Low AMH Levels?
How to Increase AMH Level

Ever wonder if there was a way to “check your fertility” with a simple blood test? 

Or what your anti-mullerian hormone (AMH) level actually means? 

And if there’s a way to increase AMH? 

Well, you’re not alone! 

Here’s a quick overview of what you’ll discover:

Anti-mullerian hormone (AMH) is a glycoprotein made by granulosa cells, which are teeny tiny cells that line the ovary’s resting follicles (antral follicles). It’s an overall indicator of the number of eggs a woman has remaining.

How do you test AMH?

AMH can be evaluated via a serum sample which can be provided by a typical blood draw or a blood spot (finger prick). Unlike other markers of ovarian reserve, AMH can be tested anytime throughout the menstrual cycle. 

Understanding Your AMH Results

Serum anti-mullerian hormone levels in adult women correlate with egg quantity/number of eggs remaining (hence its use as a marker of ovarian reserve) and best predict response to ovarian stimulation with injectable gonadotropins (the injectable medications used in IVF). Normative levels are determined by age and the assay used. 

Contrary to popular belief, an AMH test does not predict the likelihood of getting pregnant, live birth, infertility, or fertility (but more on that below).

High AMH levels are commonly seen in women with polycystic ovarian syndrome (PCOS) or younger women in general. Higher AMH is associated with an increased risk of ovarian hyperstimulation syndrome (OHSS) so medication regimens and IVF treatment protocols can be chosen to reduce the risk accordingly. A high AMH does not equal increased fertility or infertility for that matter. Again it’s a marker of egg number. Higher doesn’t always mean better. 

Normal AMH levels suggest a predictable response to injectable gonadotropins (IVF medications) and that you have an expected egg reserve remaining based on your age. Again, a normal AMH does not guarantee fertility or a favorable outcome with treatment.

Low AMH levels and lower limits of normal are determined by age as noted above. In general, based on age the lower limits of normal are as follows (1): 

• 0.5 ng/mL for 45 years
• 1 ng/mL for 40 years
• 1.5 ng/mL for 35 years
• 2.5 ng/mL for 30 years
• 3.0 ng/mL for 25 years

Some clinics will use an AMH cutoff of < 0.7 ng/mL or < 1ng/mL to be considered a “low level” at all ages. Low AMH levels have been associated with an earlier age of menopause (2-4), diminished ovarian reserve (DOR) (fewer eggs) with a poorer response to IVF medications (5, 6), and a higher cycle cancellation rate (7). Interestingly, it has not been associated with fertility or the likelihood of getting pregnant. Women with lower AMH often need more aggressive IVF treatment regimens to get a favorable response.

How is Follicle Stimulating Hormone (FSH) used with AMH?

Follicle-stimulating hormone (FSH) is the hormone made by a tiny area in the brain called the anterior pituitary that is sent out early in the menstrual cycle to recruit a follicle each month. When a serum FSH is drawn on menstrual cycle day 2 or 3 with a serum estradiol level it is a good indication of how well the ovary is communicating with the brain.

A high FSH early in the menstrual cycle indicates poor ovarian production of hormones as a part of a decreasing number of follicles/eggs or diminished egg reserve. High estradiol and low FSH can be interpreted similarly. 

Unlike AMH, FSH cannot be drawn at any point in the menstrual cycle and must also be drawn with estradiol to be interpreted correctly. It is also highly variable from one cycle to another. And while a high FSH level (generally > 10 mIU/mL) is a good predictor of diminished ovarian reserve and poor ovarian response to gonadotropins, a normal FSH is less predictive.

If an initial FSH is abnormal or doesn’t match AMH, it is typically repeated given the high variability as noted above which can help confirm what treatment regimen might be best.  

Limitations of AMH

Although AMH level strongly correlates with ovarian response to gonadotropin stimulation in IVF, it is a poor predictor of non-pregnancy, infertility, or fertility. Meaning just being a woman has a low AMH, that doesn’t mean she has a lower chance of getting pregnant (8). 

Further, data has shown that AMH levels are a poor predictor of pregnancy and live birth with the use of assisted reproductive technologies (ART) and in vitro fertilization (IVF) (9, 10). This would support the fact that AMH best predicts egg quantity, but not the quality of eggs.

When interpreting AMH levels, one must also take into account all possible influencing factors to make the most accurate assessment of ovarian reserve or the remaining egg number. 

IVF and egg freezing for that matter can work with low AMH levels but it’s important to know that it may take more than one IVF cycle to achieve live birth as typically a lower number of eggs will be retrieved with each cycle. It’s important to have a realistic conversation with your fertility doctor about overall family building goals and which method of treatment may yield the highest chance of live birth for you (IVF with your own eggs, ovulation induction or donor egg, etc.) taking into consideration, diagnosis, age, and ovarian reserve.

As noted above, age is the biggest predictor of egg count and egg quality. But the question remains, is there anything a woman can do to increase her AMH levels?

Fortunately, there are a few things in your control that support overall health as well.

Few studies have examined the association between dietary intake and markers of ovarian reserve. From the research that has been done:

So bottom line, consuming a pro-fertility diet rich in fruits and vegetables, high-quality carbohydrates, plant-based or seafood sources of protein and anti-inflammatory fats, maintaining healthy body weight, and staying away from tobacco can all be beneficial to overall health and fertility.

However, if you tend to search Dr. Google for alternative answers, beware of someone or something that promises to increase your AMH or number of eggs, decrease your FSH, or guarantees that you’ll get pregnant with a magical treatment or simple dietary or lifestyle fix… 

Because it really isn’t that simple.

AMH is an incredibly helpful tool fertility specialists use to help guide fertility treatments and overall patient counseling, but it’s important to understand its limitations and that it can’t be interpreted in a vacuum. 

If you’ve been trying to conceive for some time, then AMH will be a part of your basic fertility evaluation. And if you haven’t been trying to conceive but are just curious, knowing your AMH can be very empowering and informative. 

No matter your test results, be sure to discuss it with a fertility doctor to have a good understanding within the bigger context of your overall fertility and family-building goals.