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Anti-Mullerian hormone (AMH) is a hormone produced by the follicles in the ovaries (the fluid filled sacs that contain eggs). It requires a simple blood draw and is most often used as a marker of ovarian reserve. Ovarian reserve is the term for the number of healthy eggs left in your ovaries. Since people with ovaries are born with a fixed number of eggs, this number naturally declines over time. 

A low AMH level is usually related to natural aging, but it can also have other causes. In this article, we’ll explore what a low AMH result means and answer some common questions that can come up.

AMH and its role in fertility

So what exactly can AMH tell you about your fertility? As mentioned, your AMH level is positively correlated with the number of follicles you have in your ovaries. Simply put, the more follicles you have, the higher your AMH level typically is. As a result, AMH levels have been shown to be a good predictor of ovarian reserve and someone’s expected response to fertility treatments. 

In fact, several studies have shown that there is a strong correlation between what your AMH level is and the number of mature eggs retrieved during an egg freezing or in vitro fertilization (IVF) cycle. To learn more about those studies, check out AMH and Egg Retrieval Outcomes

What your AMH level can’t tell you is the exact number of eggs you have left in your ovaries or what your chances of pregnancy are. There are a number of other factors like your age, overall health, and genetics that also affect the number and quality of eggs and your overall fertility. So while AMH can be a useful tool in assessing your fertility, it shouldn’t be the only factor when making decisions about fertility treatments.

What is a low AMH result?

As with most things in medicine, there’s no absolute answer here. What is considered a low, normal, or high AMH level depends on your age and the lab where you take the test. Since there is no international standard, it’s best to use the reference ranges that come with your test results.

In general, an AMH between 1.0 and 3.5 ng/mL is considered to be in the “normal” range, which means you’re likely to have a good response to fertility treatments. Anything below 1.0 ng/mL is considered low and a sign of a declining ovarian reserve.

What does a low AMH mean?

Having a low AMH level can be a sign that your ovaries are making less of the preantral follicles. The lower the number of follicles, the lower your ovarian reserve is. 

So what does this mean in terms of fertility?

First, having a lower AMH does not automatically mean you aren’t ovulating regularly or that you won’t be able to get pregnant naturally or with assisted reproductive technologies. However, research has found that what AMH is good at predicting is the response to ovarian stimulation and the number of eggs retrieved, regardless of a person’s age. So, someone with a higher AMH is generally expected to be able to get more eggs in one cycle than someone with a lower AMH. Because of this, fertility doctors typically use AMH levels (along with other information) to figure out the drugs and dosages you’ll need to maximize your response to ovarian stimulation medications. 

If you’re trying to conceive naturally, you’ll be glad to hear that multiple studies have shown that AMH does not correlate with how likely you are to actually get pregnant. In fact, one study looked at levels of AMH, FSH, and another ovarian hormone, inhibin B and tracked people for a year. They found that there was no correlation between someone’s ovarian reserve and their ability to conceive and that a low ovarian reserve was not associated with lower fertility. As a result, they did not recommend the use of FSH or AMH levels to “assess natural fertility.”

Reasons AMH would be low

There are a few reasons that could explain a low AMH. Let’s explore them.

Natural decline with aging

By far, the most common reason for a low AMH is age. People with ovaries are born with all the eggs that they’re going to have in their lifetime. These eggs are then slowly used up over time as you ovulate during each menstrual cycle until menopause is reached. As a result, ovarian reserve naturally decreases over time, meaning the AMH level also decreases. 

Hormonal birth control

Research suggests that hormonal birth control may affect AMH levels but it depends on the type of birth control. Specifically, birth control use is associated with a lower average AMH level than for people who are not on birth control, with the exact effect depending on the type of birth control. 

The amount of time you’re on birth control may also be a factor. Multiple studies have shown that AMH doesn't change if you use combined oral contraceptive pills for less than six months. However, you may have a lower AMH if you’ve been a long-term user of the pill (or other hormonal methods). Thankfully, this is temporary – AMH levels typically rebound after a person stops using birth control.

