Anti-müllerian hormone (AMH) (pronounced “ant-ee mull-air-ee-in”) is produced by specialized cells in your ovarian follicles, called granulosa. AMH levels are highest in immature egg follicles – so testing AMH levels gives us a good indication of how many immature egg follicles you have left, with the idea being the higher the better when trying to get pregnant.
As a result, AMH testing determines “ovarian reserve” and is often referred to as an ovarian reserve test.
What’s So Great About AMH Testing?
AMH is produced consistently, and isn’t menstrual cycle dependent the way other hormones (FSH, estrogen, progesterone) do. This means we can test your AMH levels at any time of the month. This basic blood test can tell us:
- How many immature follicles (4mm in diameter or less) you have left (more mature follicles produce decreasing levels of AMH, follicles 8mm in diameter or more don’t produce any).
- A guestimate of how many fertile years you have left
- A better indicator of how much fertility medication (dosage) is needed to stimulate egg production for at-home conception or a particular fertility treatment.
This information is invaluable to your doctor or a fertility specialist because it helps us create a more personalized fertility plan for our patients.
What’s Considered Normal?
Your doctor will use a very specific guide when comparing your AMH test results. If you’re older than 35-years and having a hard time getting pregnant, you should speak to your OB or discuss a referral to a fertility specialist after three, consecutive months of unsuccessful attempts to get pregnant. If other, non-age-related infertility factors are at work for you or your partner, it’s best to find that out sooner rather than later.
The following AMH levels are for women 35-years and younger:
- High (often PCOS): > 4.0 ng/ml
- Normal: 5 – 4 ng/ml
- Low-normal: 0 – 1.5 ng/ml
- Low: 5 – 1.0 ng/ml
- Very low: < 0.5 ng/ml
What Causes Decreased AMH Levels?
If AMH levels are lower than expected, there are several potential causes. Some are treatable and others are not. Innovations in fertility treatments mean you can probably still get pregnant – even if it requires a more creative approach to fertility (such as using a donor egg).
Some of the most typical causes for low AMH levels include:
- You’re 36-years or older. Age definitely matters in fertility and by the time you hit 35, the large majority of your eggs have been absorbed by your body or released when you ovulated.
- You’ve started menopause early. Women in their late 20s or early 30s can be surprised to learn they’ve started menopause early. This reduces AMH levels and is most usually genetically-related – although not always.
- Endometriosis, a leading cause of female infertility
- Auto-immune disorders
Any of these causes will be quickly determined by your OB or fertility specialist once they review your medical history and/or ask additional questions about your reproductive and menstrual cycle history.
If you’re struggling to get pregnant, schedule a consultation with Women’s Health Associates to discuss potential fertility tests, including ovarian reserve testing.