AMH 101: Everything You Need to Know

Ever scrolled through that health and wellness side of social media and stumbled upon something called AMH? Maybe your best friend casually mentioned getting her AMH tested, and you were too embarrassed to ask what the heck she was talking about. You're young, you feel great, and having babies isn't even on your radar right now. But here's the thing: understanding this thing called AMH could be a major game-changer for your future.

What is AMH?

AMH stands for Anti-Müllerian Hormone.  Think of it as a little signal your ovaries send out. This hormone level tells your doctor about how many eggs you have left – also known as your ovarian reserve. Basically, AMH is one clue into your fertility.  And, here's why you should care even if kids aren't on your mind yet.

Why does AMH matter in your 20s and 30s?

AMH can be a helpful biomarker for your health and fertility. Why?

1. Knowledge is power: Knowing your AMH levels gives you valuable insights into your reproductive timeline. It helps you make informed decisions about when you might want to start a family and whether fertility preservation options (like freezing your eggs) might be something to consider down the road.
2. Fertility isn't forever: You might think of your 20s as your prime fertility years, and while you're not wrong, it's not the full picture.  Your fertility peaks in your early 20s and starts a gradual decline in your mid-30s. For some people, this decline is faster, and AMH levels can give you a heads-up.
3. Unexpected roadblocks: AMH testing can help detect potential fertility issues early on, like Polycystic Ovarian Syndrome (PCOS) or premature ovarian insufficiency. Getting this info sooner rather than later can help you take steps to manage these conditions and protect your fertility.

What can AMH test results tell you?

So what exactly can AMH tell you about your fertility? Your AMH level is positively correlated with the number of follicles you have in your ovaries. Simply put, the more follicles you have, the higher your AMH level typically is. As a result, AMH levels have been shown to be a good predictor of ovarian reserve and someone’s expected response to fertility treatments. 

In fact, several studies have shown that there is a strong correlation between what your AMH level is and the number of mature eggs retrieved during an egg freezing or in vitro fertilization (IVF) cycle. To learn more about those studies, check out AMH and Egg Retrieval Outcomes. 

What your AMH level can’t tell you is the exact number of eggs you have left in your ovaries or what your chances of pregnancy are. There are a number of other factors like your age, overall health, and genetics that also affect the number and quality of eggs and your overall fertility. So while AMH can be a useful tool in assessing your fertility, it shouldn’t be the only factor when making decisions about fertility treatments.

So, you got your AMH tested. Now what? Here's a basic breakdown of what those numbers usually mean: 

• Normal AMH means you're right on track for your age – good news!  
• High AMH might suggest a good number of eggs remaining, and potentially even point towards conditions like PCOS where your egg count is unusually high. 
• Low AMH could mean you have fewer eggs remaining than typical for your age group.  It might signal a faster decline in fertility, but it doesn't mean you can't get pregnant at all.  

Remember, your AMH level is just one piece of the fertility puzzle. Other factors like your overall health, other hormone levels, family history, and lifestyle habits matter too!

What are normal AMH numbers?

What is considered a “normal” AMH level depends on your age, as well as the lab where you take the test. Since there is no international standard, it’s best to use the reference ranges included on the test results (your doctor can share those with you if you did a test through a clinic). 

In general, however, an AMH between 1.0 and 3.5 ng/mL suggests a “normal” range that is likely to have a good response to egg freezing.

Common reasons for high AMH

The most common reason for high AMH is that you are very fertile and likely to retrieve more eggs in an egg freezing cycle.  But, it does not necessarily mean that the eggs are of good quality. Egg quality is determined by factors such as your age, genetics, and environmental factors, and cannot be measured directly by AMH levels.

But a high AMH level may also indicate PCOS, which is a hormonal disorder that affects 8–13% of females of reproductive age. Those with PCOS typically have high levels of androgens (male hormones) and may have irregular periods, acne, and excess hair growth. Patients with an average AMH level ≥ 4.45 ng/ml have a 9.35 times higher likelihood of developing PCOS, but not all patients with a high AMH have PCOS.

