Anti-Mullerian Hormone Levels by Age
How Does AMH Affect Fertility?
AMH hormone levels decline as a woman gets older, and this reduction is associated with the age-related decline in fertility and egg supply.¹ Because of this association, the AMH blood test is a very useful measure of a woman’s ovarian reserve and fertility -- even more so than the antral follicle count (AFC) on ultrasound. AMH reflects female fertility because it is expressed by the granulosa cells of the ovarian follicles, the small follicles in a woman’s ovaries that are on track for ovulation.
How are Anti-Mullerian Hormone Levels Measured?
AMH hormone level can be measured at any point of a woman's menstrual cycle with an AMH blood test. This test is a routine and important part of the infertility testing workup, and it is also a part of predictive fertility testing for younger women that can help physicians identify women at risk of premature ovarian aging.
But AMH is not the only hormone measured in ovarian reserve testing. Follicle Stimulating Hormone is another important hormone in fertility testing. When we look for the potential cause of a woman’s infertility and problems with egg quality, we look at both hormones, along with others. The two test results are used in combination to get a better picture of a woman’s fertility in terms of her overall ovarian reserve, or ovarian function. This is because each hormone reflects the follicles in the ovaries at different stages of development.
Typically, follicle stimulating hormone and anti-Mullerian hormone values move in opposite directions as women age, with AMH values going down and FSH values going up. This pattern results from the natural, age-related decline of ovarian reserve.
It’s important to note a few important differences in the measurements of these hormones:
- AMH levels can be measured at any time during the menstrual cycle. This is different from follicle stimulating hormone, which has to be measured on a specific day in a woman’s cycle (usually on day 3).
- AMH appears to be a better predictor of pregnancy chances than FSH, according to recent research. It has been reported, however, that anti-Mullerian hormone loses some of its prognostic ability in women above age 42. Nevertheless, it is still helpful to take AMH into account even when a woman is past this age. This is because the two hormones together still constitute a more reliable predictor of pregnancy chances than follicle stimulating hormone alone. Levels can vary greatly depending on the woman tested and her age.
- AMH levels reflect how many very immature eggs are “on deck” to start the journey toward maturation while FSH levels reflect the eggs that are currently going through the maturation process and will be available for ovulation (or egg retrieval, if going through an IVF cycle).
What is a Normal AMH Test Value According to Age?
It is important to remember that the normal range for this hormone changes depending on a woman’s age.² For example, normal AMH results for a woman at 42 could suggest premature ovarian aging (POA) if the same level was found in a 32-year-old woman. It’s crucial to evaluate test results in this age-specific way. In this example, the 32-year-old woman would likely struggle to conceive naturally, as she clearly suffers from POA with ovarian reserve 10 years ahead of her physiological age. She would also have problems if she is given a one-size-fits-all in vitro fertilization protocol that did not address her declining ovarian reserve.
Likewise, AMH levels are also used to diagnose whether a younger woman in her 20s has an elevated risk of POA, so that she can consider egg freezing if she is not ready to start a family yet.
Relatively high AMH is normal at a young age, but alternatively, it can sometimes signal polycystic ovary syndrome (PCOS). While a low level of AMH is usually accompanied by high FSH, when a woman’s AMH levels are normal or high and her FSH levels are also high, this can signal hypoandrogenic PCOS, a relatively new type of PCOS that CHR researchers were the first to identify. CHR’s research has found that patients with hypoandrogenic PCOS, even when they are in their mid- to late 40s, tend to produce a good number of high-quality eggs in IVF cycles, once their low androgen state is corrected with DHEA supplementation. Consequently, these patients also have surprisingly good pregnancy rates with IVF.
Based on extensive clinical research conducted at CHR, we have established charts for age-specific hormone levels. This allows us to arrive at a timely diagnosis of POA and tailor our treatments for patients with declining DOR that may not be immediately obvious. Focusing on these age-specific levels, we can do a much better job of assessing a woman’s ovarian reserve and fertility potential, devising an appropriate treatment plan, and estimating in vitro fertilization pregnancy chances.
Anti-Mullerian Hormone Levels Chart
< 33 Years
= 2.1 ng/mL
= 1.7 ng/mL
= 1.1 ng/mL
= 41+ Years
= 0.5 ng/mL
"Pregnancy is still possible with low AMH."
How to Increase Low AMH Levels For Better Pregnancy Chances
Treating Low AMH levels with DHEA
DHEA can be used to significantly increase pregnancy chances in women with low AMH and high FSH levels.
How can I increase AMH levels to get pregnant? This is a question that many women ask. However, that’s not the right way to frame the question. It’s important to keep in mind that a low level of AMH is just an indicator of a real condition: diminished ovarian reserve, or DOR. So increasing AMH is not the goal. Addressing the causes and mitigating the negative effects of diminished ovarian reserve is what is necessary for achieving a successful outcome: a healthy pregnancy and a baby to take home.
Many patients come to CHR after being told by other fertility clinics that their chance of pregnancy is less than 1% because of their low level of AMH and high level of FSH. These clinics often push women to use donor eggs, which we believe is often unnecessary or premature. Proper treatment designed to address problems with the levels of these hormones considerably increases the likelihood of success. In many cases, CHR physicians have found that those “less than 1% chance of pregnancy” prognoses are outright wrong. Many of the women who have heard this prognosis actually have far higher chances of pregnancy using their own eggs with in vitro fertilization.
This is especially true if a woman can produce a higher number of eggs, or multiple embryos, in an IVF cycle with ovarian stimulation. CHR recently conducted an analysis of IVF outcomes for our patients with very low AMH levels. In the study, we found that even above age 41, as long as the woman’s ovaries still produced more than two transferable embryos, pregnancy rates were in the 6-7% range. This video about the role of early egg retrieval for women over 43 explains how one of CHR’s innovative reproductive medicine treatments doubled pregnancy success rates in older women. Because innovative, personalized treatment can make all the difference, it’s particularly important to seek out fertility treatments from an IVF center with specialized expertise in treating women with low AMH/DOR.
1. Sabahat Rasool. Fertility with early reduction of ovarian reserve: the last straw that breaks the Camel’s back. Fertil Res Pract. Link. Published Oct 11 2017. Accessed August 26, 2020.
2. Gleicher, N. Anti-Müllerian hormone (AMH) defines, independent of age, low versus good live-birth chances in women with severely diminished ovarian reserve. Link. Published June 10, 2010. Accessed August 26, 2020.Volume 94, ISSUE 7, P2824-2827.
3. Wikipedia. Center for Human Reproduction. Link. Published 20 August, 2020. Accessed August 26, 2020.
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.