Anti-mullerian Hormone Levels (AMH): Top 10 Questions

1 What is AMH?

AMH or anti-mullerian hormone is a substance that is produced by granulosa cells in the ovarian follicles. Anti-mullerian hormone is first made in the primary follicles, which advance from the primordial follicle stage. At this stage, follicles are microscopic and can’t be seen through ultrasound.

The production of AMH is highest during the preantral as well as in small antral stages of development. The production of this hormone decreases and then ceases as follicles grow. This is the reason why almost no anti-mullerian hormone is made in follicles that are over 8 millimeters.

The state of ovarian reserve as well as the quantity of eggs left in the ovaries can be measured through a blood test. Doing so can help verify whether and how treatment is urgently needed and how a woman will respond to a corresponding treatment.

Anti-mullerian hormone levels naturally decrease as women age because the ovarian reserve is depleted. Thus, women who are in their 40s have low AMH levels. An AMH level of above 21.98 pmol/l is considered satisfactory; however, age and other circumstances must be considered in order to make the most precise assessment. Treatments are available for women who have low AMH levels.

2 What is ovarian reserve?

Ovarian reserve is a term that refers to the capacity of the ovaries to produce egg cells that are capable of fertilization and can lead to a healthy and successful pregnancy. With advanced age, the number of egg cells that can be recruited successfully for a possible pregnancy decreases, constituting a main factor in the inverse relation between female fertility and age.

Each menstrual cycle, an egg cell is released through ovulation, and the remaining follicles that were recruited for maturation are lost through atresia. Few, if any, egg cells are replenished during the reproductive years. However, this loss through menstrual cycles only accounts for around 10 egg cells every month. Thus, it accounts for but a small fraction of the actual and total loss of egg cells throughout a woman’s lifetime.

An additional contributory factor in the downturn in ovarian reserve with age appears to be the reduced gene expression of proteins that are involved in DNA repair by homologous recombination.

Women over 35 years old who have attempted or are attempting to get pregnant but have been unsuccessful for at least 6 months should undergo ovarian reserve testing. The day 3 FSH test is the most popularly used test to check ovarian reserve. This test checks the FSH level on the third day of a woman's menstrual cycle. Day 3 of the cycle was chosen because at this time, estrogen levels are expected to be low.

Women with low ovarian reserve will have a hard time conceiving without infertility therapy.

3 What are normal AMH levels for specific age groups?

The pool of primordial follicles is reduced as women age because of degeneration. Consequently, the number of follicles that are awakened from their dormant state is reduced. As the size of the group of antral follicles decreases, the total amount of AMH produced by these follicles is also decreased. Therefore, older women are expected to have lower AMH levels than younger women.

The average AMH level in younger women is much higher than the average level in older women even if each group has a range of AMH levels. Thus, the older the group, the lower the average AMH level.

Below is the list of normal AMH levels for specific age groups:

                Age                                                                        Median AMH level (pmol/l)

20 to 29 years                                                                                   13.1 - 53.8

30 to 34 years                                                                                   6.8 - 47.8

35 to 39 years                                                                                   5.5 – 37.4

40 to 44 years                                                                                   0.7 – 21.2

45 to 50 years                                                                                   0.3 – 14.7

 

4 Is it possible to conceive naturally with low AMH levels?

Having low AMH levels do not cause of infertility; however, it can be a sign of a smaller egg reserve. When there are fewer eggs developing in the ovaries, the chances of mature and healthy eggs being released and fertilized are decreased. Moreover, in age-related low AMH, the quality of the eggs might also be affected as the eggs build up mutations over time. This means that there is an increased chance of abnormal fertilization and miscarriage.

5 What is the treatment for low AMH levels?

DHEA Supplementation for Low AMH Levels

DHEA supplementation has been shown to be effective in improving IVF pregnancy rates in women with low AMH. Published studies have shown significant improvements in the AMH levels of women after DHEA supplementation. These improvements in AMH levels were found to be one of the most reliable factors for a successful pregnancy with IVF.

IVF with Low AMH Levels

The chances of success of In Vitro Fertilization (IVF) greatly depend on a woman's ovarian reserve and her capacity to produce a large number of high-quality eggs in a cycle. Low AMH levels as well as very high FSH levels could mean a compromised ability of the ovaries to generate a good number of high-quality eggs. This can result in a poor fertility prognosis and low possibility of success with IVF.

Acupuncture and Chinese Medicines

Acupuncture and Chinese medicine do not increase the number of eggs that exist in the ovaries. They do, however, help a woman’s body make the most of what is left. This includes improving blood flow to the ovaries which can support the nourishment of the eggs and the relaxation of muscles and softening of tissue, allowing the remaining eggs to develop.

6 What are kinds of food that increase AMH levels?

To promote healthy ovarian tissue, egg development, and healthy follicles, there must be certain fertility nutrients that must be included in the diet.

Food Vitamins

The body requires a constant supply of vitamins and minerals to increase the number of eggs. Women who are preparing to get pregnant must take multivitamins.

L-Arginine

L-Arginine increases ovarian response as well as endometrial receptivity, which prevents miscarriage. In addition, L-Arginine helps increase blood flow to the ovaries, uterus, and fallopian tubes, thus improving the flow of nutrients to the ovaries. Lastly, L-Arginine helps increase the quality and production of eggs.

