Understanding AMH (Anti-Müllerian Hormone) and Fertility

Both men and women have AMH, but in people with uteruses, AMH is produced in the ovaries. More specifically, it’s produced by young ovarian follicles. These correspond to the store of eggs in the ovaries that have the potential to mature in a woman’s reproductive cycle.

Doctors know that AMH levels correspond with a person’s ovarian reserve: The more egg follicles you have, the higher your AMH levels will be. In clinical settings, AMH tests are used to understand one’s number of eggs or ovarian reserve, or how many eggs are left and viable for fertilization.

If you’re wondering, “What is a low anti-Mullerian hormone level?” it’s important to note that labs and clinicians may differ in their assessment of healthy ranges. That said, in women, AMH tends to peak around 25 years of age. Typical ranges include:

• Average – Between 1.0 ng/mL and 3.0 ng/mL
• Below average – Under 1.0 ng/mL
• Very low – .4 ng/mL

While AMH can indicate one’s egg count, it can’t signal anything about egg quality. High AMH levels also don’t guarantee your ability to become pregnant. For instance, someone with low ovarian reserve may still ovulate or respond well to fertility treatments.

Ultimately, AMH is just one piece of the whole fertility puzzle.

What does the AMH test show?

Doctors primarily use AMH tests to understand how many ovarian follicles a person has. This assists with fertility planning and treatment, providing insight into age and fertility.

AMH tests can also tell you about:

• Potential receptivity to IVF –IVF (in-vitro fertilization) works by stimulating eggs to grow. Because low AMH levels indicate a lower number of follicles, people with low AMH may not be as responsive to this form of fertility treatment.
• Risk of premature ovarian insufficiency – Low AMH may indicate the premature or sudden depletion of one’s available follicles. This is known as premature ovarian insufficiency, or POI.

While AMH tests can be a helpful tool in assessing the potential efficacy of IVF, they can’t predict a person’s ability to conceive, especially when used in isolation. The ability to conceive involves a wide range of factors, so it’s important to work with your healthcare provider to look at the total picture of increasing your fertility.

Low AMH Levels: Causes and Conditions

Clinicians often consider AMH low when:

• It highlights a diminished ovarian reserve with respect to age
• It’s at a level that could limit the effectiveness of fertility treatments

While low AMH doesn’t indicate infertility, it can help inform decisions about fertility planning. Knowing some of the causes and conditions of low AMH can also help determine the most effective treatment plans.

Reproductive Age

Age remains the most significant factor in declining AMH levels. As you get older, the number of ovarian follicles declines naturally, corresponding with diminishing AMH levels. While many ask “what is a recommended AMH level to get pregnant,” the answer often depends on individual circumstances and biological age.

While no “healthy” range is set in stone, the following AMH levels are considered typical for certain ages:

• 25 years – 3.0 ng/mL
• 30 years – 2.5 ng/mL
• 35 years – 1.5 ng/mL
• 40 years – 1 ng/mL
• 45 years – .5 ng/mL

For most women, the decline in ovarian reserve and AMH tends to accelerate in the early to mid-30s.

Genetic or Familial History

Some people are genetically predisposed to have a lower ovarian reserve than others. This is typical of people with genetic disorders impacting the X chromosome, as well as those with a family history of fertility challenges.

Medical Conditions and Procedures

Some medical issues or interventions can influence ovarian reserve by damaging ovarian tissues or impacting reproductive organs. Examples include:

• Reproductive health conditions, such as endometriosis or PCOS
• Radiation or chemotherapy
• Removal or loss of an ovary
• Certain autoimmune conditions

Lifestyle or Environmental Factors

A growing body of research indicates that certain environmental or lifestyle factors may play a role in lowering AMH levels. These include:

• Smoking or vaping – Smoking has long been associated with a diminished ovarian reserve. Today, vaping has also been linked to lower AMH levels.
• High BMI – While more research is needed, one study discovered lower AMH levels in women who were obese, compared with non-obese women in late reproductive age. That said, researchers believe that decreased levels of AMH may indicate an issue with follicular function, rather than a lower-than-average ovarian reserve.
• Environmental toxins – A new, major review of the impact of environmental toxins on fertility showed that certain endocrine-disrupting chemicals, like phthalates and Polychlorinated Biphenyls, may contribute to low AMH. Exposure to heavy metals, like lead and cadmium, is also associated with lower AMH and accelerated ovarian aging.

Is it possible to increase AMH levels?

One of the main questions that comes up when addressing what causes low AMH is whether AMH levels can be raised at all. In short, the answer is: Not reliably.

AMH reflects follicle count. Once these are depleted, your body can’t regenerate them. That said, by assessing your lifestyle with your healthcare provider, you can identify strategies for supporting your reproductive health, like quitting smoking, reducing stress, and maintaining a healthy diet.

Getting Pregnant with Low AMH: Fertility Treatments and Next Steps

Having low AMH can feel scary, but it by no means takes parenthood off the table. Your healthcare provider can help point you toward evaluation and treatment options like ovarian stimulation, as well as family planning solutions.

Treatment pathways typically involve the following steps.

Consulting a Reproductive Specialist

Once you’ve received your test results, consider booking an appointment with a fertility doctor or reproductive endocrinologist (RE).

These specialists can help interpret your AMH in relation to your age and other hormone levels (like FSH and estradiol). They can also help explain how these factors may impact your family planning agoals. With the information they offer, you can determine if further fertility testing is needed for your situation.

Understanding Your Prognosis

Low AMH levels are a biomarker, not a final verdict on fertility. Some people with low AMH still conceive naturally, while others may need assisted reproductive technology (ART). It’s important to clarify with your doctor if they think you’ll be receptive to IVF or other stimulation treatments.

Weighing Your Options

Even if your AMH levels correspond with fertility challenges, there are many ways people walk the path to parenthood. Some helpful treatment options include:

• Fertility preservation – Cryopreservation, which could include both egg and embryo freezing, is an increasingly popular procedure. It’s best for people who want a baby but are worried about the health of their ovarian reserve. This is also an excellent option for people who know they want a family, but aren’t quite ready to start one yet.
• Donor options – If your ovarian reserve is very low and your healthcare provider thinks you may have a low response to stimulation, you might consider discussing donor eggs. Donation may help you pursue pregnancy with a potentially higher rate of success, depending on your age and receptivity.
• Tailored IVF – Tailored IVF protocols are intended for people with a diminished ovarian reserve. In these procedures, your provider may recommend minimal stimulation IVF or undergoing several retrieval cycles to retrieve fewer, but higher-quality eggs.

Finding Strength, Hope, and Emotional Support

For some, low AMH points to a longer and more challenging road ahead. While fertility struggles can be emotionally taxing, you don’t have to go through it alone.

Whether you work with a fertility counselor, a support group, or simply lean on loved ones for support, nurturing your emotional well-being is a critical part of many people’s fertility journeys—no matter what that journey looks like.

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