Anti-Mullerian Hormone (A.M.H.) In Fertility

If you’re looking into information about trying to conceive and your fertility, you may have come across the letters A-M-H. Those letters stand for anti-Mullerian hormone, a hot topic in the medical community right now. Research is showing that AMH levels can help determine ovarian reserve quality, but there is a push for more research to be done. 

Knowing your anti-Mullerian hormone levels can be an important step in your fertility journey. It can allow your provider some insight into what may be preventing you from conceiving, allowing a plan to be created to help you along your fertility journey. Let’s take a look at what exactly AMH is and why it may be important for you to explore. 

What is AMH?
AMH stands for anti-Mullerian hormone. AMH plays a very important role in the regulation of ovarian follicle growth. AMH levels can help a doctor determine egg count. According to Advanced Fertility, “AMH blood levels are thought to reflect the size of the remaining egg supply – or “ovarian reserve”. It used to be referred to as “Mullerian Inhibiting Substance” or “MIS”.

What is a typical AMH?

The typical AMH in a fertile person is 1.0-4.0 ng/ml.

Dr. Nataki Douglas of Modern Fertility recommends testing once, then again in about 12 months. When you should consider retesting depends on your age, your AMH level, and how it is changing over time.

Why would you test your AMH?

AMH testing can be used to determine the start of menopause, determine reasons for early menopause, find out the reason for lack of menstruation (amenorrhea), diagnose poly-cystic ovarian syndrome (PCOS), check infants with genitals that cannot be determined as male or female at birth, and to monitor ovarian cancer. It is often used to diagnose amenorrhea in females younger than 15 and to diagnose PCOS in those trying to conceive. 

You may want to request an AMH test if you are experiencing decreased breast size, weight gain, facial and body hair growth, acne, menstrual disorders, or irregular periods. You may also need testing before beginning IVF (in vitro fertilization) or to diagnose Trisomy X Syndrome. 

It is important to know that AMH levels can fluctuate and that your levels at this current level may be a determinant if you are able to conceive. That is why it is important to track AMH. 

Fertility begins to decline up to 10 years before menopause and the average age of menopause is 51. By 41 fertility is already taking a major decline. With so many people waiting longer to start a family, AMH is becoming more important to monitor in order to be successful in your pregnancy journey. It may determine if someone chooses to start a family earlier rather than later.

What to know about low AMH

• AMH tends to decline as a person gets older
• Low AMH can be due to autoimmune disease, surgery from endometriosis, ovarian cyst removal, age, or just your DNA
• You may have primary ovarian insufficiency. POI is the loss of ovarian function before age 40. It impacts 1 in 100 women
• People with few remaining follicles have low anti- Mullerian hormone levels
• Those that are close to menopause have low anti- Mullerian hormone
• There are no somatic symptoms associated with low AMH
• Low AMH may mean a shorter reproductive window
• Research has shown that there is no difference in the outcome of IVF between patients with low and extremely low AMH levels

What to know about high AMH

• It is easier to get pregnant with high AMH than it is with low
• Women with many small follicles, such as those with polycystic ovaries have high AMH levels
• In IVF you may have the option of freezing more embryos
• You may have polycystic ovarian syndrome. PCOS affects 1 in 10 women.
• In IVF patients high AMH levels correlate with low cancellation rates, retrieval of more eggs, higher live birth rates, and a high chance for freezing of leftover embryos

Increasing AMH 

Some research has shown taking micronutrients present in antioxidants can increase AMH. Poor nutrient absorption can contribute to low AMH, as seen in people with Crohn’s disease. It is important to consult with specialists if you have an autoimmune disease because treating your autoimmune disease, if possible, may improve your AMH levels. The Journal of Human Reproductive Sciences published a study showing increased AMH when people began exercising moderately. There is no conclusive evidence of if AMH levels can be increased, but proper diet and exercise can prepare your body for a healthier pregnancy. 

