 95% CI −0.91 to −0.15, p < 0.007), while it was significantly increased following vitamin D supplementation in ovulatory women without PCOS (SMD 0.49, 95% CI ...Is too much CoQ10 bad for fertility? ›
Although an ideal dose of CoQ10 has yet to be established, a typical daily dose ranges between 30 to 200 mg. However, it bears noting that the studies finding benefits for fertility used larger doses of CoQ10 (as high as 600 mg a day), which were found to be safe and well-tolerated.How much CoQ10 should I take for eggs? ›
Most fertility specialists recommend taking anywhere between 100mg and 600mg of CoQ10 daily. As with all nutrients or supplements, be sure to consult with your doctor, especially if you are taking medications, have health concerns, or are already pregnant.At what point in cycle is AMH the highest? ›
The highest value was 3.9 +/- 1.3 ng/ml at day -12 and the lowest value was 3.4 +/- 1.1 ng/ml at day 14, and the difference was not significant. Conclusion: In this study, we demonstrated that serum AMH levels do not change significantly throughout the menstrual cycle.What is the lowest AMH level for IVF? ›
AMH was considered to be low with levels 1 ng/ml and below. Levels below 0.5 ng/ml were considered extremely low level. Eighty-four women decided not to be enrolled in the IVF/ICSI program after explaining the poor prognosis in their individual cases.
The mean level of AMH in patients with PCOS showed that Q10 significantly decreased the AMH (2.2 ± 10.36 vs. 1.4 ± 8.57, p value = 0.02). Conclusion: The effect of Q10 intake as an inexpensive and effective therapy significantly reduced the level of AMH in patients with PCOS.What is the cure for low AMH? ›
- Yoga and Regular Exercise.
- Balanced Diet.
- DHEA (Dehydroepiandrosterone) supplements. DHEA is mainly a hormone that has the ability to improve the quality and quantity of eggs.
When a stimulus is perceived as stressful, the HPA axis and SAM pathway may be activated . As a result, growing follicles are lost due to the oxidative damage of ovarian follicle cells, which leads to a decrease of AMH level.