Fertility and AMH Levels: A Complete Guide
By our Co-Chief Medical Officer and fertility expert, Dr. Phoebe Howells
If you’re starting to learn more about your fertility, AMH levels are something you’ll frequently hear of and you might have questions. Can I increase my AMH levels? What should my AMH be for my age? Anything I can do to slow the decline of my AMH?
In today's guide, we're explaining what AMH is, why it matters in fertility, how to measure it, and what levels are considered normal.
We're also discussing ways to improve your AMH levels to improve your fertility chances.
What Is AMH?
AMH stands for Anti-Mullerian Hormone, one of the key hormones for reproductive function. It's also known as MIH, which is an abbreviation for Mullerian-Inhibiting Hormone.
Both females and males produce AMH - in the ovaries and testes respectively- but it's typically considered a parameter for reproductive and fertility health in women only.
What Is the Significance of AMH for Fertility?
The follicles in the ovaries produce the AMH hormone. Ovarian follicles are tiny fluid-filled sacs that contain immature eggs called oocytes.
The idea is that the higher your AMH levels, the greater the number of follicles/eggs you have.
As such, AMH levels enable health professionals to estimate the total number of immature eggs a female is carrying. This is referred to as the ovarian reserve; the sum of the remaining immature eggs that can be fertilized.
AMH levels are a reflection of quantity, not quality. Your AMH is a good indicator of ovarian reserve, or how many eggs you have left, but does not show if they contain genetically normal DNA.
AMH Levels and Pregnancy Chances
AMH levels can be used to indicate the likelihood of pregnancy in a female.
Having a good level of AMH means that you have a better chance of conceiving because it indicates a healthy ovarian reserve.
Females with low AMH levels have a diminished ovarian reserve, which means they're more likely to struggle with getting pregnant. That said, high AMH levels don't guarantee or predict your ability to become pregnant spontaneously.
This 2013 study shows that pregnancy rates aren't affected by AMH levels and that AMH shouldn't be a basis for excluding females from receiving IVF treatments.
AMH Levels in IVF
AMH values can help doctors plan IVF treatment as it can help them predict ovarian response to treatment and drug protocol. We know that AMH levels correlate with the number of eggs (oocytes) retrieved after stimulation.
The ovaries make one egg per monthly cycle for fertilization under normal circumstances. In IVF, the eggs are taken from the ovaries and mixed with sperm outside of the body.
As such, the healthcare provider prescribes medication to stimulate the ovaries to hopefully make many eggs at once. This way, more eggs can be retrieved for the procedure, and the chances that a high-quality egg is present increases.
Females with elevated AMH levels tend to respond better to ovarian stimulation, which generally corresponds to greater success rates of IVF.
Research suggests the following outline regarding the use of AMH levels in IVF:
- More than 3.5 ng/mL: this shows a healthy egg supply and caution should be taken to avoid OHSS (ovarian hyperstimulation syndrome) as a result of treatment
- Between 1.0 and 3.5 ng/mL: this suggests you would have a good IVF stimulation response
- Less than 1.0 ng/mL: this would tell us you have a lower egg supply and therefore your protocol for IVF might need to be more aggressive.
- Less than 0.5 ng/mL: this would suggest that you might have difficulty during IVF in growing more than 3 follicles, which would mean a reduced chance of pregnancy.
Side note: AMH can be measured in both ng/ml and also pmol/l. 1ng/ml = 7.18pmol/l, and 3.5ng/ml = 25pmol/l.
What Is an AMH Test?
An AMH test measures the concentration of the hormone in the blood in ng/mL (nanograms per milliliter).
The test is of little to no risk and doesn't require any special preparations. Prior to starting any IVF treatment, this test will likely be included in your blood tests. We do not advise testing solely for AMH as it doesn’t tell the full story, you’ve likely to also be tested for estradiol and FSH levels too. For those having NHS treatment, please note that your GP will not routinely test your AMH levels. It is still worth asking as some Integrated Care Boards (ICBs) are willing to provide this test.
If you’re also considering IVF insurance coverage through the likes of Gaia, then a more accurate quote is available if you have an up-to-date AMH result to share.
Why Is an AMH Test Important?
The results obtained from an AMH test help you make informed decisions regarding infertility treatments. Note the NHS do not routinely provide AMH testing but it is still worth asking your GP or Reproductive Endocrinologist.
An AMH test offers insight into:
- The size of your ovarian reserve.
- Your body's response to fertility medications.
