Understanding Your AMH Test Results: Complete Guide to Ovarian Reserve

Getting your AMH results can feel like receiving a fertility verdict. But before you panic over a number, understand what this test actually measures—and equally important, what it can't tell you.

What Is AMH and Why Does It Matter?

Anti-Müllerian Hormone is a protein produced by the granulosa cells surrounding each developing egg follicle in your ovaries. The more developing follicles you have, the higher your AMH level. This makes AMH a useful marker for estimating your remaining egg supply—your "ovarian reserve."

Unlike FSH and estradiol, which fluctuate throughout your menstrual cycle, AMH remains relatively stable. You can test it any day of your cycle without affecting accuracy, making it a convenient and reliable snapshot of ovarian reserve.

What AMH Tells You

• Approximate egg quantity – How many eggs you have remaining relative to others your age
• Likely response to IVF medications – How many eggs you might retrieve during a cycle
• Potential timeline – Whether menopause might arrive earlier than average
• PCOS indicator – Very high levels often accompany polycystic ovary syndrome

What AMH Cannot Tell You

• Egg quality – The chromosomal health of your eggs (age is the best predictor of quality)
• Whether you can get pregnant – Women with very low AMH conceive naturally every day
• Exactly when menopause will occur – It provides estimates, not certainties
• Your fertility this month – It doesn't predict any single cycle's outcome

AMH Reference Ranges by Age

AMH levels naturally decline with age as your egg supply diminishes. What's "normal" for a 25-year-old differs significantly from what's normal at 40. Here are the typical ranges:

Typical AMH Levels by Age

These are median values—there's significant individual variation. A 35-year-old with AMH of 1.2 ng/mL is on the lower end but not necessarily facing fertility problems. Context matters enormously.

Interpreting Your Results: What Each Range Means

What Low AMH Really Means for Getting Pregnant

Low AMH is not a fertility death sentence—but it is important information. Here's what the research actually shows:

Natural Conception

A landmark 2017 study in JAMA followed women trying to conceive naturally. After 12 months:

• Women with low AMH had similar pregnancy rates to women with normal AMH
• 65% of women with low AMH conceived within a year
• AMH did not predict natural fertility in women under 38 without known fertility issues

The study concluded that AMH levels should not be used to counsel young women about their ability to conceive naturally. Low AMH doesn't mean you're less likely to get pregnant this cycle—it suggests you may have fewer cycles remaining before your supply depletes significantly.

IVF Response

Where AMH becomes highly relevant is predicting IVF outcomes:

• Low AMH (0.5-1.0): May retrieve 5-8 eggs vs. 10-15 with normal AMH
• Very low AMH (<0.5): May retrieve 1-4 eggs, potentially requiring multiple cycles
• Pregnancy per transfer: Similar if good-quality embryos develop—quantity affects how many "tries" you get per cycle

High AMH: When More Isn't Always Better

AMH above 3.5 ng/mL—especially above 5.0—often indicates polycystic ovary syndrome (PCOS). While having abundant eggs sounds positive, high AMH comes with its own considerations:

Potential PCOS Indicators

• Multiple small follicles visible on ultrasound (polycystic-appearing ovaries)
• Irregular or absent periods
• Elevated androgens (acne, excess hair growth)
• Difficulty ovulating regularly

IVF Considerations with High AMH

• OHSS risk: Ovaries may over-respond to medications, causing dangerous fluid shifts
• Lower medication doses: Typically start with minimal stimulation
• Trigger options: May use GnRH agonist trigger instead of hCG to reduce OHSS risk
• Freeze-all protocol: Often recommended to allow hormone levels to normalize before transfer

The good news: Women with high AMH due to PCOS often have excellent success once ovulation is achieved, whether through medication like letrozole or through IVF with appropriate protocols.

Common AMH Misconceptions

What to Do After Getting Your Results

If Your AMH Is Low

1. Don't panic – Low AMH doesn't mean infertility. It's information, not a verdict.
2. Get complete testing – AMH alone doesn't tell the full story. Request FSH, AFC, and other baseline tests.
3. Consider your timeline – If you're not ready to conceive now, discuss egg or embryo freezing.
4. Evaluate lifestyle factors – Smoking, extreme weight, and certain medications can affect AMH. Address modifiable factors.
5. Discuss options with a specialist – Reproductive endocrinologists can provide personalized guidance based on your complete picture.