In rare cases, abnormally high AMH could be a sign of an ovarian tumor. Certain types of ovarian tumors, such as granulosa cell tumors, can produce high levels of AMH. 

Read more in: What Does a High AMH Result Mean?

Common reasons AMH would be low

By far, the most common reason for a low AMH is age. People with ovaries are born with all the eggs that they’re going to have in their lifetime. These eggs are then slowly used up over time as you ovulate during each menstrual cycle until menopause is reached. As a result, ovarian reserve naturally decreases over time, meaning the AMH level also decreases. 

Research suggests that hormonal birth control may affect AMH levels but it depends on the type of birth control. Specifically, birth control use is associated with a lower average AMH level than for people who are not on birth control, with the exact effect depending on the type of birth control. 

The amount of time you’re on birth control may also be a factor. Multiple studies have shown that AMH doesn't change if you use combined oral contraceptive pills for less than six months. However, you may have a lower AMH if you’ve been a long-term user of the pill (or other hormonal methods). Thankfully, this is temporary – AMH levels typically rebound after a person stops using birth control.

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There are several other, less common causes for a low AMH level. These include:

• Genetic disorders that affect the X chromosome
• Medical treatments like radiation or chemotherapy
• Having surgery on your ovaries
• Losing one or both of your ovaries
• Autoimmune conditions

Read more in: What Does a Low AMH Result Mean?

Factors that can influence AMH levels

It's important to know that some things can temporarily or even permanently change your AMH:

Birth control

Certain types of birth control can suppress your natural AMH levels. One study looked at data from women on various types of birth control and found: 

• Combined oral contraceptive pill led to 23.7% lower AMH
• Progestin-only pill led to 14.8% lower AMH
• Vaginal ring led to 22.1% lower AMH
• IUD led to 6.7% lower AMH
• Implant led to 23.4% lower AMH
• Copper intrauterine device led to 1.6% lower AMH

The authors concluded that birth control use is associated with a lower mean AMH level when compared to those who are not on contraceptives, with variation depending on the type of birth control

Health conditions

Things like PCOS, endometriosis, vitamin D deficiency, or even a recent ovarian surgery can impact your AMH levels.

Chemotherapy 

Chemotherapy treatments for conditions like cancer can significantly lower AMH levels. Research indicates that pre-chemotherapy AMH levels may be helpful in predicting ovarian function and potential fertility after treatment. A prospective study of women treated with chemotherapy for early breast cancer showed that long-term ovarian function after treatment was predictable using serum AMH levels before treatment. 

Obesity

Studies suggest a connection between obesity and lower AMH levels, though the exact relationship is complex. Obesity is linked to hormonal imbalances and inflammation, which can disrupt ovarian function and potentially affect AMH production. However, it's important to note that not everyone with obesity experiences lowered AMH, and other factors could also be at play. More research is needed.

Smoking

Studies have also shown that tobacco use, usually cigarette smoking, decreases AMH levels. This effect appears to be reversible though–it was only seen in people who were active smokers, not people who had previously smoked. 

What is a good AMH level for egg freezing?

Research has found that AMH is a good predictor of the response to ovarian stimulation and the number of eggs retrieved. Because of this, fertility doctors typically use your AMH levels (along with other biomarkers) to determine the drugs and dosages you will need to maximize your response to ovarian stimulation. 

Now, what about a correlation between AMH and actual babies born (live birth rate)? Well, while AMH does seem to have some association with live birth rates after IVF, its ability to actually predict a live birth is not that great. This is especially true for younger people. A 2021 study found that AMH is a good predictor of live birth in older (>39 years old), but not younger, people. They found that younger participants (≤38 years old) could get pregnant even with low AMH levels as long as they had frequent egg retrievals. 

