A guide to AMH and its role in reproductive health

Ah, AMH: another acronym to add to the alphabet soup that is trying to conceive. But, in certain circumstances, it’s an important one. The level of anti-Mullerian hormone (AMH) in your blood can give you vital information about your egg reserves and how your body might respond to fertility drugs. 

As always, though, it’s not simple, and everyone is different. When you’re trying to get pregnant, it can be all too easy to fall into the trap of comparing yourself to other people, especially if your friends or loved ones are getting pregnant quicker than you are. So, here’s the lowdown on anti-Mullerian hormone,  when a doctor might suggest testing your levels, and why it can be useful to know what AMH is. 

Key takeaways about AMH and its role in reproductive health 

• Anti-Mullerian hormone is a chemical produced in your ovaries. It helps to select a “dominant” follicle during ovulation. This is the small fluid-filled sac where an egg grows and matures. 
• AMH is thought to be a good indicator of your ovarian reserve or how many eggs you have. However, it isn’t a good predictor of fertility because so many factors can impact this. 
• There’s no universal “good” AMH level. We’re all different. 
• You might have your AMH levels tested if you’re considering fertility treatment, but rarely before that. In fact, at-home AMH tests are available, but doctors do not recommend them.
• AMH tests can’t tell you how long it’ll take to get pregnant or whether you are infertile.
• If you’d like to learn more about the hormones that trigger your menstrual cycle, you can download an app like Flo. 

What is anti-Mullerian hormone (AMH)?

Anti-Mullerian hormone is produced by cells in your ovaries called granulosa cells. They are “like the egg’s helper cells,” says Dr. Jennifer Boyle, obstetrician and gynecologist, US. These cells “line the follicle where the developing egg lives and grows.”  Alongside AMH, they also produce estrogen and progesterone. Unlike estrogen and progesterone, though, AMH levels don’t fluctuate much through your cycle. 

What role does anti-Mullerian hormone (AMH) play in reproductive health?

One of AMH’s most important roles in your cycle is selecting a follicle before ovulation. At the start of a new cycle (marked by the start of a new period), several small fluid-filled sacs start to develop in your ovaries. These are known as follicles. “The job of AMH in a woman’s reproductive cycle is to pause the development of other early follicles so that a dominant follicle can be selected and developed, leading to ovulation,” says Dr. Boyle. 

Because AMH is secreted by all the follicles that are up for selection for the dominant follicle, its level is thought to be a good indicator of the overall number of follicles you have — and therefore, “it can be used as a very rough tool to get a sense of our egg and ovarian health,” says Dr. Boyle. 

As we are all different, this can differ from person to person, and it’s unlikely that you would ever test for this at home. In fact, even if you’re trying to conceive, doctors don’t recommend that you test your AMH levels at home, as they aren’t a good indicator of how long it’ll take you to get pregnant. 

What is a good AMH level for getting pregnant?

“It is so important to understand that AMH is not a test that will tell you if you can or cannot get pregnant. It also cannot tell you how long it will take to become pregnant,” says Dr. Boyle. That’s because there are many reasons it might take longer than expected to get pregnant, from blockages in your fallopian tubes to issues with sperm health or mobility to chronic conditions like endometriosis. 

What also complicates things is that “good” AMH levels differ not only for each age group but also for each brand of AMH test, says Dr. Boyle. So, while one level might be considered “good” at one lab, another lab might have a different level, depending on how their test works.

It’s also worth pointing out that high AMH levels don’t necessarily mean you are ultra fertile: “AMH levels can be high, or elevated, in women with polycystic ovary syndrome (PCOS). Sometimes, people with PCOS have a difficult time becoming pregnant. This just goes to show that AMH is absolutely not a ‘fertility test.’”

When do doctors do AMH tests?

The usual way to test AMH is by using a blood test administered by a doctor. AMH tests are part of the routine battery of fertility tests. However, some studies have shown that unless your AMH levels are very low, low AMH shouldn’t make it significantly harder to get pregnant.

However, if you are about to start in vitro fertilization (IVF), it’s likely you’ll be given an AMH test. That’s because, says Dr. Boyle, “AMH tests are really good at predicting how someone will respond to drug regimens that are given during IVF. A person’s AMH level will help a fertility specialist design the best medication regimen for a person who is going to do IVF.” 

Some hormone testing companies offer at-home AMH tests, which are finger-prick tests that you send back to a lab. To get a really good idea of what’s going on, it’s helpful to have a doctor interpret your results. And these can also cause more worry than is necessary because, as we have already said, low AMH does not necessarily mean you are infertile. 

What AMH tests can tell you

• How you will respond to injectable fertility drugs: AMH is used by doctors to design IVF protocols — the combination of drugs your ovaries will respond best to. 
• What your egg count is: The higher your AMH levels, the more eggs you are estimated to have. 
• How quickly your ovaries are aging: You are born with a certain number of eggs, which decline over your lifetime. Lower-than-expected AMH levels can indicate that your ovaries are aging fast. 
• Whether you might have PCOS: Some studies have shown that AMH levels are two or three times higher in people with polycystic ovary syndrome than in others, so high AMH may indicate that you have PCOS.

What AMH tests can’t tell you

• What is causing your infertility: Low AMH levels may indicate that you have decreased ovarian reserve, which is when you have fewer eggs. However, you can’t know this for sure without going to your doctor for additional tests. Even with a good AMH level, there may be other factors, such as blockages in your fallopian tubes, an abnormally shaped uterus, sperm mobility issues, or other health concerns, preventing you from becoming pregnant.
• How long it will take to get pregnant: One 2018 study showed no statistically significant correlation between AMH level and how long it will take you to become pregnant. 
• When you’ll go through menopause: Even if you have high AMH levels for your age group, lifestyle factors such as smoking can speed up menopause. 

The connection between AMH and getting pregnant

As we’ve already shown, there’s no strong correlation between AMH levels and getting pregnant naturally, so if you’ve only been trying to conceive for a few months, try not to panic about your AMH levels. 

“It is absolutely not necessary or helpful to have your AMH level checked unless you are starting to do a fertility workup or fertility treatments,” says Dr. Boyle. That means you’ve been trying to conceive for more than 12 months if you’re under 35 or six months if you’re over 35. 

It may be helpful to start tracking your cycles, though. Flo’s ovulation-tracking app and ovulation calculator may help you spot patterns in your cycles and log any symptoms you might notice. Flo also has educational resources on your fertile window and conception.