What is AMH?
AMH stands for Anti-Mullerian hormone. It is a hormone produced by granulosa cells. Granulosa cells are cells in the ovary that nurture and support developing eggs. The egg and its supportive granulosa cells exist together in a follicle. A follicle is the functional unit of the ovary that makes hormones and supports egg growth. In the ovary, there are many follicles at different stages of development. Most AMH is secreted by intermediate stage follicles because they have the most granulosa cells. AMH is thus an indirect measure of how many eggs are present in the ovary, or “ovarian reserve.”
Think of ovarian reserve as a basket of eggs. People who have ovaries are born with a basket with a certain number of eggs. This number varies among individual people at birth. No matter how many eggs you are born with, that number will decrease throughout life. By menopause, the basket of eggs is emptied.
There are many ways of testing ovarian reserve, but AMH is a simple blood test that can be done on any day of your menstrual cycle and does not require you to be fasting.
Your AMH level may vary slightly each time it is checked, based on your body changing and also on variability within the test. But generally, it is thought to decrease gradually from its peak, until it becomes undetectable at the time of menopause. AMH may also be artificially affected in a reversible way, by certain hormonal medications such as some birth control pills.
What does your AMH level mean?
AMH is sometimes referred to as a “fertility” test but it is very important to understand that AMH does NOT predict natural fertility and does NOT tell us anything about egg quality, which is much more important for conception and fertilization in an IVF cycle. Natural fertility is impacted by many factors. Age is the best predictor of egg quality, which is known to decrease with age.
AMH is best used to estimate the number of eggs that may grow during an ovarian stimulation cycle, when injectable medications are taken to stimulate the growth of multiple eggs. This can be done as a part of an egg freezing, embryo freezing, or in-vitro fertilization treatment. This helps physicians estimate how many eggs may be retrieved at the time of an egg retrieval procedure. Although many factors determine the success of a treatment, the number of eggs can impact the probability of a success.
What does a low AMH mean?
A very low AMH is associated with a lower chance of retrieving eggs during an ovarian stimulation cycle. A low AMH is NOT associated with a decreased chance of natural fertility in patients who have regular menstrual cycles. It may be associated with a higher risk of premature menopause, although it is very difficult to predict this and currently AMH is not recommended as a clinical predictor of menopause. It can be noted that about 1% of people with ovaries experience menopause earlier than age 40, a condition known as premature ovarian insufficiency. A low AMH may be caused by some hormonal medications such as birth control pills without indicating a truly low ovarian reserve.
While a low AMH does not predict the need for fertility treatment in the future, a low AMH does suggest that IF in-vitro fertilization is indicated in the future, the efficiency of each cycle is likely to be lower, due to lower egg yield. Some people consider egg freezing or embryo freezing in this situation.
What does a high AMH mean?
A high AMH is associated with a higher risk of ovarian hyperstimulation, which is an excessive response to taking the medications used to grow multiple eggs simultaneously. Ovarian hyperstimulation leads to fluid leaking out of blood vessels which can cause many symptoms, including bloating, nausea, abdominal pain, shortness of breath, and dehydration. A high AMH may be associated with a clinical condition called Polycystic ovarian syndrome (PCOS). In very rare instances, a very high AMH may be associated with an ovarian granulosa cell tumor. AMH is not, however, clinically recommended as a general screening test for these conditions.
Can I impact my AMH level?
There are a few things that may impact AMH level such as oral contraceptive pills or some supplements, although this is not thought to change ovarian reserve. Currently, there are no established clinical treatments that decrease the progression to menopause. Avoiding smoking, maintaining a healthy weight, and generally living a healthy lifestyle with regular exercise, a healthy balanced diet and adequate stress management may improve regular ovulation for those who do not ovulate regularly, and can also decrease the risk of pregnancy complications. Egg or embryo freezing before treatments known to be detrimental to the ovary, such as chemotherapy or radiation, are clinically validated treatments, to preserve fertility.
What to do next?
We do recommend that you share the result of this test with your primary care physician or gynecologist.
If you have any questions you may reach out to our clinical team at firstname.lastname@example.org.
If you are interested in exploring your options for fertility treatment in Oklahoma or Central California, you may also book a consultation on our website here. If you live in the Northern Virginia or Pittsburgh areas, we have clinics launching there in early 2023!
We recommend tracking your menstrual cycle as abnormal menstrual cycles may indicate you need further evaluation by a physician. Many comercial apps such as helloclue.com are easy to use and can help you track your cycle.
We recommend you see a primary care or gynecology physician for an annual history and physical appointment and encourage you to discuss your reproductive goals with your physicians.
Other tools for education.
If you would like to learn more about fertility, reproduction and ovarian reserve, we highly recommend the following resources: