If you’ve been going through infertility treatments, you have likely been bombarded with a number of acronyms (i.e. FSH, IUI, LH, ICSI etc.). They all have their importance and we should all do our best to understand what they mean. There is one acronym, however, that you should take the time to learn if you haven’t already.
What is the AMH Test?
AMH or anti-mullerian hormone, is a hormone secreted in the granulosa cells of follicles and is fast becoming the “go to” measurement for ovarian reserve. A simple blood test is all that is needed to measure your AMH level. Many clinics will include it when you get your regular Day 3 blood-work. AMH also correlates to the antral follicle count (AFC) which is another method of determining a woman’s fertility potential. If you haven’t been asked to do an AMH test, ask your doctor if it is something you should do.
Why Should You Get Your AMH Level Tested?
Getting your AMH level can help you and your partner decide what the best course of action may be for your fertility situation. For example, say you get your levels tested and they are in the optimal range. This may allow you to hold off on going right into IVF and to perhaps try less invasive procedures such as IUI or trying naturally. Your AMH level will also help determine how well (or not so well) you will respond to any stimulating medications (a high AMH will generally respond well to follicle stimulating medications).
On the other side, receiving a low AMH number can be difficult to take. However, it will make your plan that much more clear rather than wasting months of your time trying methods that have a low success rate. Some specialists speculate that in the future, women will test their AMH to ensure they have time to pursue a career before having children. Those with low AMH levels may consider having a family earlier in an attempt to avoid difficulties conceiving.
FSH vs AMH: Which is Better?
In the past (and still), most fertility clinics will do a Day 3 blood test to test the FSH levels of females along with other hormones related to fertility. Your FSH number can indicate how hard your body is working to produce and grow follicles. A high number (above 10-12) indicates that your body is working extra hard to produce follicles and may be a sign that your fertile potential is decreasing. A low FSH (below 10) should indicate that your body is still responding well to its own internal hormones and may indicate a higher fertility potential.
However, there are some problems with the FSH test. For example, the FSH levels of females fluctuate throughout the menstrual cycle and can vary from month to month. This is why most clinics attempt to do the test on day 3 of the menstrual cycle. In addition to that, estrogen may suppress a high FSH level into a normal range, creating an inaccurate result. This can result in wasted time doing treatments that may not work.
When to Take and How Much?
An AMH test is ideal as levels are consistent throughout the cycle so you don’t have to wait until day 3 to do one. In Ontario (where I practise), you have to pay out of pocket to get the results of this test. The cost is usually under $200.
AMH Units of Measurements
AMH levels vary and are dependent on age and the presence of certain conditions (i.e. PCOS – I know of clients who have had an AMH level over 90 pmol/L). It is important to note that two different units of measurement are used. So when you receive your AMH results, so be sure to get the unit it was measured in or else you may be very confused.
Here is a chart* outlining the two different measurements as well as the ranges.
|
Ovarian Fertility Potential |
pmol/L |
ng/mL |
| Optimal Fertility | 28.6 – 48.5 | 4.0 – 6.8 |
| Satisfactory Fertility | 15.7 – 28.6 | 2.2 – 4.0 |
| Low Fertility | 2.2 – 15.7 | 0.3 – 2.2 |
| Very Low / undetectable | 0.0 – 2.2 | 0.0 – 0.3 |
| High Level | > 48.5 | > 6.8 |
*from http://www.drmalpani.com/amh.htm
My AMH is Really Low, Should I Stop Trying?
Don`t get me wrong, AMH testing is not the best test ever. It`s simply the best we have at the moment for measuring ovarian reserve and the likelihood of your ovaries responding to medication. Much like any other test processed in a lab, mistakes can be made. Tests sometimes need to be performed twice to ensure reliability. The following article looked at women with low AMH levels and still found that pregnancy was a good possibility! Low AMH and Pregnancy Don`t let a low AMH take away your hope of having a family…there is still a reasonable chance that a pregnancy can occur.