Does AMH predict the number of eggs you will retrieve during egg freezing?

The overall success of an egg freezing cycle largely depends on the number and quality of eggs retrieved. Studies have shown that AMH levels can be used as a predictor of egg quantity, and can thus help to predict the potential success of egg freezing. Those with higher AMH levels tend to have better outcomes with egg freezing, as they are likely to have more eggs retrieved and a higher chance of success in future fertility treatments. 

But by no means does a high AMH level guarantee a lot of eggs during an egg retrieval procedure for fertility treatments. The number of eggs retrieved during an egg freezing cycle depends on several factors, including your age, ovarian response to stimulation medications, any other underlying medication conditions, and the skill of the fertility doctor performing the procedure.

When eggs are retrieved, only a portion of those eggs will be mature. A mature egg is one that’s ready and able to be fertilized. At most clinics, any non-mature eggs are discarded, though you can talk to your clinic about whether they’re open to freezing those too. 

Multiple studies have shown a strong correlation between AMH levels and mature eggs retrieved during egg freezing or IVF.

Let’s look at a few of the studies:

The study: Correlation between anti-Müllerian hormone, age, and number of oocytes 

Who: 1500 patients in Brazil between July 2012 and April 2019

The findings: “A positive correlation was found between serum AMH levels and total number of retrieved and mature oocytes from stimulated cycles”

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The study: Different anti‐Műllerian hormone (AMH) levels respond to distinct ovarian stimulation methods in assisted reproductive technology (ART) 

Who: 1,112 patients undergoing an egg retrieval as part of ART

The findings: “AMH showed a stronger correlation with egg number compared with age over a wide age range”

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The study: Relationship Between Anti-Müllerian Hormone and In Vitro Fertilization-Embryo Transfer in Clinical Pregnancy 

Who: 314 infertility patients with an average age of 31.0 ± 4.5 years

The findings: “the AMH level of women of all ages was positively correlated with the number of retrieved oocytes “

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The study: Antimullerian hormone (AMH) is a predictor of the number of eggs retrieved and D3 embryos in women with fluctuating and persistently elevated FSH levels 

Who: 58 women with fluctuating and persistently high serum day 3 (D3) FSH.

The findings: “These data demonstrate for the first time that serum AMH is a prognostic indicator independent of age and FSH of the number of eggs retrieved”

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The study: Random anti-Müllerian hormone (AMH) is a predictor of ovarian response in women with elevated baseline early follicular follicle-stimulating hormone levels 

Who: 73 women undergoing ART with elevated early follicular FSH levels

The findings: “Random AMH levels were strongly correlated with the number of oocytes retrieved during an ART cycle among women with elevated FSH”

Read more in AMH and Egg Retrieval Outcomes

What AMH do I need to donate my eggs?

Through Cofertility’s Split program, qualified freezers can freeze their eggs for free when donating half of the eggs retrieved to a family who can’t otherwise conceive. In the context of donating through our Split program, having an appropriate level of AMH is important. Fertility doctors typically consider an AMH level above 2.0 ng/ml as a good indicator for egg donation, and this is the benchmark used at Cofertility. Note that some clinics have a higher requirement.

This level suggests that you are likely to respond well to fertility treatments and produce a sufficient number of eggs for both donation and personal use. This allows us to proceed with the egg retrieval process in a manner that is both safe and effective.

However, if your AMH level is lower than this, it does not necessarily mean you cannot freeze your eggs. You can still qualify for our Keep program — where you keep 100% of eggs retrieved for your own future use — we offer exclusive discounts on expenses, such as frozen egg storage. Keep members also still gain free access to our Freeze by Co Community, a safe space for those engaging in the egg freezing process (or gearing up for it) to connect and lean on each other.

Everyone is unique, and AMH is just one factor of many that we consider during the evaluation process. You can learn more about qualifications for our Split program here. 

When should I test my fertility? 

