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What is AMH Testing? 

20 September 2020

The Anti Müllerian Hormone, or AMH, is an important sex hormone for both men and women, but one that comes in particularly handy when for predicting future fertility in women. AMH testing can be used to estimate the number of ovarian follicles a woman has and, therefore, how long she can conceivably wait before trying to get pregnant. So how exactly do AMH tests work? What can and can’t they predict? And can you increase you AMH levels if you find out they are low? Let’s dive in! 

The role of AMH in gender development 

Anti Müllerian Hormone plays an important role if our development, even before birth. If a fetus has XY male genes, high levels of AMH and other male hormones will promote the development of male organs and prevent the development of female ones. If the AMH levels are too low, however, the organs of both sexes may form, resulting in ambiguous genitalia, a condition otherwise known as intersex. Conversely, if a fetus has female XX genes, only small amounts of AMH should be produced.  

The role of AMH in adult women 

Once a woman reaches puberty, AMH takes on a different role. Even though a woman is born with all the eggs she’ll ever have, her ovaries will start producing AMH as egg cells grow inside them, ready for release at ovulation time. The higher the AMH levels produced from the ovaries, the more eggs a woman is likely to have tucked away in her so-called ovarian reserve, where microscopic follicles hang out in “deep sleep” waiting to be summoned to the front line, so to speak. As a woman’s fertility declines with age, so too does her ovarian reserve and therefore her AMH level. 

What are AMH blood tests? 

Studies show that the size of a growing pool of follicles (on the "front line") is heavily influenced by the size of the ovation reverse (in "deep sleep"). The bigger the growing pool of follicles, the higher the level of AMH that can be detected in the blood. Performing an AMH blood test can therefore help a doctor estimate the number of viable eggs a woman has. 

AMH tests can also be used to predict the start of the menopause and discover reasons for early menopause; help find the reason for amenorrhea (the lack of a menstrual cycle, either in girls who have not started menstruating or older women who have missed several periods); to diagnose polycystic ovary syndrome; and to monitor women with certain types of ovarian cancer. 

Interpreting AMH results for fertility 

When AMH tests are used to predict fertility, the higher the levels of AMH, the larger the egg reserve is likely to be. Results higher than 1 ng/mL usually signifies a “normal” ovation reserve, while AMH results lower than 1 ng/mL may signify a diminished ovarian reserve. Confusingly, however, very high levels of AMH can indicate polycystic ovary syndrome, which is a common cause of infertility in women. 

Women with low AMH levels may have fewer viable eggs and therefore struggle to get pregnant. Women who find themselves in this camp may choose to freeze their eggs or try to conceive earlier. Those with a normal reserve may be able to wait years before trying to get pregnant. Likewise, AMH test results may also suggest how well you are likely to respond to fertility treatments such as vitro fertilization (IVF), if that’s a road you choose to go down. While IVF doctors will choose the most viable eggs cells for fertilization and implantation, the more eggs cells they have to pick from, the better. 

What AMH testing cannot predict 

Unfortunately, AMH tasing cannot predict for sure whether or not a woman will be able to get pregnant in the future. An AMH blood test does not give any information on the quality of a woman’s eggs or myriad other factors that can affect fertility. The only sure way to know if you can get pregnant or not is to try, and for some, trying is a long and complicated process, even if AMH levels are normal. 

What’s more, women with low AMH levels may have no trouble getting pregnant. And as AMH levels decline as we age, just because you have a normal AMH level now, does not mean it will stay normal in the future. The speed of decline of the hormone produced in the eggs will vary from woman to woman. 

What to do if you have low AMH levels 

If you find out you have low AMH levels, you may want to ask your doctor to conduct more tests, as there is a variety of ways to assess a woman’s potential ovarian reserve. One easy and commonly used method is via a transvaginal ultrasound, where the number of visible follicles in the ovaries (the front line) is counted. In addition, other hormones can be tested via the blood. 

If all indications suggest your ovarian reserve is indeed low, you may want to start trying to conceive earlier or talk to your doctor about egg freezing so you can save your youngest and therefore healthiest eggs for a later date. Even if you have to undergo IVF fertility treatment down the line, a frozen younger egg is more likely to develop into a healthy embryo for implantation. 

Wondering how to improve AMH levels? Unfortunately, there is no proven way to do this, although some research suggests that vitamin D and DHEA (the latter is a hormone produced in the adrenal glands) can help. You’ll need a doctor’s prescription for DHEA in the UK but you can buy vitamin D over the counter.

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