What is Age Specific AMH?
Age specific AMH is a way of factoring in the age of the individual in relation to their AMH level. For example, an average AMH for a 22 year old will be different then an average AMH for a 42 year old. To think that a 42 year old should have an AMH like a 22 year old is not logical. Researchers are working on a method of factoring in age when examining AMH levels. Age-Specific AMH
Can I Raise My AMH Naturally?
AMH levels can be hard to change (much like it is hard to stop the aging process) but certain research indicates that the following factors may play a role. Don’t expect your AMH to skyrocket. However, following the advice of a natural healthcare practitioner would be a wise addition to any fertility treatments you may be considering.
Vitamin D and AMH
Specific vitamins have been connected to a higher AMH level. In the following study, those suffering from a vitamin D deficiency where significantly more like to suffer from a low AMH compared to those without vitamin D deficiency. Vitamin D and AMH It is interesting to note that in this study, AMH levels decreased by 18% depending on the season (i.e. winter months). These effects were mitigated with the supplementation of vitamin D. For my clients in Canada, this is important news and is a big reason why I encourage all of my clients to take a dose of 4000IU per day of vitamin D in the winter months.
DHEA and AMH
Supplementing with DHEA is also showing a lot of promise for those with low AMH. Please talk to your fertility specialist about supplementing with DHEA as taking this on your own is not recommended. Check out DHEA and AMH for more information about DHEA and low ovarian reserve. There are saliva tests available which is a non-invasive way to measure your DHEA levels. Once you know your levels, you can then consider a DHEA supplement. Click on the following link for more information about DHEA saliva tests.
DHEA-S (DS) – Saliva Hormone Level Imbalance Test Kit –
Diet and AMH
Also, diet may play a role. In one study, it was seen that AMH levels were lower in women suffering from Crohn`s disease compared to a control. Since Crohn`s disease can reduce the amount of nutrients absorbed, one can hypothesize that a nutrient dense diet (perhaps with the help of supplements) may provide the optimum environment for an AMH level to rise. This connection may be a bit of a leap, but maintaining a proper diet certainly will not hurt. Crohn’s and AMH.
Immunity and AMH
Certain diseases like Lupus can also lower AMH levels. Lupus and AMH. Since Lupus is an inflammatory condition, one may hypothesize that reducing systemic inflammation will help rise AMH levels. Acupuncture is an effective therapy to reduce inflammation and would be ideal in cases where inflammation exist. Clearly, more research needs to be done in this area.
Lifestyle and AMH
Cigarette smoking has been shown to decrease AMH levels compared to a control. Another reason to stop smoking (do we really need more reasons?). Smoking and AMH.
As a practitioner of Traditional Chinese Medicine and a Nutritional Consultant, I encourage regular acupuncture, Chinese herbs and a solid diet and supplement regime. Currently, there are not a lot of studies examining acupuncture and Chinese herbs and their effects on AMH levels. However, I believe that they contribute to the best possible health of an individual, resulting in an optimal AMH. Talk to a fertility acupuncturist and see if Chinese herbs and acupuncture are right for you.
In conclusion, if you are getting involved in fertility treatments, ask your specialist if the AMH test is right for you. After all, it`s an inexpensive way to get a much clearer picture of what your ovarian reserve may be. The result of this test will certainly help you make better informed decisions for you and your future family.
I’m 40 my amh 1.55 I checked my follicle did rupture so I have a chance but been trying for 2years .I’m over weight not eating healthy I have children my youngest is 7yr old….if I take vit d a d dhea will this increase my chances
Sam,
Thanks for the email.
If you are currently not taking vitamin D and you live in a cold climate, most experts agree that adding vitamin D is a good idea. DHEA is something I recommend only if you are being monitored by a fertility doctor. Research has shown that both can be helpful in fertility enhancement.
Weight management can be helpful for those who don’t ovulate regularly (i.e. PCOS sufferers). Losing even a small amount of weight can help regulate ovulation and may increase your chances of success.
Given your age and your recent AMH level, working with a fertility clinic may be a good option if you haven’t considered it already.
I hope this was helpful Sam.
Drew
I’m 34 . I was tested one month ago and my amh was 8.6 and fsh has always been good 10,6. Do I still have a chance to get pregnant?
Flora,
Thanks for the email.
Although FSH and AMH number are very important and helpful, they don’t tell the whole story and make it hard to make predictions about your fertility. First, I would need to know the units of measurement for your AMH level (pmol/L or ng/ml). I will assume it is pmol/L. If this is the case, it suggests that your fertility is lower at this time. Your FSH is around 10 which is often a good thing and suggest that your body isn’t working extremely hard to produce follicles.
Assuming that your partner has good sperm quality and that you don’t have any major structural, immune or blood clotting issues, you should (theoretically) still be able to conceive. Given your AMH results, I suggest working with a fertility clinic to help.
Again, I am only making educated guesses with the small amount of information you have provided. Please consult with a fertility doctor to get additional testing done to ensure you can reach your pregnancy goal.
I hope this was helpful.
Drew
Hi I have been trying to conceive for over 2 years now and i have had 2 cycles of clomid recently had my results back from my AMH and the level of pmol/l was 8.6 i am 39 years old. is this low?
Emma,
Thanks for the email.
An AMH of 8.6pmol/L is technically considered to be “low fertility”. However, is it low for a 39 year old? This is something which hasn’t been completely determined at this time. “Age specific AMH” levels are something that may come out sooner than later. More and more fertility doctors are coming to a consensus about this concept and we should have something soon to refer to soon. The best I could find at this time can be looked at here – https://www.researchgate.net/publication/261518333_Age-specific_serum_anti-Mullerian_hormone_levels_Estimates_from_a_large_population-based_sample
More up to date research is coming I am sure.
Sorry I can’t be more helpful and specific regarding your question.
All the best Emma.
Drew
Hello,
Husband and I have been TTC for 2 years for baby #2. My cycles are irregular and vary from 32-45 days (avg 35-38 days the past 4-6 months). We are extremely healthy, fit and active. All blood work came back normal EXCEPT AMH level. At 34 yrs old my level was detected at 94.9. Everything I am reading is suggesting a very strong likelihood of PCOS with levels that high but I don’t show any other visibile symptoms of PCOS other than irregular cycles and fertility issues.
I welcome any insight.
Alex,
Thanks for the email.
It would appear that you are in the PCOS “ish” category…particularly with those AMH levels. However, the good thing is that you have conceived before and there are likely no other major issues going on (blocked tubes or sperm issues etc.). For those who have PCOS but who tend to ovulate fairly regularly (which you seem to be doing lately) , the one issue which seems to come up is egg quality. If you were a client of mine, I would focus on cycle regulation and boosting egg quality as much as possible. Herbs, supplements and acupuncture would all be recommended.
If you haven’t read my article on PCOS and supplements, I suggest you give it a read – https://drewnesbitt.ca/pcos-supplements/
In it, you will find some of the most common supplements to help those with PCOS.
Also, many people in your situation do well with the modern medicine fertility route. You may want to chat with your doctor to ask for a referral to a fertility clinic if that is something you are open to.
All the very best Alex, I hope this information was helpful.
Drew
Hi Drew-
My family member has a history of irregular cycles, some hirtuism, and elevated testosterone. She didn’t have cystic ovaries on ultrasound but that was about 5 years ago..since then an endocrinologist put her on a low dose of spironolactone (25-50mg at times she skips it even) for the hirtuism. This seemed to help even though periods were still somewhat irregular. She got on the pill for about 6 months but didn’t like the weight gain so stopped that. After that her periods would not start back-so after about four months and a lot of research (I thought) she tried Ovasitol (myoinositol and dchiro inositol). She only ever took 1 packet a day (half dose)and didn’t seem to need the other dose to see benefit. Anyway-she resumed cycle within a month of starting this and also claimed to feel much better with less sugar cravings…however–she is thin and has never been really tested for insulin resistance…All was going well until I was just googling one day and found some info in a forum about the potential for myoinositol to potentially lower AMH levels in patient’s who do not necessarily have pcos and I guess insulin resistance…it would seem she might have both based on her symptoms but never had a def dx of insulin resistance….so I got scared and told her to stop taking it until we could find out more…I have asked several doctors and even a reproductive endocrinologist who say it can’t hurt and it seems to be helping her so let her continue…she has actually continued it some but only half a pack(so 1/4 dose) bc she says she feels so much better on it…I know you cannot give medical advice but I wondered when doing research On AMH levels–it does seem that metformin and myoinositol both work the same way somehow and bring AMH levels down do you think the reason it lowers this in pcos is bc it is typically high in these patients and when it corrects the problem the cysts go away and the AMH is lowered..? Meaning that maybe someone without the cysts wouldn’t be affected as far as AMH..? Does that make sense..? Also, do you think after discontinuing this supplement, AMH levels would go back up to baseline? I have worried myself absolutely sick over this. This supplement has helped her so much and I want her to be able to continue it but would not want her to if Decrease in AMH levels were irreversible..?
Lou,
Thanks for the email.
Interesting question…here is my take (I’m not a doctor either):
The research (I took a quick look on this) which you referred to in the forum you visited may have been examining women who are dealing with full PCOS. This is significant when we are talking about AMH has AMH levels are often elevated in those with PCOS (it is a diagnostic factor – unusually high AMH often means PCOS).
So, if the inositol was successful in those with full PCOS, it stands to reason that the AMH would decline (to normal).
That being said, I doubt that inositol is “harming” the egg quality or diminishing her reserve.
I think you can be comfortable that the inositol your family member is taking is not hurting her future chances of conception.
I hope this helps.
Drew
Hi, I’m 35 and received a result of 0.3 pmol/L AMH and have high TSH. The fertility clinic I went to informed me that I am not a good candidate for IVF and that my only option is egg donation. Can any of your methods increase my AMH for better IVF chances? Also, this article references your “AMH Optimizing List” but I don’t see a link to it anywhere.
Barb,
Thanks for the email.
While your AMH is on the low end, I would encourage you to get a second opinion from another fertility clinic to see what other options you might have. The fact that your TSH is high can be easily controlled with thyroid medication and really isn’t the big concern. Working with a fertility clinic using IVF will be your best option for sure. If you were my client, I would concentrate on the supplements, acupuncture and herbs for at least 8 weeks and then move forward with the IVF process.
The AMH Optimizing Supplement list can be found in the sidebar of that article. Sorry for the confusion there. Just click on “Get the list” in the sidebar and it should take you to the list.
Don’t be afraid to connect with a different clinic…this happens all the time. I find that when clients switch clinics, they are often given better options and care.
I hope this was helpful Barb. All the best.
Drew
Thank you for your quick response! I meant high FSH not TSH, sorry about that. The AMH and FSH results indicate I have POI hence the option of egg donation.
Thanks for clarifying Barb.
That makes a little more sense as to why the clinic is encouraging the egg donation. Still, if you feel that they are not giving you the option to move forward with your own eggs, you can consider a different clinic. No question, egg donation would be more successful statistically – however, many people try IVF at least once with their own eggs and then move on to donation.
It is really up to you and what you are comfortable with.
Working with someone like myself who is familiar with natural fertility enhancement may be helpful. Changing AMH levels is very difficult but low AMH levels do not mean you cannot get pregnant with your own eggs.
Keep us posted Barb.
Drew
I just got the results from my AMH test from my doctor. He is telling me it says undetectable. I had a cigarette before my test and was extremely stressed out. Could this have affected my result?