Antioxidants

Eating food that is recognized for its antioxidant properties can help ensure good quality eggs, thus the protection of cell DNA. This type of food prevents chromosomal abnormalities and mutations because they help the body in fighting against the damaging effects of free radicals. Free radicals can damage not only egg cells but also other cells in the body. With the help of antioxidants, damaged cells are able to repair themselves.

Maca

Maca is considered a fertility superfood. It balances the hormones by nourishing and balancing the endocrine system. Maca supports the balance of progesterone and estrogen as well as supports the adrenal glands.

Royal Jelly

Royal jelly helps increase the number of eggs and improves egg quality. It contains high amounts of lipids, vitamins, minerals, proteins, glucides, enzymes, and biocatalysts, all of which are needed by eggs. Royal jelly is also rich in niacin, biotin, folic acid, pantothenic acid, and inositol. For best results, royal jelly must be taken for 2 consecutive months prior to attempting conception.

7 What causes low AMH levels?

The levels of AMH can be established by the number of developing follicles in the ovaries. Age is the most vital factor in the number of follicles, as ovarian reserve lessens over time. Ovarian reserve starts to decrease in number in the mid- to late 30s and AMH, as well as ovarian reserve levels, becomes low in women in their 40s. However, age is not the only factor that causes lowered AMH levels.

Some women continue to have high levels of AMH in their 40s, while other women experience a decline in AMH levels in their 20s or 30s. This can be caused by certain environmental factors such as cancer treatment and genetic causes. Thus, it is important to determine the usual age of menopause in the woman's family, since this is a good guide to the rate of the woman’s own fertility decline.

Having low anti-mullerian hormone essentially does not present with obvious symptoms, although some notice a reduction or absence of periods.

The best way for a woman to assess her AMH levels is to undergo an AMH blood test.

8 How can a woman increase her AMH levels naturally to conceive?

Having healthy choices can help increase the levels of AMH for women and help them conceive naturally. A healthy diet and lifestyle can also help improve the health and quality of eggs.

Detoxification

Toxins can age or damage eggs. Thus, eliminating toxins from the body can help improve a woman’s fertility and her chances of conception. Fasting is a good way to eliminate toxins from the body.

Self Fertility Massage

Women with low AMH levels have poor blood circulation in the ovaries. To increase blood circulation, self fertility massage help. Self fertility massage is the best method for improving blood circulation and fertility, and also stimulates ovulation.

Yoga and Abdominal Stretches

Performing abdominal stretches and yoga daily can improve blood flow to the ovaries. As a result, the healthy nourishment of egg follicles is supported.

A Healthy Diet

Fresh and organic fruits and vegetables are full of antioxidants, which promote reproductive health. These foods are also high in folate, which is an important nutrient in preventing birth defects. Whole grains and omega 3 fatty acids are also recommended. These can reduce inflammation, regulate the menstrual cycle, and help in the production of hormones.

9 How are your AMH levels tested? What is the AMH blood test?

Measuring AMH blood levels can help determine the ovarian reserve of a woman. The general idea is that a woman with lower AMH levels has a smaller ovarian reserve compared to that of a woman who has high AMH levels. The AMH blood test is used by fertility specialists to predict who will have a hard time responding to fertility medicine as well as who will be less likely to succeed with fertility treatment.

Studies show that the size of the pool of growing follicles is greatly influenced by the size of the pool of remaining primordial follicles (microscopic follicles in "deep sleep"). Thus, AMH blood levels are thought to reflect the size of the remaining egg supply or "ovarian reserve".

As women age, the size of their pool of remaining microscopic follicles gets smaller. Similarly, their blood AMH levels and the number of ovarian antral follicles visible on ultrasound are also decreased.

Women with many small follicles, such as those with polycystic ovaries, have high AMH hormone values while women who have few remaining follicles and those that are close to menopause have low anti-mullerian hormone levels.

 

Interpretation (women under age 35)	AMH Blood Level
High	Over 4.0 ng/ml
Normal	1.5 to 4.0 ng/ml
Low Normal Range	1.0 to 1.5 ng/ml
Low	0.5 to 1.0 ng/ml
Very Low	Less than 0.5 ng/ml

10 Can IVF work even when a woman has low AMH levels?

Women with increased AMH levels will have a better reaction to the ovarian stimulation for IVF and have more eggs harvested. Having more eggs for IVF gives a higher success rate.

AMH levels do not tell much about egg quality; however, having more eggs for IVF egg retrieval gives more to work with, making it more likely to have at least one high quality embryo available for transfer to the uterus.

Having high AMH levels connects with low cancellation rates, higher live birth rates, more eggs for harvesting, and higher chances of extra embryos, which can be preserved for future use. However, low AMH levels alone do not forecast low IVF success rates in women who are under 35 years of age.

Couples should not be excluded from attempting IVF solely due to low AMH levels, since live birth success rates have been reasonable in these cases.

Meanwhile, low AMH levels in healthy young women do not seem to be a predictor of reduced fertility. This is because of the consistency of high egg quality despite low ovarian reserve.