- Your menopausal state (if you're close or you've already started).
- The presence and extent of issues with the ovaries, such as PCOS (polycystic ovary syndrome).
An AMH does NOT do the following:
- predict the health of your remaining eggs;
- predict if you'll be able to conceive; or
- predict when you'll enter menopause.
What Are Normal AMH Levels?
The levels of AMH gradually increases in women during their reproductive years and reaches their peak around the age of 25.
From there, AMH levels gradually decrease until they become virtually non-existent at menopause.
That's because females are born with approximately 300,000 to 500,000 eggs. This quantity declines over time to reach as low as 1,000 in menopausal women.
Determining typical AMH levels is a matter of some debate, but the general ranges for normal values are as follows:
- Extremely low: 0.4 ng/mL
- Low: less than 1.0 ng/mL
- Average: from 1.0 ng/mL to 3.0 ng/mL
- 20 - 25 years: 4.2 - 3.0 ng/mL
- 26 - 30 years: 3.5 - 2.5 ng/mL
- 31 - 35 years: 2.5 - 1.5 ng/mL
- 36 - 40 years: 1.3 - 1 ng/mL
- 40 - 45 years: 0.52 - 0.5 ng/mL
How to Raise Your AMH Levels
Now, let's take a look at the reasons behind decreased AMH levels and whether lifestyle, diet, and environmental factors may have an effect.
Note that medication doesn't typically affect AMH levels. Only a few studies suggest a potential relationship between some drugs and AMH.
What Causes Low AMH Levels
AMH levels naturally drop with age. But some factors may contribute to low AMH values, including:
- Genetic predisposition.
- Health problems such as PCOS, POF (premature ovarian failure), autoimmune disorders, and endometriosis.
- Medications such as birth control pills.
- Exposure to pesticides and environmental toxins.
- Obesity, excessive intake of processed/fatty food, alcohol, and smoking. This study found that a higher diet of saturated fats and fast food was linked to lower AMH levels.
- Radiation and chemotherapy in cancer treatment.
Ways to Improve AMH Levels
The research between diet and AMH levels is increasing and so whilst we need further high quality research, we can point to promising studies that suggest a link between diet and AMH levels.
Here are foods that are thought to support AMH values:
- Nuts such as peanuts, walnuts, almonds, and hazelnuts.
- Seeds; sesame seeds, pumpkin seeds.
- Dairy sources such as yogurt, cottage cheese, and eggs. This study found that consuming dairy may help regulate AMH levels and found that rapid AMH decline was reduced with increased intake of calcium, lactose, carbohydrates and proteins.
- Vegetables; arugula, kale, beans, broccoli, lentils.
- Fruits; raspberries, blueberries, avocados, strawberries.
The usual dietary recommendations of having healthy fats, dairy, protein and carbohydrates apply here. Avoid fast food and saturated fats too.
Here are medications and supplements that may boost AMH levels:
- Estrogen and progesterone hormone therapy to regulate your menstrual cycle.
- Vitamin D. Studies tell us that this vitamin impacts AMH signaling, FSH sensitivity and progesterone production release. Whether this correlates with AMH levels is yet to be determined and more research is needed.
- Vitamin E and selenium
- Levothyroxine medication, if you suffer from thyroid dysfunction.
- Vitamin C
- Coenzyme Q10
- DHEA. Note this is a prescription-only drug in the U.K, please do not buy this online from unrecognised sources and instead speak with your GP or reproductive endocrinologist.
In terms of lifestyle changes, giving up smoking may promote healthy AMH levels.
This study amongst late premenopausal women only concluded that race, body mass index, education, height, smoking status, parity, and menstrual cycle phase were not significantly associated with AMH concentrations.
A study in the Journal of Human Reproductive Sciences found that moderate exercise was “associated with improved age-specific levels of ovarian reserve.”
It is important to understand however that even if raising AMH levels was found to be possible, a cure if you like, then it still would not reverse egg loss.
- AMH levels provide an estimation of the ovarian reserve size in females, which can indicate the likelihood of pregnancy and expected fertility.
- AMH levels are not the full picture, they indicate your remaining ovarian reserve only and do not tell us anything about the quality of your egg.
- For IVF treatment, AMH levels are useful as they’ll be incorporated into your treatment plan to determine your protocol and you might best respond to maximum eggs available for collection.
- Lifestyle factors such as diet and supplementation may positively benefit AMH levels although more research is needed. A high quality preconception supplement including CoQ10 is recommended.