🎯 The Quick Take on AMH
AMH (Anti-Müllerian Hormone) measures your ovarian reserve—roughly how many eggs you have left. Normal levels range from about 1.0 to 3.5 ng/mL for reproductive-age women, declining naturally with age. Lower AMH suggests fewer eggs remaining but doesn't predict pregnancy chances directly. Higher isn't always better—very high levels may indicate PCOS.
What Is AMH and Why Does It Matter?
Anti-Müllerian Hormone (AMH) is produced by the small follicles in your ovaries—the ones that contain your eggs. Because AMH levels correlate with the number of these follicles, measuring AMH gives doctors an estimate of your ovarian reserve, or how many eggs you likely have remaining.
Here's what AMH testing does and doesn't tell you:
AMH does NOT tell you: Whether those eggs are good quality, whether you can get pregnant naturally, or exactly when you'll reach menopause.
Women are born with all the eggs they'll ever have—typically 1-2 million at birth. By puberty, that number drops to about 300,000-500,000. From there, you lose about 1,000 eggs per month regardless of whether you're on birth control, pregnant, or trying to conceive.
Normal AMH Levels by Age
AMH naturally declines with age as your egg supply diminishes. Here's what's typically considered normal at different ages:
| Age Range | Average AMH (ng/mL) | Normal Range |
|---|---|---|
| Under 30 | 3.0 - 4.0 | 1.5 - 6.0 |
| 30-34 | 2.5 - 3.5 | 1.2 - 5.0 |
| 35-37 | 2.0 - 2.5 | 0.9 - 3.5 |
| 38-40 | 1.5 - 2.0 | 0.6 - 2.5 |
| 41-43 | 0.8 - 1.5 | 0.3 - 2.0 |
| 44+ | 0.3 - 0.8 | < 1.5 |
Important note: Different labs may use different units. Results shown in ng/mL can be converted to pmol/L by multiplying by 7.14. Always check which unit your lab uses.
Average AMH Decline by Age
Interpreting Your AMH Results
AMH levels are generally categorized as high, normal, low, or very low. Each category has different implications:
High AMH (> 3.5-4.0 ng/mL)
Indicates a larger egg reserve and often predicts strong response to fertility medications.
- May indicate PCOS if very high (>5-6)
- Higher risk of OHSS with IVF
- Not necessarily "better"—quantity ≠quality
- Lower medication doses often used
Normal AMH (1.0-3.5 ng/mL)
Suggests age-appropriate ovarian reserve with expected response to fertility treatments.
- Typical response to IVF medications
- Good natural conception potential
- Standard treatment protocols apply
- No immediate urgency (varies by age)
Low AMH (0.5-1.0 ng/mL)
Indicates diminished ovarian reserve—fewer eggs remaining than typical for your age.
- May need higher medication doses
- Fewer eggs retrieved with IVF
- Consider accelerating timeline
- Can still conceive naturally
Very Low AMH (< 0.5 ng/mL)
Suggests severely diminished ovarian reserve. Proactive approach recommended.
- Lower IVF response expected
- Aggressive protocols may be used
- Natural IVF sometimes preferred
- Donor eggs may be discussed
⚠️ Common Misconception
"Low AMH means I can't get pregnant." This is false. AMH measures quantity, not quality. Women with low AMH conceive naturally all the time—they just have fewer eggs to work with. A 28-year-old with low AMH may have better quality eggs than a 40-year-old with normal AMH. Age remains the strongest predictor of egg quality.
AMH and Natural Conception
Here's what research shows about AMH and natural pregnancy:
A landmark 2017 study published in JAMA followed over 750 women without infertility, ages 30-44, comparing those with low versus normal AMH levels. The finding? No significant difference in natural conception rates. After 12 months of trying:
- Women with low AMH: 65% conceived
- Women with normal AMH: 62% conceived
This doesn't mean AMH is useless—it's highly valuable for predicting IVF response and understanding your timeline. But for natural conception, you only need one good egg, and AMH doesn't predict whether that egg will be chromosomally normal.
