An AMH level of 0.4 ng/ml, when announced over the phone, causes more panic than any other result. Here’s exactly what it measures – and what it doesn’t measure at all.
Anti-Müllerian hormone is produced by small, growing follicles in the ovaries. The more there are left, the higher the AMH level. It is therefore an indicator of quantity: how many follicles remain available. It is not an indicator of quality, and this is where most misunderstandings arise.
Values vary depending on the laboratory and the unit used; always ask for the reference ranges from the laboratory that carried out the test. As a guide, in ng/ml:
These thresholds must always be interpreted in relation to age. An AMH level of 0.8 at age 30 tells a different story from one at age 42.
Three things, and these must be clearly understood.
It does not predict the quality of the eggs. This is determined by age, primarily by the rate of chromosomal abnormalities. A 30-year-old woman with a low AMH level has few eggs, but they are typical of a 30-year-old.
It does not predict natural fertility. Studies carried out on women with no known fertility problems have shown no link between low AMH and a reduced likelihood of conceiving naturally within a year. AMH predicts the response to ovarian stimulation, which is a different matter.
It does not predict the date of the menopause with sufficient accuracy for individual cases.
The antral follicle count (AFC) is performed by ultrasound at the start of the cycle: follicles measuring 2 to 10 mm are counted in both ovaries. Combined with AMH, it provides the most reliable estimate of the expected response. An AFC of less than 6 is usually accompanied by a low AMH level.
FSH, measured on the third day of the cycle, rises when the ovaries respond less effectively. An FSH level above 10–12 IU/l is a warning sign. Unlike AMH, it varies considerably from one cycle to the next.
Oestradiol measured on day 3 helps to interpret the FSH result: a high oestradiol level may artificially mask a high FSH level.
LH and prolactin complete the picture, particularly in cases of irregular cycles.
Unlike FSH, AMH can be measured on any day of the cycle. If you are currently using hormonal contraception, this may slightly lower the result: please inform your doctor.
Firstly, there’s no time to waste. This is the only real urgency arising from this result: every year counts for more. Secondly, we adapt our approach:
No dietary supplement has been shown to increase ovarian reserve. DHEA and CoQ10 are sometimes recommended; however, the evidence remains limited and contradictory. Be wary of anything that promises to ‘boost your AMH’.
If you are under 37 and have a low AMH level, the question of egg freezing becomes a serious consideration – and one that needs to be addressed quickly. It will probably take two cycles to obtain a sufficient number of eggs, which is yet another reason not to delay.
As a guide, between 1.0 and 3.5 ng/ml indicates a normal reserve, whilst below 1.0 indicates a diminished reserve. Reference ranges vary by laboratory and should always be interpreted in relation to your age.
No. AMH measures the number of remaining follicles, not the quality of the eggs or the ability to conceive naturally. It primarily predicts the response to ovarian stimulation.
Any day, unlike FSH, which is measured on the third day. Please mention if you are currently using hormonal contraception, as this may slightly lower the result.
No. No supplement has been shown to increase ovarian reserve. DHEA and CoQ10 are sometimes recommended, but the evidence is limited and contradictory.
Source: https://fertilitegrece.com/en/blog/amh-ovarian-reserve/ — Triada Baloukoudis, IVF patient coordination in Greece. General information, not medical or legal advice. Printed on
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