If Your AMH Is Normal

1. Continue standard TTC advice – Time intercourse during your fertile window, track ovulation if desired.
2. Don't become complacent – Normal AMH doesn't guarantee conception. Age still affects egg quality.
3. Seek help after 12 months – Or 6 months if you're 35+. Normal AMH doesn't rule out other fertility factors.

If Your AMH Is High

1. Evaluate for PCOS – High AMH often accompanies PCOS. Check for irregular cycles and other symptoms.
2. Confirm ovulation – Abundant eggs don't help if you're not ovulating. Track with OPKs or temperature charting.
3. Discuss treatment if needed – If you have PCOS with irregular ovulation, medications like letrozole can help.

AMH and Fertility Treatment Decisions

When AMH Influences Treatment Path

Your AMH level may affect which fertility treatment your doctor recommends:

The Antral Follicle Count Connection

AMH and antral follicle count (AFC) measure similar things differently. AFC counts visible follicles via ultrasound at cycle start. When AMH and AFC align, confidence in the assessment is high. When they disagree, doctors typically rely more heavily on AFC for IVF dosing decisions.

• Low AMH + Low AFC: Confirms diminished ovarian reserve
• Low AMH + Normal AFC: May have better response than AMH suggests
• Normal AMH + Low AFC: AFC may be more predictive of cycle response

Can You Improve AMH Levels?

You cannot create new eggs or reverse ovarian aging. However, some factors may influence AMH readings:

Factors That May Lower AMH

• Smoking (accelerates egg loss and lowers AMH)
• Ovarian surgery (especially for endometriomas)
• Chemotherapy or radiation
• Vitamin D deficiency (may artificially suppress readings)
• Hormonal contraceptives (may slightly lower values)

What Research Shows About Supplements

• DHEA: Some studies suggest improved IVF response in low-reserve patients, but doesn't increase true AMH
• CoQ10: May support egg quality and mitochondrial function; no proven effect on AMH
• Vitamin D: Correcting deficiency may normalize artificially low readings

When to Retest AMH

Because AMH declines naturally with age, retesting makes sense in certain situations:

• Before starting fertility treatment – Confirm current status if last test was 6+ months ago
• After lifestyle changes – If you quit smoking or addressed vitamin D deficiency
• Unexpected result – Labs can make errors; retest if result seems inconsistent with your clinical picture
• Before egg freezing – Get current numbers to estimate expected yield

Routine monitoring (e.g., every few months) typically isn't necessary and can cause unnecessary anxiety over normal fluctuations.

Frequently Asked Questions

Can I get pregnant naturally with very low AMH?

Yes. Women with AMH below 0.5 ng/mL conceive naturally, though typically at lower rates and with less time before menopause. If you're young (under 35) with low AMH, natural conception is still quite possible—your egg quality likely remains good even if quantity is reduced. Success depends on actually ovulating regularly and having no other fertility factors.

Should I freeze my eggs if my AMH is low?

It depends on your timeline and goals. Low AMH means you may retrieve fewer eggs per cycle, potentially requiring multiple rounds. If you're not ready to conceive for several years, egg freezing provides insurance against further decline. Discuss with a specialist whether the likely yield justifies the investment given your specific situation.

How quickly does AMH decline?

On average, AMH decreases about 5-10% per year through most of the reproductive years, with acceleration after age 35. Individual variation is significant—some women maintain stable levels for years while others decline more rapidly. Serial testing can help establish your personal trajectory.

My AMH was different at two labs. Which is accurate?

Different labs use different assays that don't always produce identical results. Variations of 20-30% between tests can occur. For the most consistent tracking, use the same lab with the same assay each time. If values differ dramatically, your doctor may rely more heavily on AFC and clinical findings.

Does birth control affect AMH results?

Hormonal contraceptives may slightly lower AMH readings because they suppress follicle development. If tested while on birth control, your true AMH may be somewhat higher. Most clinics recommend testing off contraceptives if possible, though the effect is typically modest.

What's more important—AMH or age?

Both matter, but for different reasons. Age best predicts egg quality (chromosomal normality), while AMH predicts quantity. A 30-year-old with low AMH often has better outcomes than a 40-year-old with normal AMH because her eggs are more likely to be chromosomally normal. For IVF specifically, both factors together predict success better than either alone.

Should I test AMH if I'm not trying to conceive yet?

Testing can provide useful information for family planning, especially if you're delaying childbearing. However, don't let a single number drive major life decisions. A low result doesn't mean you must get pregnant immediately—it's information to discuss with a specialist in context of your complete fertility picture.