AMH Testing - What Does it Tell Me?
What it is = Anti-Mullerian Hormone
AMH is a hormone produced by the cells that surround each egg within the developing ovarian follicle. The production and serum level of AMH are reflective of a women’s ovarian reserve and decline with age.
Who and what it IS used for:
- The assessment of ovarian reserve in infertile women
- It provides information on the number of remaining eggs you have and whether your ovaries might be aging too quickly.
- May reveal how well your respond to fertility medication used to stimulate your ovaries to mature multiple eggs during an IVF protocol.
- Data is emerging on its use as a biomarker for PCOS
Who and what is it NOT used for:
- No data exists to support its use in counselling women without a diagnosis of infertility.
- If you have not tried to become pregnant or have become pregnant previously without assistance, AMH may not be relevant for you.
- It cannot be used to predict time to pregnancy.
- It is not recommended for use in predicting pregnancy loss.
- It is not currently used as a predictor of time to menopause.
What is Ovarian Reserve Anyways?
The number of oocytes in the ovary peaks at 20 weeks gestation at about 7-8 million. By puberty the number of oocytes has dropped to approximately 500,000 within both ovaries. Every month a group of oocyte containing follicles will be activated and mature to either the point of ovulation (for the dominant follicle), or not (non-dominant follicles). The number of gonadotropin hormone responsive follicles at any given time is what’s referred to as an “Ovarian Reserve”. Ovarian reserve is also commonly assessed using antral follicle count via ultrasound, and serum FSH measurement (with estradiol). One big takeaway I like to let people know if that AMH tells us about the number of hormone responsive follicles, NOT THE QUALITY OF THE EGG. Ovarian reserve often gets put together with egg quality and AMH does not tell us that.
If it applies to me, what should it be?
Step 1 – make sure you know the ranges and units.
There are two commonly used ranges with different units in AMH testing which makes looking at the units for the AMH number important. If you are comparing your results to someone else’s online make sure you note the units. Units are a big deal. Saying your lab value for any test without units is like saying “I walked 5 today”. Walked 5 what? Five miles, 5 km, 5 minutes? It makes a huge difference!
Step 2 – Check your number against those in your age range
There is some variation in ranges that you see online even within common units. This occurs because the labs testing use different equipment and results of what is “good” or “low” will vary slightly. Below are a few sources that I found. Please check with your healthcare provider who ordered the test to let you know what the range is for the lab it was done at. This variation is also important to keep in mind when you are reading online and comparing your numbers to someone else. Another good reason not to compare yourself to others😊
In pmol/L
Age-related reference intervals in women
The reference intervals represent the 2.5th – 97.5th percentile values for healthy women in each age bracket.
- 20 – 24 years 8.7 – 83.6 pmol/L
- 25 – 29 years 6.4 – 70.3 pmol/L
- 30 – 34 years 4.1 – 58.0 pmol/L
- 35 – 39 years 1.1 – 53.5 pmol/L
- 40 – 44 years 0.2 – 39.1 pmol/L
- 45 – 50 years 0.1 – 19.3 pmol/L
(table source = https://www.tdlpathology.com/t...)
In ng/dL
Normal ranges from The Cleaveland Clinic website
• Average: Between 1.0 ng/mL to 3.0 ng/mL.
• Low: Under 1.0 ng/mL.
• Severely low: 0.4 ng/mL.
What is a good AMH level for your age? – Estimate on the lower side of spectrum
• 25 years old: 3.0 ng/mL.
• 30 years old: 2.5 ng/mL.
• 35 years old: 1.5 ng/ mL.
• 40 years old: 1 ng/mL.
• 45 years old: 0.5 ng/mL.
My AMH Takeaway
AMH is one of many tools used in fertility assessment by IVF clinics and Fertility Doctors in various settings. I do test for it but context matters, A LOT! If it is low, it doesn’t mean you won’t get pregnant. Your IVF doctor will use it to guide treatment and as a Naturopathic Doctor, I also use it to guide my treatment. It tells me we should ramp up our efforts in all other areas of your fertility. It is a sign that your body needs extra support and approaching your reproductive health in a wholistic way can help you achieve your goals of becoming pregnant. Don’t let low discourage you, let it empower you to take your fertility in your own hands and support your body the way it truly needs.
Article Sources
- ACOG website - https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/04/the-use-of-antimullerian-hormone-in-women-not-seeking-fertility-care
- The Doctors Laboratory website - https://www.tdlpathology.com/tests/profiles/antimullerian-hormone-amh-plus/)
- The Cleveland Clinic website: https://my.clevelandclinic.org/health/diagnostics/22681-anti-mullerian-hormone-test
Dr. Nicole Shortt, ND
Dr Nicole Shortt, BSc, ND is a Naturopathic Physician who is passionate about naturopathic medicine and the choices it gives people in health care.
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