Dianna,
Thanks for the email.
It is very unlikely that the cigarette influenced your AMH levels on that day. Stress can play havoc with hormones but if you were just extra stressed on the day of your AMH test, I doubt it would have had any influence on the result as well.
A low AMH can be a devastating blow but don’t give up hope yet. Seeing someone who has experience optimizing AMH levels may make a different. If you don’t have an opportunity to see someone in person, perhaps consider an online consultation (I have just recently started offering this service to people who do not live near my area).
Talk to your doctor about options on their side and then consider adding some natural methods to help improve your AMH.
I hope this was helpful Dianna. All the best.
Drew
My question is if is it normal that the AMH test to do the 5 days to the cycle.Thank you
Ester,
I think you are asking if it is okay to do the AMH test on day 5 of your cycle. If I am correct, the answer is yes, you can do the AMH test at anytime during the cycle.
I hope this helps Ester.
All the best.
Drew
Hi,
I have recently had my amh come back at 1.1. My fertility specialist has me on 50mg of clomid and said he will not be recommending ivf as he doesn’t believe I’ll be a good candidate based on my very low amh level and my history. Is there anything else uou would recommend trying?
Casey,
Nice to hear from you.
I don’t know the details of your fertility history but I think most fertility doctors are okay with moving forward with IVF if you are. If you are willing to pay for it, most clinics will be okay with taking you through the IVF journey. On another note, if you feel that you are not being cared for the way you want, I would also say that it is not unusual to seek a second opinion…many clients do this. A different clinic/doctor may simply be a better fit for your situation.
I hope this was helpful Casey.
Drew
I’m 20 (young, I know). I smoke, and live in a remote community with a very old climate, so I don’t get much natural vitamin D. My fiancé have been trying to get pregnant for over a year. After some research and standard blood work and testing, everything has come back normal. After further reseaech, I found that women with type O have poorer quality eggs and will have more trouble conceiving. Should I visit a fertility clinic and get my AMH levels checked right away where I’ve been already trying for a year. Or should we continue trying before we seek more help. My blood group is O+. Should I also start going to a tanning bed in attempt for vitamin D? Or should I just take the supplements. I will be quitting smoking ASAP. Thanks, hope to hear from you soon.
Alex,
Thanks for the email.
Yes, you are young. Getting your AMH tested may be a little premature but I would ask your doctor to see if they can do it just in case you want to test it in the future. I would encourage your fiance to get a semen analysis as well…it takes two to tango as they say.
Supplementing with vitamin D3 is the best option. If you are not getting real sun, I prefer supplementing over tanning.
All the best with this Alex…be patient and I’m sure things will work out.
Drew
I’m 32 and I have PCOS. I was tested two years ago and my amh was 8.6 and fsh has always been good 3-4. Is that odd that with PCOS my egg count is low? Do I still have a chance to get pregnant?
Crystal,
Thanks for your email.
I would consider getting re-tested as it has been a fairly long time since your last AMH result. If your new AMH is lower than your last result, I would consider talking to a fertility clinic (if you haven’t already).
In my experience, PCOS is not always black or white…there are many variables which makes someone full blown PCOS. Many people are simply PCOS “ish”. It just might be that your AMH is not high because your PCOS is not as “strong” as others can be.
All the best Crystal.
Drew
Hello,
I am 39, received a very low AMH level, but a normal FSH level as well I am ovulating, producing follicles and still have a very regular period. Have been ttc for about 6 months, have done 2 rounds of clomid with IUI. (With no positive result) I am having my AMH level retested as my new dr thinks it’s odd to see everything else fine, but that. Is he correct in thinking that?
Thanks!
Hello there,
Thanks for emailing.
