If you're thinking about your fertility - whether you're planning to conceive soon, considering egg freezing, or just curious about your reproductive timeline - there's one biomarker you should know about: AMH (Anti-Mullerian Hormone).
AMH is considered the most reliable blood test for estimating ovarian reserve. Yet most women have never heard of it, and it's rarely included in routine healthcare.
What Is AMH?
AMH is a hormone produced by the small follicles (antral follicles) in your ovaries - the ones that contain eggs waiting to mature. The more of these follicles you have, the higher your AMH level.
In simple terms: AMH gives you an estimate of how many eggs you have remaining.
Every woman is born with all the eggs she'll ever have - typically around 1-2 million at birth. By puberty, that number drops to about 300,000-400,000. Each month, you lose eggs regardless of whether you're ovulating, on birth control, or pregnant.
Why AMH Matters
AMH testing provides valuable information for:
- Family planning: Understanding your timeline helps you make informed decisions about when to try to conceive
- Egg freezing: Knowing your AMH helps predict how you might respond to stimulation medications
- IVF planning: Clinics use AMH to customize treatment protocols and set expectations
- Early menopause detection: Low AMH may indicate premature ovarian insufficiency
- PCOS diagnosis: High AMH can be a marker for polycystic ovary syndrome
Key point: AMH tells you about egg quantity, not egg quality. Egg quality is primarily influenced by age and cannot be measured with a blood test.
What AMH Levels Mean
AMH levels are typically measured in ng/mL (nanograms per milliliter). Here's a general guide:
| AMH Level | Interpretation |
|---|---|
| >3.0 ng/mL | High (may indicate PCOS or strong ovarian reserve) |
| 1.0 - 3.0 ng/mL | Normal ovarian reserve |
| 0.5 - 1.0 ng/mL | Low-normal (diminished ovarian reserve) |
| <0.5 ng/mL | Low ovarian reserve |
Important context: These ranges are general guidelines. AMH naturally declines with age, so interpretation depends heavily on your current age. A 25-year-old with an AMH of 1.5 may warrant different consideration than a 40-year-old with the same level.
AMH by Age: What's Expected
Average AMH levels decline predictably with age:
| Age | Average AMH (ng/mL) |
|---|---|
| 25 | 3.0 - 4.0 |
| 30 | 2.5 - 3.5 |
| 35 | 1.5 - 2.5 |
| 40 | 0.5 - 1.5 |
| 45 | <0.5 |
Advantages of AMH Testing
- Can be tested any day of your cycle - Unlike FSH and estradiol, which must be tested on cycle days 2-4, AMH remains relatively stable throughout your menstrual cycle
- Not affected by birth control - You can test AMH even on hormonal contraception (though some studies suggest slight variations)
- Single test gives useful information - While trending over time is helpful, even one result provides meaningful data
What AMH Can't Tell You
It's crucial to understand AMH's limitations:
- Not a fertility test: Low AMH doesn't mean you can't get pregnant naturally. Women with low AMH conceive every day.
- Doesn't predict pregnancy success: AMH tells you about quantity, not the quality of those eggs or your likelihood of conception.
- Doesn't predict menopause timing: While very low AMH may suggest early menopause, it's not a precise predictor.
- One snapshot: AMH can fluctuate slightly between tests and may be affected by illness, vitamin D deficiency, or other factors.
Bottom line: AMH is one piece of the fertility puzzle, not the whole picture. Age remains the single most important factor in fertility outcomes.
When Should You Test AMH?
Consider testing if:
- You're curious about your fertility status and timeline
- You're planning to delay pregnancy and want baseline information
- You're considering egg freezing
- You have a family history of early menopause
- You've had ovarian surgery, chemotherapy, or radiation
- You have irregular periods or suspected PCOS
- You're about to start IVF and want to understand your likely response
The Complete Fertility Panel
For the most complete picture of reproductive health, AMH should be tested alongside:
- FSH (Follicle-Stimulating Hormone): Best tested on cycle day 2-4; elevated FSH may indicate diminished reserve
- LH (Luteinizing Hormone): Helps assess ovulation and PCOS
- Estradiol: Baseline estradiol provides context for FSH interpretation
- TSH: Thyroid dysfunction can impair fertility
- Prolactin: Elevated prolactin can interfere with ovulation
Knowledge Is Power
Understanding your AMH isn't about creating anxiety - it's about having information to make empowered decisions. Whether your AMH is high, low, or somewhere in between, knowing your number helps you plan accordingly.
Your fertility journey is yours. Having data doesn't determine your path - it simply helps you navigate it with confidence.
Plan with confidence. Get your AMH tested along with a complete fertility panel to understand your reproductive health.
Sources
- Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve. JAMA. 2015.
- American College of Obstetricians and Gynecologists. Infertility Workup for the Women's Health Specialist. ACOG Committee Opinion. 2019.