Anti-Mullerian Hormone (AMH)
What is AMH?
AMH (meaning “anti-Mullerian hormone”) is a hormone secreted by the cells of the developing antral and pre-antral folliclesantral and pre-antral follicles (or egg sacks) in the ovaries. Once secreted from these growing follicles, it stops more immature ones from being recruited into the maturation process, which prevents all of the eggs from maturing at the same time. Because an anti-Mullerian hormone level measurement shows the number of eggs maturing in the ovaries and on their way to ovulation, it is a strong indicator of a woman's ovarian reserve (OR), which is the ovaries' ability to produce good-quality eggs.
Declining AMH Signals Declining Ovarian Reserve
As women age, the number of follicles/eggs available for reproduction gradually declines. Together with the follicles, anti-Mullerian hormone levels also decline with age. Reproductive endocrinologists can assess how well a woman’s ovaries are functioning by evaluating her AMH levels. Women with low levels have a condition called diminished ovarian reserve (DOR).
When AMH hormone levels are low, patients will commonly have lower pregnancy chances (with or without IVF) compared to women of the same age with normal levels. In these cases, fertility treatment must be carefully tailored to each patient’s ovarian reserve status (as well as other compounding factors) in order to achieve success. This individualization of IVF protocols is what differentiates CHR from most other IVF centers.
What Does a Low AMH Level Mean?
When patients receive their test results, they are often left with many questions. What affects AMH levels? Does low anti-Mullerian hormone mean poor egg quality? Does it mean infertility?
Low levels of AMH indicate that there are few very immature follicles, or eggs, developing in the ovaries weeks to months before ovulation. When there are few eggs that are coming into the maturation process, obviously fewer eggs will mature eventually. Thus, low anti-Mullerian hormone is an indicator of low ovarian reserve, meaning that the patient is producing few eggs that can be used for fertilization later on.
For this reason, when trying to conceive naturally or with fertility treatments like IVF, a woman with low anti-Mullerian hormone levels will have lower chances of conceiving. In addition, AMH test results that come back low usually indicate poor egg quality. This is because egg quantity and egg quality typically go hand in hand. In combination with other tests and clinical history, your doctor or IVF specialist will be able to best advise you on how AMH levels that are low affect your own personal fertility chances and what can be done about it.
At CHR, we tailor all of our treatments to every individual patient. We have decades of experience treating cases of anti-Mullerian hormone infertility through a variety of methods including a combination of DHEA supplementation and specialized IVF protocols. CHR’s research focus in the last decade has been low ovarian reserve, so our nuanced treatments are based on in-house research, with many only available at CHR.
Low AMH Symptoms
Symptoms of AMH levels that are low are often very slight - if they are felt at all. Other than missing or irregular periods and difficulty conceiving, there are no clearly established symptoms or outward signs. Hormone testing is necessary in order to determine whether a patient’s menstrual irregularity or inability to conceive is due to low ovarian reserve, indicated by low anti-Mullerian hormone levels.
Can Low AMH Levels Cause Miscarriage?
Women with anti-Mullerian hormone that is low may also experience a higher incidence of miscarriage, and may even experience recurrent miscarriages, due to the poor egg quality associated with low AMH/low ovarian reserve. The incidence of miscarriages due to abnormal anti-Mullerian hormone levels can be reduced with appropriate treatment. If your AMH is low and you experience recurrent miscarriages, seeking proactive treatment before getting pregnant can help prevent further pregnancy losses.
Causes of Low AMH - What Causes Low AMH?
AMH levels naturally decline with age, as the supply of eggs a woman was born with begins to run low. Very low levels can signal that the body is preparing to enter into menopause; this can be happening at the appropriate time, or happening as premature menopause, if the patient is not yet of normal menopausal age.
Aside from normal age-related decline, almost anything that disrupts the feedback cycle of follicular development and AMH secretion can cause low anti-Mullerian hormone levels. This can be due to an autoimmune attack on the ovaries (the patient’s own immune system attacking the ovaries), or it can also be genetic: One of the more recent research findings at CHR involved a discovery about the FMR1 gene’s involvement in regulating how ovarian reserve changes over time for each woman. Women with a particular type of FMR1 gene were more likely to develop DOR at a younger age.
Depending on the cause of low anti-Mullerian hormone and DOR, CHR physicians develop tailored treatment approaches in order to maximize pregnancy chances with IVF for women with low and very low levels of AMH.
The Center for Human Reproduction is always at the forefront of the latest anti-Mullerian hormone research. Stay up to date with the most recent findings by reading CHR’s fertility updates. If you have additional questions about anti-Mullerian hormone, or would like to schedule a consultation to discuss your fertility test results, feel free to contact us today.
Read more about Anti-Müllerian Hormone
Anti-Müllerian Hormone (AMH) is a hormone secreted by the cells of the developing...
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.
Last Updated: April 28, 2020