Anti-Mullerian hormone (AMH) is a hormone that is produced predominantly by granulosa cells of the growing follicles within the ovary. These follicles are the smallest, earliest stages of growth and development of the follicle or egg.
Your AMH level is a reflection of your growing or actively maturing follicles which can be correlated with your follicle count or ovarian reserve.
In healthy women, their AMH level increases until early adulthood, peaks at 25 years of age, and then slowly declines until after menopause (at which time there are no more growing follicles).
If you have low AMH levels, it means that you have fewer growing follicles and at that moment in time, your ovarian reserve is low.
According to research, AMH levels are ‘not a good predictor of female fertility’!
‘AMH measurement is only useful as an indirect marker of the remaining female fertile years in those women who have premature ovarian failure.‘
The American Journal of Reproductive Medicine Fertility and Sterility Journal Review discusses a very recent paper on the clinical use and misuse of AMH in current reproductive medicine practice – quote:
“… using AMH to forecast fertility potential can be fraught with error and can drive unwarranted medical treatment. Certain conditions and medications can also result in falsely low AMH determinations, which can again lead to inappropriate treatment recommendations. The knowledge of the proven usefulness of AMH and its limitations is therefore critical for optimal clinical practice.”
Among women aged 30-44, without a history of infertility who had been trying to conceive for 3 months or less… ‘findings do not support the use of AMH levels to assess natural fertility with these characteristics’.
So even though your AMH levels naturally start to decrease with age, you should still be able to conceive. The issue is that there are fewer follicles to recruit, so it might become more difficult the older you get.
Excerpt from “Fertility and Sterility On Air – TOC: January 2023”
Fertility specialists are interested in measuring AMH levels as it helps them decide which assisted reproductive technique, ovarian stimulation protocol, and medication dosage they will use for the IVF cycle.
It has nothing whatsoever to do with predicting the quality of your eggs during egg retrieval.
In other words, if you are undergoing IVF, your specialist would need to work out if you have enough follicles for a successful outcome, and also how well your ovaries will respond to being stimulated with medication.
In these cases, women with low AMH levels might need their stimulation medication adjusted accordingly. And women with high AMH levels, as in PCOS, would need to be carefully monitored.
Your AMH levels can change during various times during your cycle and under certain conditions.
As you’ve seen in the above examples, genetic and epigenetic (lifestyle) factors can influence your AMH levels.
There are many avenues I use in my practice to help women improve their health status and hence their AMH levels.
Even though there are no medical options available for improving AMH status, naturopathically there are many.
As a Naturopathic Fertility Practitioner, I consider AMH levels as just one part of a much bigger picture when making my overall assessment of each patient. I consider many factors when giving advice and making my treatment decisions.
I hope I have given you a better understanding of AMH and how I approach it from a naturopathic perspective.
I also hope I’ve given you more confidence in your fertility prospects regardless of what your levels are.
Joanne Lipinski – Fertility Naturopath Melbourne
Markers of ovarian reserve as predictors of future fertility
“Benjamin S. Harris M.D., M.P.H. , Anne Marie Jukic Ph.D. , Tracy Truong M.S. , Caroline T. Nagle M.P.H. ,
Alaattin Erkanli Ph.D. , Anne Z. Steiner M.D., M.P.H.”