Making Sense of AMH & Ovarian Reserve | New Research
A common recommendation for couples trying to conceive (TTC) and certainly after some time has passed without a positive pregnancy test, is comprehensive testing.
Getting baseline lab information about the status of health is essential to make sure there is nothing being missed that can be supported in your efforts to conceive.
One of the test panels that is often ordered is AMH.
And like so many healthcare situations, women often get their lab results with very little education about WHY or WHAT they can do about it.
AMH stands for anti-mullerian hormone and here’s what it does:
Research is just starting to understand the role & impact AMH has on our hormones. But, a lot is not yet understood..
What we do know is that AMH has many effects for both men + women. Specific to fertility, AMH is secreted by the granulosa cells in the ovarian follicle (where the eggs are made).
Its main function is to regulate how & what follicle begins fully maturing. So, the more AMH, the more follicles are in the early stage of development (preantral or small antral stage). The lower the level of AMH, the theory is there are less eggs awaiting the next stage of maturation.
AMH is highest for women in their mid-20s, then slowly starts to decline over time, until menopause.
But, there are many other factors that can influence AMH.
“I just had labs done, my AMH was 0.9, I’m 39 and my doctor told me my only option is IVF. HELP!”.
Another really common scenario is women with irregular periods who either have low AMH OR high AMH. Both can be indicators that there may be imbalances in the body, depending on age and other aspects of health.
Other causes of changes in AMH include hypothalamic amenorrhea, hypothyroidism, hormonal birth control use, endometriosis and PCOS.
Doesn’t AMH predict ovarian reserve status?
Yes, this is the traditional use of this marker.
But recent research suggests that a lower AMH makes no statistical significant difference when it comes to live pregnancy rates.
This recent assessment is very encouraging. Couples have spent thousands of dollars on IVF + gone through deep emotional turmoil because they were told that was their only option, based on this lab alone. And while it might be for some women with low AMH, the reliance on a lab value as prediction of fertility potential is becoming less independently acceptable.
AMH can be a possible indicator of ovarian reserve, but should also be taken into account WITH other laboratory information.
For a comprehensive list of testing to consider for fertility work up, get my Fertility Checklist here!
Other things to consider:
AMH can be falsely low if you’ve recently been on hormonal birth control or are currently on hormonal birth control (this includes hormonal IUD + the mini pill). It’s recommended to wait at least 3 normal menstrual cycles before testing AMH if you’re wanting a clear indication of level.
I’m over 35 & have been told my AMH is too low, what should I do?
Talk with your doctor about comprehensive lab testing, including cycle specific labs like estradiol, FSH and LH alongside an AMH test.
And, read through the recommendations below.
I’m actually the opposite, I’ve been told my AMH is too high!
Yes, this is common too. Especially for my PCOS ladies. What’s happening here is that PCOS follicles can over-develop. The granulosa cells can be dysregulated in PCOS, leading to a higher secretion of AMH than a normal functioning ovary. This doesn’t necessarily suggest that a higher AMH in someone with PCOS will have greater ovarian reserve, as much as their ovary may be secreting higher amounts of AMH.
Another great example of how AMH alone does not directly reflect ovarian reserve or follicle count.
It’s important to understand the underlying endocrine imbalances of PCOS and support them appropriately.
Best ways to support AMH & fertility potential:
Optimize your hormones. If your goal is pregnancy, getting hormones in balance to support healthy ovulation is key. This might be supporting lower estrogen, managing estrogen dominance or hyperandrogenism.
Moderate stress. Cortisol (our stress hormone) can interrupt hormone production + result in hormone imbalance. This practice is a great place to start building stress resilience.
Therapeutically support PCOS, if you have it.
Ensure nutrient levels are sufficient, this includes vitamins + minerals which are integral to hormone balance.
Eat nutrient rich foods. Focus on healthy fats, whole grains, 6-9 servings of vegetables + fruits daily.
Nourish your microbiome: Gut bacteria impacts how well we absorb nutrients, produce and break down hormones (among thousands of other mechanisms).
Check vitamin D levels. And supplement if necessary.
Optimize egg quality + decrease inflammation. Optimizing pelvic health & overall wellness can improve fertility + pregnancy outcomes.
The takeaway!
Getting a comprehensive workup is essential. Gather information alongside education, to help inform the most supportive plan for your fertility journey is a holistic approach.
AMH levels alone are not diagnostic or a prognosis for how successful a fertility journey will be. AMH should be used as an informational tool to better understand health + fertility status alongside other measurements, patient history, clinical presentation and family planning goals.
If you’re looking for a comprehensive and functional approach to your hormones + fertility, you’re in the right place.
Uncovering the root cause of hormone imbalances + optimizing fertility health is the core of my work. If you’re ready for clarity about how best to balance your hormones and prepare for a pregnancy, learn more about my approach + highly successful strategy.