You can learn more about birth control and AMH here.

Tobacco use

Studies have shown that tobacco use, usually cigarette smoking, decreases AMH levels. This effect appears to be reversible though–it was only seen in people who were active smokers, not people who had previously smoked. 

Less common causes 

There are several other, less common causes for a low AMH level. These include:

  • Genetic disorders that affect the X chromosome.
  • Medical treatments like radiation or chemotherapy.
  • Having surgery on your ovaries.
  • Losing one or both of your ovaries.
  • Autoimmune conditions.

Can I still donate my eggs with a low AMH?

If you are looking to donate your eggs, minimum AMH requirements are usually 2.0 or above. With Cofertility’s Split program, we require a minimum AMH of 2.0, though clinics may have their own unique requirements. This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.

What to do if you have a low AMH result

Finding out you have a low AMH can be disheartening, especially if you had future fertility plans that you’re worried may be affected. While there’s unfortunately not much that can be done to reverse a low AMH, there is still hope for starting a family someday even with a low AMH. With the exception of birth control or cigarette smoking, most studies have shown that lifestyle changes like diet or supplements have an insignificant effect on AMH levels but despite this, I promise it’s not all gloom and doom. 

Let’s go through a few things you can do as you move forward with this new information. 

Lean on your village

The first thing to do is take a deeeeeep breath… There are a lot of nuances involved here which can make it hard not to get lost in the weeds. Fertility is impacted by so many different things that you can drive yourself crazy trying to manage all of them. 

Having friends, family, and mental health specialists available to support you when you need it is going to be crucial. Navigating fertility is hard no matter what, so having people around you who you can lean on on bad days and celebrate with on good days will help immensely. 

Consult a fertility specialist

Speaking of your village, it should definitely include a fertility specialist. Consulting with a fertility doctor can help you better understand your reproductive health and provide guidance on any concerns or questions you may have. They’ll be able to review your specific options and work with you on a plan that helps you reach your family-building goals. This treatment plan will depend on a lot of things including how soon you want to have a child, how many children you want to have, your finances, and your desire to have a child who is genetically related to you. 

So does this mean I have to freeze my eggs ASAP?

This is typically the first question people ask and the answer is not necessarily. As mentioned before, there are many other factors involved in assessing your fertility and modern technology has allowed for advances that make family building a possibility for virtually everyone. Your fertility specialist will be able to discuss all the options for starting a family based on your unique family-building goals. This could certainly include freezing your eggs for later use but it could also mean trying to conceive unassisted, undergoing IVF with your own eggs or with donor eggs, using a gestational carrier, or even options beyond these. Again, this is something that will require you to examine your personal goals and work with your provider to figure out the best way to reach them. 

You are not a number

Repeat after me: you are more than one number! Your AMH level provides valuable insights into your ovarian reserve, but it’s just one piece of the puzzle when it comes to your fertility. AMH is always used as part of a full fertility evaluation, which often includes information about your medical history and age, a partner semen analysis, an ultrasound of the pelvis, an x-ray of the uterus and fallopian tubes, and/or additional lab work.

If that sounds like a lot, it is. This process can be overwhelming but focusing on the things that you can control can help you feel more grounded during your fertility journey, whatever that may look like.

How Cofertility can help

Cofertility is here to help you every step of the way on that journey. Our Split program offers women a chance to freeze their eggs for free when donating half the eggs retrieved to a family who cannot conceive otherwise. If you qualify for the program and decide to donate half of your retrieved eggs, every expense associated with the egg freezing procedure —  medications, supplements, travel if necessary, insurance, and 10 years of storage — are completely free of charge. We don’t even need a payment or credit card up front, as the family you match with covers all the expenses.

In our Keep program, you can freeze and store your eggs for your own future use, with lower prices on things like storage and medication. as well as our team’s support and access to our community.In addition, you’ll have access to our team’s support and access to our community where you can engage with other people freezing their eggs at the same time! 

Your journey is uniquely yours and our team is here to help you through it in whatever way you need.