Anti-müllerian hormone (AMH) is a protein produced by small developing follicles in your ovaries. These follicles contain your eggs, and AMH levels can give doctors information about your ovarian reserve – the number of eggs remaining in your ovaries. Many people have this lab done as part of an evaluation of their fertility.
What AMH Tells Us
AMH levels gradually decline as women age, reflecting the natural decrease in egg quantity over time. The hormone becomes undetectable after menopause. Unlike other fertility hormones that fluctuate during your menstrual cycle, AMH levels remain relatively stable throughout the month, making it convenient to test at any time.
For Individuals Without Infertility
If you don’t have fertility issues, it’s important to understand that AMH testing may not be very helpful for predicting your future fertility. Recent research has shown:
- AMH levels do not correlate with time to pregnancy or future fertility potential in women without fertility problems.
- A 2017 study published in JAMA found that among women aged 30-44 years without infertility, low AMH levels were not associated with reduced fertility
- A 2023 study published in Fertility & Sterility again found that among women aged 30-44 years without infertility, low AMH levels were not associated with reduced fertility or reduced fecundability (likelihood of getting pregnant in a menstrual cycle).
ACOG (American College of Obstetricians and Gynecologists) recommends against routine AMH testing for women without fertility concerns who are trying to predict their reproductive potential. Some Reproductive Endocrinology & Infertility (REI) doctors disagree with ACOG’s stance on AMH testing for women without infertility. They argue that as long as patients are appropriately counseled about the meaning of the results it should be offered as it may impact their choices when it comes to planning their family. People who experience infertility, and are told they have a low AMH, often say they wish they had known earlier. If someone is at elevated risk of needing IVF due to other medical conditions, a personal history of cancer, or a partner with medical issues associated with infertility, an AMH level can provide useful information to inform the timing of likelihood of success for assisted reproduction.
In my experience, many physicians do not counsel patients about what AMH means until after the results come back. My concern with this approach is twofold. First, results are often released to patients before they receive a call from their provider which can cause a lot of undue stress. Patients look up these results, see it discussed online as a marker of fertility and become distressed, internalizing the belief that there is something wrong. And second, when the meaning of AMH is not discussed prior to the result coming back, the patient is not given the opportunity to decide if and how they would use the result. This is a lab that can cause a great deal of anxiety and I believe if the lab is being ordered, the patient (you!) should have a clear idea of how the results would change your decision making.
Making Informed Decisions
While AMH shouldn’t be used in isolation, it can help inform reproductive planning:
- For individuals considering egg freezing, AMH can help determine optimal timing
- For those with infertility, it helps customize treatment protocols
- For women with conditions like endometriosis or prior chemotherapy, conditions associated with an increased chance of needing assisted reproduction, it may indicate earlier intervention is warranted
Remember that AMH is just one piece of the fertility puzzle. A complete fertility evaluation often includes:
- Medical and Surgical History
- Physical Exam
- Other hormone and lab testing
- Antral follicle count via ultrasound
- Imaging of uterus, ovaries and fallopian tubes, including evaluating if fallopian tubes are open
- Partner’s semen analysis
For Individuals With Diagnosed Infertility
For those diagnosed with infertility or planning IVF treatment, AMH testing can be very useful:
- It helps predict how your ovaries will respond to fertility medications
- It can indicate whether you might be a poor or high responder to ovarian stimulation
- General guidelines suggest:
- AMH <0.5 ng/mL indicates reduced ovarian reserve
- AMH <1.0 ng/mL suggests limited egg retrieval potential
- AMH 1.0-3.5 ng/mL predicts good response to stimulation
- AMH >3.5 ng/mL suggests high response potential
However, it’s crucial to note that AMH levels alone cannot predict live birth success rates. Studies have shown that AMH should not be used to exclude couples from trying IVF treatment.
When to Consider AMH Testing
AMH testing may be most appropriate if you:
- Have been diagnosed with infertility
- Are considering/planning IVF treatment
- Are considering egg freezing
- Have had ovarian surgery or cancer treatment
- Have a family history of early menopause
Other Important Considerations
- AMH test results can vary between laboratories due to different testing methods
- Results should be interpreted using your specific laboratory’s reference ranges
- Direct-to-consumer AMH tests may provide misleading information
- Birth control pills may temporarily suppress levels
- Levels can vary by up to 30% month-to-month
- Age remains the strongest predictor of fertility
The most important thing is to discuss your individual circumstances and family-building goals with a qualified healthcare provider who can help interpret AMH results in the proper context of your complete fertility picture. And remember– you are more than a number.
Sources
ACOG Committee Opinion No. 773: The Use of Anti-Müllerian Hormone in Women Not Seeking Fertility Care April 2019
ACOG Committee Opinion No 589: Female Age-Related Fertility Decline March 2014, Reaffirmed 2020
Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the American Society for Reproductive Medicine. “Testing and interpreting measures of ovarian reserve: a committee opinion.” Fertility and sterility vol. 114,6 (2020): 1151-1157. doi:10.1016/j.fertnstert.2020.09.134
Harris, Benjamin S et al. “Markers of ovarian reserve as predictors of future fertility.” Fertility and sterility vol. 119,1 (2023): 99-106. doi:10.1016/j.fertnstert.2022.10.014
Steiner, Anne Z et al. “Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age.” JAMA vol. 318,14 (2017): 1367-1376. doi:10.1001/jama.2017.14588