While trying to conceive and holding out hope for that BFP (Big Fat Positive) test result, you will be inundated with so many terms and acronyms that it might become difficult to remember what everything means and what role it plays in your fertility.
For example, at the start of your fertility journey, you may begin to track your BBT (Basal Body Temperature) to more accurately time your BD (Baby Dance). If you’re interested in learning more about your fertility, your doctor might order an AMH, or anti-Müllerian hormone, test, which can help determine your ovarian egg reserve. But what does that really mean?
Does low AMH mean infertility?
While an AMH test is a great resource for those contemplating their fertility options, it does not predict the ability to naturally conceive. Low AMH levels do not indicate infertility. Just because a person with ovaries has low AMH levels does not automatically mean they will have a difficult fertility journey. It is completely possible to get pregnant with your own eggs with low AMH. In the same vein, normal or high levels of AMH do not always equate to an easy road to conception. AMH also reflects how many eggs you have, not their quality.
Having an AMH test conducted can have several benefits. For starters, it is a great indicator for your OBGYN or fertility doctor to determine how your ovaries may respond to certain fertility treatments, i.e. IVF or egg freezing, including roughly how many eggs may be retrieved. In simple terms, an AMH test informs your doctors what your ovaries are capable of, where they’re currently at, and what they can handle. Knowing your AMH levels can help you decide the next plan of action for you and your eggs so that you can be proactive rather than reactive.
Let’s break it down: What is AMH?
Let’s take it back to the beginning. As women, we are born with a finite amount of eggs, roughly 1-2 million. By the time of our first menstrual cycle, only about 300,000 to 500,000 remain, and that number continues to decrease. Why is that? Well, during each menstrual cycle, our body collects a group of follicles, each with an egg inside, in hopes that it might ovulate. Typically, just one egg ovulates per month, and the rest of the eggs inside the follicles that were not chosen then dissolve. Eggs are also lost through this natural process, called atresia, between cycles. Therefore, with each passing month, the number of eggs in our reserve decreases.
So, where does AMH come into play? The small, early-stage follicles growing in our ovaries are responsible for producing AMH. Therefore, the hormone is often used by healthcare providers as a marker to test the level of eggs remaining in a woman’s ovarian reserve.
Your OBGYN or fertility doctor will conduct a hormonal blood test to determine your AMH levels. An AMH level between about 1 and 4 ng/mL is generally considered normal. Anything less than 1 ng/mL might indicate that a woman has a lower, or diminished, ovarian reserve. On the other end, high AMH levels are often associated with polycystic ovary syndrome (PCOS). Keep in mind that cutoffs vary from lab to lab, so your results will come with your lab’s own reference range.
Who is at risk for low AMH levels?
As people with ovaries age, they naturally begin to lose eggs from that finite amount they were born with. The rate of eggs lost is a steady decline until around age 32, then speeds up, and even more so after 37 years of age.
As a general guideline, the following levels represent approximate average serum AMH values by age (your lab’s ranges may differ):
Questions Women Are Asking
20–25 years old: 4.23 ng/mL
26–30 years old: 3.48 ng/mL
31–35 years old: 2.43 ng/mL
36–40 years old: 1.28 ng/mL
40–44 years old: 0.52 ng/mL
In some cases, an AMH test might come back lower than expected. For instance, if you’ve been on hormonal birth control long-term or have hypothalamic suppression (such as hypothalamic amenorrhea), your AMH levels may appear lower than they truly are. In these cases, another way to determine a woman’s ovarian reserve is to conduct an antral follicle count during a transvaginal ultrasound.
When should I test my AMH?
Knowledge is power, and AMH tests can be good indicators of where our ovarian reserve stands at the moment of testing. Because AMH levels stay fairly stable throughout the menstrual cycle, you can be tested at any point in your cycle. As people with ovaries, we can empower ourselves by gaining as much insight into our own fertility as possible to help us feel even more confident in our decision-making process about what, if anything, we want to do for our fertility health and family planning.
While it won’t tell your whole fertility story, if you think knowing your AMH levels will help you make better-informed choices regarding your own journey toward conception, then talk to your OBGYN or fertility doctor about getting tested! Just keep in mind that ACOG doesn’t recommend AMH testing as a fertility check for women who aren’t seeking fertility care, since it can’t predict your chances of getting pregnant naturally. Taking control of our health and fertility when it’s possible and being well-informed is our best defense against the many frustrating unknowns.
