Tree of Life Center / AMH (Anti-Müllerian Hormone) levels FAQ - All you need to know!

AMH (Anti-Müllerian Hormone) levels FAQ - All you need to know!


AMH FAQ answered by LOS ANGELES Fertility EXPERT Reproductive Endocrinologist Dr. Jovanovic, MD, FACOG

AMH Report with 1.75 value and no reference range or units

What information does the anti müllerian hormone (AMH) test provide?

The Anti-Mullerian hormone level is a blood test that evaluates how many eggs remain in your ovary. This is is also known as "ovarian reserve." It does not tell us anything about the quality of your eggs. The quality of your eggs will mainly depend on your age and cannot be evaluated unless the eggs are taken outside of your body, and fertilization attempts are made.

Every woman experiences a natural decline in AMH over time. Therefore, your levels need to be interpreted in comparison to your age group. The reference intervals on your laboratory results are usually vast and might not be useful in putting your egg reserve into perspective.

At the time of menopause, the AMH levels become undetectable. The AMH is a relatively novel marker of measuring ovarian reserve, introduced into clinical practice somewhere around 2005. Previously, it was used in research only, mainly during embryonic development, since it is highly essential for male and female genital development. It is also known as MIS (Mullerian Inhibiting Substance). While males also produce AMH in the testicle, it has no clinical relevance for male patients

AMH report from Labcorp with circled result 0.490 ng/ml

Does the AMH tell me anything about my chances of getting pregnant right now?

No. The AMH test does not provide any information about a woman's chance to conceive at the moment. This will depend on many other factors, including the quality of the partner's sperm, the condition of the fallopian tubes, and if ovulation is occurring. The AMH level alone cannot predict anybody's fertility.

Natural conception might occur even in the setting of reduced AMH values. Ovulation is a crucial factor in the natural inception of pregnancy. If you have regular cycles, your pregnancy success will correlate with your age and not with your AMH level. To clarify again, your AGE is the most reliable fertility predictor regardless of your AMH levels.

However, low AMH levels might suggest that you have only a very short time left to become pregnant and need to seek help!

AMH report of 1.44 ng/ml with reference ranges for male and female by ages

Does the AMH tell me anything about my chances to conceive in the future?

Yes. The AMH level can provide us with information if a female is likely to enter premature menopause. In early menopause, the woman loses all of her eggs prematurely and cannot reproduce anymore. Typically, premature menopause is preceded by a period of diminished ovarian reserve.

AMH can detect diminished ovarian reserve. This can happen even at a younger age, and we encourage women of all ages to check their AMH. Some women have a genetic predisposition for premature menopause, like Fragile-X premutation or Turner Syndrome.

I have low AMH. Does it mean I am infertile?

No. As long as you have regular periods and you will ovulate one egg per month. You will have the same pregnancy rates as a woman with high AMH in the same age group. The reason is that regardless of the AMH level, a woman's ovary will mature and ovulate one egg per month. The overall number of eggs in the ovary will not affect this. If you plan to delay your fertility, you might consider egg freezing or embryo freezing.

Anyhow, if you are diagnosed with low AMH, you should consult a fertility specialist immediately. This will ensure that you receive recommendations concerning your results and situation. As noted above, some cases of the diminished ovarian reserve may uncover another underlying medical problem.

We will help you obtain the recommended genetic testing for patients with diminished AMH levels. We advise every woman with low AMH levels to check FSH and Estradiol levels at cycle day 1-3. We can help you arrange for those tests at a Labcorp or Quest location anywhere in California or the United States. Elevated FSH levels in the setting of normal Estradiol levels are concerning.

I was found to have high AMH levels. Does it mean I am super-fertile?

Example from German AMH report with high value of 18,42

No. You will ovulate one egg per month, like anyone else. In some cases, you actually might experience irregular periods associated with high AMH. We find higher than average AMH levels in women with polycystic ovary (PCOS). Under some circumstances, this might reduce your chances to conceive. However, having a high number of eggs might give you some advantage in the future since you are less likely to enter menopause early. It will also improve your success rates during IVF treatment.

I was found to have low or high AMH levels, and my cycles are irregular. Is this concerning?

Yes. You should have a consultation with a fertility specialist immediately.

In cases with low AMH levels, you might be experiencing some early signs of premature ovarian failure or menopause. This is usually an irreversible condition associated with hot flashes and vaginal dryness. While in rare cases, immunosuppression was able to more or less improve the ovarian function, the only recommended option is natural cycle IVF or Egg Donation.

