Originally published: 21.NOV.2018
Last updated: 18.AUG.2023
Once you decide that you are ready to start a family of your own, it becomes apparent that getting pregnant isn’t as simple as your high school sex ed teacher made it out to be. As well as your general health and well-being, you have to consider your cycle: this of course includes your hormonal health.
One of the most important hormones to understand when you decide to start a family is the anti-müllerian hormone (AMH): a hormone produced by the follicles in your ovaries that can give an idea of how many eggs are present in your ovaries.
Below we cover everything you need to know about your AMH levels, what they mean, and how to test them if you are concerned about your fertility or want answers to certain symptoms.
- What is AMH?
- How Does Your Body Produce AMH and Eggs?
- What is a Normal AMH Level?
- What Else Can AMH Explain?
- Should You Test Your AMH Levels?
What is AMH?
AMH stands for anti-müllerian hormone. Anti-müllerian hormone is a glycoprotein hormone that is produced by granulosa cells in the ovaries. So, how does it all work?
Follicles are produced in your ovaries. Follicles develop into eggs that are transported through the fallopian tubes and they secrete AMH.
Women are born with millions of eggs "in reserve". A baby girl starts her life with two million tiny follicles in her ovaries, these ovaries produce and secrete AMH. This is why AMH is a good teller of how many eggs you have "in reserve." The more follicles you have, the more eggs and AMH you will be capable of producing.
The number of eggs you have continuously decreases in quality and quantity as you age. So while AMH may be indicative of how many eggs you have left for a viable pregnancy, AMH will not tell you the quality of your eggs.
In most circumstances, a woman will carry these eggs for the rest of her life. There is no way of slowing down the depletion of eggs, as they lower with each cycle, and there is no way of increasing the number of eggs in your ovaries naturally.
Follicles are produced in your ovaries, as follicles develop into eggs that are transported through the fallopian tubes, they secrete anti-mullerian hormone.
The amount of AMH in your blood will tell you:
- How many eggs you have left
- How likely you are to respond to IVF treatment
- What stage of the reproductive cycle you are in
The amount of AMH in your blood will not tell you:
- The quality of your eggs
- When you are likely to get pregnant
Related article: Pregnancy Planning? Four Tests to Consider Before Starting a Family
How Does Your Body Produce AMH and Eggs?
Your body produces AMH during the production of your ovarian follicles. Ovarian follicles are responsible for the secretion of essential hormones that are released during the menstrual cycle as well as the nourishment of the oocyte ahead of ovulation.
When it comes to thinking about your eggs including how many you produce and how many you lose each month, it would seem like perfect sense to think "I lose one egg because only one egg will be fertilized if it fuses with sperm."
This is not the case. Each month you lose a little over 1,000 eggs. Do not panic. This is perfectly normal and healthy.
The one egg you're thinking about is the lucky candidate that has made it through a period known as folliculogenesis. Folliculogenesis refers to the maturation of the ovarian follicle. The ovarian follicle is packed with cells that produce the immature egg which will later be released from the ovary in a process known as ovulation.
Before ovulation, the immature egg sits in the fluid-filled sacs until they are mature enough to go through the process of ovulation. Eggs that are viable for this process will exist in the following four stages.
Stage #1: Primordial Follicle
Primordial follicles are small and flat, dormant cells covered in one thin layer of protective cells.
Stage #2: Primary Follicle
When a primordial follicle is stimulated, it develops into a primary follicle. Follicles in the primary stage begin dividing allowing for the continued growth of cells in the ovaries.
Stage #3: Preantral Follicle
Preantral follicles are also commonly known as secondary follicles. At this point, they have two or more layers of granulosa cells surrounding them with the continued division of cells. This cell growth supports the growth of the follicles into an ovum or egg.
Stage #4: Antral Follicle
Antral follicles or secondary follicles can grow as large as follicle-stimulating hormone allows. Antral follicles are mature ovarian follicles that hold and nourish the immature egg that will later burst through the ovary wall and travel through the fallopian tube.
The release of these follicles allows for the production of progesterone and estrogen, both control the timing and symptoms of your period and menstrual cycle overall.
What is a Normal AMH Level?
Normal AMH levels are typically dependent on several factors including
- Certain medical conditions
- Fertility status
Do not panic if you see that your AMH levels are outside the range as documented in the diagram below.
Normal AMH levels are solely dependent on your age because as described, our number follicles and developing eggs are responsible for the amount of circulating AMH in our blood.
While girls are born with approximately 2 million eggs, this number will have depleted to 400,000 by the time a girl reaches puberty. From the girl's first period, she will begin to lose about 1,000 eggs a month. Therefore it is no surprise that AMH levels will also begin to lower as you get older.
This diagram illustrates normal ranges for AMH per age group.
Again, it is important to note that AMH testing will not offer you insight into the quality of the eggs in your ovarian reserve. To measure the quality of your eggs, you will need to undergo an ultrasound.
In that vein, it is also important to note that you may have a low AMH reading but it doesn't necessarily mean you will not be able to get pregnant. It only takes one egg and one sperm to fuse for a healthy pregnancy. You should see AMH as an indicator of where you are in your reproductive years.
Related article: 5 Steps to Promote Healthy Fertility
What Else Can AMH Explain?
It is important to know that AMH levels and their meaning are dependent on several variables, most importantly, your age. Universally, AMH levels can be indicative of many conditions.
Low AMH is generally a sign of:
- Low Ovarian Reserve
- Premature Ovarian Failure (POF)
- Crohn’s disease
- Autoimmune thyroid disease
- Irregular AMH is generally a sign of:
High AMH is generally a sign of
- Polycystic Ovary Syndrome (PCOS)
Should You Test Your AMH?
If you are curious about your hormone health or are hoping to start a family of your own, you should test your AMH levels. You can test with your healthcare provider or from home with LetsGetChecked’s Ovarian Reserve Test (AMH test).
The Ovarian Reserve Test is for anyone curious about their fertility status or interested in knowing if their ovarian reserve is normal for their age. This test can provide insights into how many eggs you have left. Our dedicated clinical team will be available to support you and provide guidance on your next steps.
You should take the test if:
- You are interested in learning more about your reproductive health
- Interested in learning more about your ovarian reserve (an indicator of how many eggs you have left)
- You want to know more about how you might respond to treatments such as IVF
It’s important to note that this test cannot tell you about the exact number of eggs you have or provide any information about egg quality or other fertility problems. It is not advised to delay trying to get pregnant based on one AMH reading. Further tests with a healthcare professional are required for a complete fertility assessment.
The AMH test can only be taken by those between the ages of 18 and 55 (inclusive), as results cannot be provided to those outside of these age ranges.