IVF and AMH

AMH can help you understand how many eggs may be extracted during egg retrieval for egg freezing and IVF. Your AMH levels may be checked during your initial lab work when pursuing IVF. These levels can determine if you are a good IVF candidate. In IVF patients high AMH levels correlate with low cancellation rates, retrieval of more eggs, higher live birth rates, and a high chance for freezing of leftover embryos. Research shows no difference in success for patients with low vs extremely low AMH. Age is a key factor in the success of IVF.

Past Pregnancy Delivery Mode

There has not been a connection found thus far between the type of delivery and AMH levels. A past cesarean section would not impact levels over a vaginal delivery. 

Birth Control and AMH

The oral birth control pill has been shown to lower AMH levels temporarily. This differs from brand to brand and person to person. It is important to consult with your doctor when making decisions about which birth control option is best for you and for your future fertility goals. 

Testing Methods

Testing is usually conducted via a standard blood sample and technology has made it possible for at-home tests now.

Egg Count

• The average female is born with 1 to 2 million eggs
• Half of those eggs will disintegrate throughout puberty
• 800-1,000 undergo natural cell death monthly
• AMH peaks at age 25, typically
• By 35 ovarian reserve decline becomes more rapid
• Egg count and AMH are undetectable by menopause, around age 51

Throughout the journey of conception, there can be so many questions people want to ask and they want detailed answers. People do not want a “we just don’t know” type of answer from their provider, which is why further research is so important. People deserve to know what is going on in their bodies. It can be hard to know what to ask when consulting with a provider and in lots of cases, if you don’t know what to ask, they might not tell you something you wish you had known. The anti-Mullerian hormone is a key term to know when trying to conceive, especially for those experiencing infertility. Remember that you can always ask your provider if AMH testing is right for you and consult with other providers if you think AMH testing could bring you a clearer picture of what is happening inside of your body. 

References:

Advanced Fertility. (2020, December 15). AMH fertility test, Anti-Mullerian Hormone. Advanced Fertility Center of Chicago. Retrieved February 2, 2022, from https://advancedfertility.com/infertility-testing/amh-fertility-testing/ 

Fertility, F. (2021, December 16). How to increase AMH Levels Naturally & AMH testing. Fertility Family. Retrieved February 2, 2022, from https://www.fertilityfamily.co.uk/blog/how-to-increase-amh-levels-naturally/ 

Grynnerup AG, Lindhard A, Sørensen S. The role of anti-Müllerian hormone in female fertility and infertility - an overview. Acta Obstet Gynecol Scand. 2012 Nov;91(11):1252-60. doi: 10.1111/j.1600-0412.2012.01471.x. PMID: 22646322

Hariton, E. (2021, June 11). Define_me. Retrieved February 2, 2022, from https://www.ajog.org/article/S0002-9378(21)00685-2/fulltext#:~:text=these%20contraceptive%20groups.-,Results,0.71%E2%80%930.86%3B%20P%3C.

Medline Plus (2020, December 15). Anti-müllerian hormone test: Medlineplus medical test. MedlinePlus. Retrieved February 2, 2022, from https://medlineplus.gov/lab-tests/anti-mullerian-hormone test/#:~:text=AMH%20has%20a%20different%20role,the%20ability%20to%20get%20pregnant.

Moini, A., Pirjani, R., Rabiei, M. et al. Can delivery mode influence future ovarian reserve? Anti-Mullerian hormone levels and antral follicle count following cesarean section: a prospective cohort study. J Ovarian Res 12, 83 (2019). https://doi.org/10.1186/s13048-019-0551-z

Zaghloul, Y.I., Amin, Y.M., Mansour, R.T. et al. Live birth rate after IVF/ICSI in women with low and extremely low AMH: an age-matched controlled study. Middle East Fertil Soc J 25, 2 (2020). https://doi.org/10.1186/s43043-019-0014-x