In cases of high AMH, you might be experiencing irregular cycles related to polycystic ovarian syndrome (PCOS). Treatment of PCOS is relatively simple, and there are many options available to restore regular ovulatory periods. This can be achieved with Clomid, Letrozole, or injectable gonadotropins. The overall prognosis is excellent.

Why do fertility clinics check AMH levels?

Many of our treatments utilize the ability of your ovary to ovulate multiple eggs during the same treatment month. While a human ovary naturally (almost) always ovulates a single egg, other species like cats, dogs, and mice ovulate multiple eggs at the same time. With fertility medications, your ovary will ovulate numerous eggs, and we use this in IVF (in vitro fertilization) or Invocell cycles to obtain many eggs at once. Your AMH can predict how many eggs are likely to mature with ovarian stimulation in one IVF cycle. Given the high cost of IVF, predicting the ovarian response, and optimizing the fertility drug dosage is crucial for success.

AMH is an excellent guide in choosing the ideal fertility therapy and helps your fertility specialist. In fact, at Tree of Life Center, your AMH level is always displayed at the top of your medical record. This ensures that all your treatment is tailored to your level. It will, however, not necessarily help you much to determine your chances to conceive naturally.

Should I work on increasing my AMH levels?

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. Since your eggs multiply in your ovary only during one occasion before your birth, this overall number of eggs gradually decreases throughout your reproductive life.

Still not convinced? Let's consider a plausible analogy that everyone will understand: You go to the store and want to buy (chicken) eggs. Because of the Coronavirus crisis, the eggs got more expensive! The store decides to sell smaller quantities and fills up the packages with a variable number of eggs. While from the outside the units look alike, you have a price sticker that varies on each box. The higher-priced boxes have more eggs, and lesser-priced boxes have fewer eggs. You know that the carton with a higher price tag will have more eggs. Does the change of the price tag on the package, change the number of eggs in the container??? NO! So, imagine the AMH level is the price tag, and the eggs are your eggs in the ovary. Does it now make sense to work improving your AMH level? No, the efforts are futile, and by now, you hopefully understand why. This is not comparable to a vitamin level measured in your blood that you can replenish and fix. This is a reflection of a status deep inside your ovaries, and the serum level itself does not do anything. Even if it goes up, it does not mean the egg count got better. The overall price of eggs can go up while the number of eggs in the box remains unchanged!

This is contrary to some claims and remedies that advertise medication or treatments to improve AMH levels. While some studies suggest that specific stem cells can recreate new eggs, these findings are controversial. There is no medication you can buy to initiate this process at home. New evidence points that ovarian rejuvenation with PRP might help, but this is not something to try at home!

There are some protocols to increase the number of available eggs for maturation before fertility therapy. New evidence also suggests that attempts of ovarian rejuvenation with PRP might improve ovarian function. Those changes, however, will not be necessarily reflected in the AMH level. Those changes might be visible in your Follicle Stimulating Hormone (FSH) and Estradiol levels at the start of each menstrual cycle. In a given treatment cycle, the FSH and Estradiol are better predictors of cycle outcome. This is why a fertility specialist always checks the FSH and Estradiol levels at the start of advanced fertility treatment cycles.

What should I do if my levels are low?

It all depends on what your life goals might be. If you completed your family and desire no more children, you shouldn't be worried. If you undergo menopause early, we can provide you with appropriate hormone replacement therapy and not having eggs is on itself, not abnormal. It happens to every woman who lives beyond her reproductive age!

If you do indeed want to start a family, you should get alerted! If you are younger and have no partner, we might be able to freeze some eggs. If you are already considered advanced reproductive age, you need to put a full effort into conceiving right away and don't delay. If you take this concern seriously, you need to partner up with a fertility specialist. Low AMH levels mean that the time for conception is running out, and you need professional help that can only be provided by a board-certified reproductive endocrinologist. If you are reading this article, it appears that you still have some unanswered questions. Anybody can afford an essential consultation, and this is the minimum you should do!

What other tests can measure the number of eggs in the ovary?

We utilize transvaginal ultrasound to evaluate the number of available eggs for maturation, also known as Antral Follicle Count (AFC), in the cycle to come. We also utilize the Follicle Stimulating Hormone (FSH) and Estradiol (E2) levels on cycle day 1-3 to evaluate how many eggs might be able to mature. We advise every woman with low AMH levels to check FSH and Estradiol levels at cycle day 1-3. We can help you arrange for those tests at a Labcorp or Quest location anywhere in California or the United States.

Do you still have questions that we did not provide an answer?

Please use the opportunity to have your affordable individual AMH consultation. We will try our best to clarify any open question and can discuss your level with you directly. We will keep adding more FAQ here so we can serve your needs better. Please contact us anytime and take advantage of our AMH Special.