AMH and IVF Success
Where AMH really matters is in fertility treatment planning, particularly IVF:
What AMH Predicts for IVF
- Number of eggs retrieved: Higher AMH typically means more eggs per retrieval cycle
- Medication response: Helps doctors choose appropriate dosing
- OHSS risk: High AMH increases ovarian hyperstimulation risk
- Number of embryos: More eggs usually means more embryos to work with
What AMH Doesn't Predict for IVF
- Egg quality: Age is the better predictor
- Fertilization rate: Depends on egg and sperm quality
- Embryo development: Quality matters more than quantity
- Pregnancy success: One genetically normal embryo is all you need
Other Ovarian Reserve Tests
AMH is just one piece of the puzzle. A complete ovarian reserve assessment typically includes:
Antral Follicle Count (AFC)
A transvaginal ultrasound counts the small follicles visible in your ovaries at the beginning of your menstrual cycle. Combined with AMH, AFC gives a clearer picture of your reserve. Normal AFC is 6-10 follicles per ovary.
FSH (Follicle-Stimulating Hormone)
Tested on day 2-4 of your cycle. High FSH (>10-15 mIU/mL) suggests your pituitary is working harder to stimulate your ovaries, often indicating diminished reserve. Less sensitive than AMH but still informative.
Estradiol (E2)
Also tested on day 2-4. If elevated early in your cycle (>80 pg/mL), it may mask high FSH and suggest declining reserve. Provides context for FSH interpretation.
When to Test AMH
Unlike FSH and estradiol, AMH can be tested at any point in your menstrual cycle—levels remain relatively stable throughout. This makes it convenient for routine screening.
Consider AMH testing if:
- You're planning to delay pregnancy and want to understand your timeline
- You have risk factors for diminished ovarian reserve (family history of early menopause, endometriosis, ovarian surgery, cancer treatment)
- You've been trying to conceive for 6+ months without success
- You're considering egg freezing and want to predict response
- You're preparing for IVF
- You have irregular periods or suspected PCOS
Factors That Can Affect AMH Levels
While AMH is relatively stable, some factors can influence your results:
- Hormonal birth control: May slightly lower AMH while on it; normalizes after stopping
- Recent ovarian surgery: Can reduce AMH if ovarian tissue was removed
- PCOS: Typically causes higher-than-expected AMH
- Vitamin D deficiency: Some studies suggest association with lower AMH
- Obesity: May be associated with slightly lower AMH
- Lab variability: Different labs may give different results—compare results from the same lab when tracking over time
Frequently Asked Questions
Can I improve my AMH level?
Unfortunately, no—AMH reflects your remaining egg supply, which cannot be increased. Some supplements (DHEA, CoQ10) are sometimes used in fertility treatment but don't increase actual egg count. Focus on overall health to support the eggs you have.
How quickly does AMH decline?
AMH typically decreases by about 5-10% per year, though this varies significantly between women. Some women see rapid decline, others remain stable for years. Repeat testing every 6-12 months can reveal your personal trend.
My AMH is low—should I freeze my eggs immediately?
That depends on your goals, age, and circumstances. Low AMH might mean fewer eggs per retrieval cycle, so earlier may be better if you're planning to freeze. However, if you're actively trying to conceive with a partner, egg freezing may not be necessary. Discuss your specific situation with a specialist.
Why is my AMH high if I don't have PCOS?
High AMH doesn't always indicate PCOS—some women naturally have higher ovarian reserve. However, if AMH is very high (>5-6 ng/mL), your doctor may evaluate for PCOS even without typical symptoms. High AMH can also be seen in younger women with abundant follicles.
Will my AMH predict when I'll reach menopause?
AMH can give a rough estimate but isn't precise. Very low AMH (<0.1) suggests menopause may occur within 5-7 years, but there's significant individual variation. Menopause timing also depends on factors beyond egg count.
Should I retest AMH if I got an unexpected result?
It's not unreasonable to repeat AMH testing, especially if results seem inconsistent with other findings (AFC, FSH). Use the same lab for comparison. Results shouldn't change dramatically over a few months unless there's been ovarian surgery.