It certainly won’t hurt to get the AMH tested again. It isn’t something I recommend doing that often but I have had clients who have tested differently from previous results (only a few). I would also be interested in what is considered “very low” as at 39 years of age as a lower AMH is expected. I believe there are people out there who are working on the “age-specific AMH levels” which make much more sense. Either way, I hope that your AMH is at a level which should improve your chances of success.
All the very best.
Drew
Hi,
thankyou so much for such a detailed information. im 30 yrs old and TTC for 8 months now, got my AMH tested came to be 0.9ng/dl, repeated test after one month, came to be 0.6ng/dl.. how can my AMH reduce so much in one month? my husbands semen analysis shows asthenoteratozoospermia.. please advise me whether i should undergo IUI or directly go for IVF?
Hello Nivedita,
It is a little unusual for the AMH to decrease that quickly but I am not entirely sure why it would do this. Either way, since your husband has some issues to deal with, it would be most common for RE’s to suggest IVF sooner than later (note; I am not an RE or MD). Given his issues, this may be the best option at this time.
In the meantime, I would suggest that both of you do everything you can to improve both egg and sperm quality. Talk to an practitioner who has experience dealing with natural fertility enhancement and get started as soon as you can to take advantage of the time it can take to start the IVF process.
I hope this helps…all the best.
Drew
Hi, I recently TTC baby #2 for 13 months after being diagnosed with low ovarian reserve. (0.3 AMH) 2 rounds of clomid allowed me to get pregnant and I have a wonderful baby boy, 6 months old now. My question is, is it likely I will need clomid again to conceive given my low AMH numbers from before…those dont change after subsequent pregnancies do they?
Great question Kate.
I have not seen enough research on this area to give you a good answer but I would have to assume that your AMH levels should not be that different that what they were before. That being said, you may need a little help (Clomid or otherwise) to increase your chances if you are looking to try for baby #3. Follow the advice in the article about how to increase your AMH naturally and talk to your doctor when you are ready for your third child to see if any testing will help you make your decision.
All the best Kate.
Drew
I am 29 and my AMH level is 1.9. My doctor said it is in normal range. I am not trying to conceive yet but due to a family history of early menopause (mid 30s) she suggested I take this test to see what my ovarian reserve is. According to this article I am considered “low”. I am unmarried and concerned that if I am already low that in a couple years it will be too late.
Christina,
Your AMH is very close to the “satisfactory” level so try not to worry too much about the number. In the article, you will see that even those with lower AMH’s, pregnancies still definitely occur. However, the family history is something we have to take into account but it is hard to know how much you will be affected by this. Options definitely exist for these types of situations; egg freezing is something you can look into. You would be very smart to consider something like this and even if early menopause is not in your future, you will not have to worry about how long it may take to find someone to start a family. Talk to a fertility doctor if you are interested in exploring this option further.
All the best.
Drew
Hello! I was just diagnosed with PCOS. My hormones are fine except for elevated LH and AMH. my AMH is 38.9 ng/ml. My doctor is going to put me on a higher dose of clomid but said he wouldn’t be surprised if it didn’t work (you can imagine the stress I felt from that!) I take 5000 iu vitamin D but my levels are fine now. If I decrease my D intake could I lower my high AMH? is there anything I can do to lower it?
Elizabeth,
Nice to hear from you.
It is not often that people are asking me how to “lower” their AMH but for those with PCOS, it does come up. Your high AMH is a symptom of the PCOS and the best way to deal with the high AMH is to do everything we can to reduce the impact of the PCOS. For example, if you are carrying extra weight, increasing exercise may help. If you are consuming a lot of high glycemic foods, focusing on whole grains and minimizing white sugar/flour/rice may help. Acupuncture has been proven to help those with PCOS ovulate more frequently which could increase your chances. Certain supplements can also help.
There are many options but it is difficult to know which suggestions are best for your individual situation. I suggest visiting someone with experience treating PCOS for more specific advice.
If you are close to my clinic, feel free to email me with more information and I will do everything I can to help.
Take care for now Elizabeth.
Drew