So, when is the “right” age for testing your fertility, anyway? 

It depends.

And ultimately, it’s up to you! It’s your body, and your data, and there is no one-size-fits-all answer. We’re firm believers that knowledge is power and you deserve this information. Studies do show that our ovarian reserve declines with age — in other words, it’s a good idea to assess your fertility potential sooner rather than later. That way, if you do want to preventatively freeze your eggs, you can do so while your ovarian reserve is still higher. 

According to the American Society for Reproductive Medicine (ASRM), the optimal time to freeze your eggs is in your 20s and early 30s. This study also indicated that, as we get older, our chances of needing to do multiple egg freezing cycles increase in order to achieve a 70% live birth rate. We know we’re a bit of a broken record here, but: the younger you are, the healthier and more plentiful your eggs are.

Should I test my fertility at home or in a clinic?

At-home fertility tests have gained popularity in recent years due to their convenience and privacy. These tests typically involve collecting blood or urine samples and mailing them to a laboratory for analysis. On the other hand, in-clinic fertility tests are conducted at a medical facility, where specialized equipment and healthcare professionals are available.

The pros of at-home fertility tests include:

• Convenience and privacy: Samples can be collected in the comfort of your home.
• Cost-effective: At-home tests are often more affordable than in-clinic procedures.
• Early assessment: At-home tests allow you to gain insights into your fertility potential before actively trying to conceive. Plus, you won’t have to wait to get squeezed in for an appointment at the clinic!

The pros of testing your fertility at a clinic:

• A broader scope: At-home tests may not provide a comprehensive evaluation of fertility health, while testing your fertility at a clinic provides a more comprehensive picture of your fertility. An important note is, when testing your fertility at a clinic, you’ll also undergo a transvaginal ultrasound, where the technician or doctor will be able to get a view of what’s going on in those ovaries and the number of follicles available this cycle.
• Better accuracy: Some at-home tests may have varying levels of accuracy when compared to in-clinic tests.
• Facetime: At a clinic, you’ll have the ability to chat directly with a doctor, before and after your results.

If you do end up going with an at-home test, we have an exclusive discount with the LetsGetChecked Ovarian Reserve Test. It’s $139, and you can get 25% off with code COFERTILITY25. But there are many other options as well.

Although at-home fertility tests are a great way to get a peek behind the curtain of your fertility, they aren’t without limitations. For starters, according to recent studies, measuring AMH alone may not predict your time to pregnancy. As mentioned above, testing your fertility with a doctor at a clinic will likely provide a more comprehensive picture of your fertility outlook, especially as they consider your medical history, and conduct a physical exam and transvaginal ultrasound. Of course, you’ll also get professional interpretation of the results that you may not receive with an at-home fertility test. 

All of that being said, any fertility testing (whether at home or in a clinic) only measures your fertility at that given point in time. It should not be taken as a guarantee for future outcomes. It also can’t tell you anything about your egg quality, which cannot be truly observed until it comes time to actually fertilize those eggs. 

You are not a number

Repeat after me: you are more than one number! Your AMH level provides valuable insights into your ovarian reserve, but it’s just one piece of the puzzle when it comes to your fertility. AMH is always used as part of a full fertility evaluation, which often includes information about your medical history and age, a partner semen analysis, an ultrasound of the pelvis, an x-ray of the uterus and fallopian tubes, and/or additional lab work.

If that sounds like a lot, it is. This process can be overwhelming but focusing on the things that you can control can help you feel more grounded during your fertility journey, whatever that may look like.

Read more:

• Which Matters More for Fertility: AMH or Age?
• What AMH Level Do I Need to Freeze My Eggs?
• What Does a High AMH Result Mean?
• What Does a Low AMH Result Mean?
• Birth Control and AMH Levels
• What Medications and Supplements Affect AMH Levels?
• What AMH Do I Need to Donate my Eggs?
• AMH and Egg Retrieval Outcomes