Understanding The Average Amh
Many women want to understand whether their AMH levels are higher or lower than average. When it comes to AMH, whats really average? Because AMH has only been routinely tested in women who visit a doctor after having difficulty conceiving, past averages have been based on a population that includes many women with fertility problems. In order to truly understand where your AMH level falls on the spectrum, youll need to compare it to a population of women without known fertility issues. We performed just such a study through the Center for Fertility Research & Education .
In our research, presented at the ACOG Annual Meeting earlier this month, we looked at the results of over 2,600 AMH tests among non-infertile women who had come to Extend Fertility for a fertility assessment. As expected, AMH was negatively associated with agemeaning as age increased, AMH levels decreased, generally speaking.
Can You Improve Your Egg Quality Or Your Anti
A number of supplements, like antioxidant coEnzyme Q-10 and DHEA, have been touted as a possible way to boost ovarian reserve, but theres no reliable science to back up those claims.
Some have suggested that there may be a relationship between adequate levels of vitamin D and a higher AMH level, but again, theres no data confirming that taking vitamin D supplements increases AMH levels or improves egg quality.
What Are Amh Levels
Testing the level of AMH in your blood is a reliable indicator of your ovarian reserve. While your AMH levels dont change much throughout your menstrual cycle, they do change as you age. In females, AMH levels rise throughout childhood and peak right before puberty. As a woman progresses through her most fertile years, her level of AMH gradually decreases alongside her ovarian reserve.
As you enter puberty and your reproductive years, your egg count and AMH begin to drop. After age 25, you begin to lose eggs at a higher rate. Again, at 30 and 35, the loss becomes more rapid until you reach menopause and your egg count reaches zero. As your egg count goes down, so do your AMH levels, making this an important hormone to track if you are trying to conceive.
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Amh Beyond Ovarian Reserve
Knowing your AMH level is useful in many other ways. Heres a summary of what AMH can help you understand:
- If you may hit menopause earlier or later than average. Your moms age at menopause onset used to be the gold standard for predicting when you may hit menopause. But AMH is proving to be useful as well thats because menopause is characterized by a near depletion of ovarian reserve, which AMH levels can indicate.
- Egg freezing or in-vitro fertilization outcomes. AMH can help you understand how many eggs may be extracted during egg retrieval for egg freezing and IVF.
- If youre at risk for polycystic ovary syndrome . PCOS is very common and affects 1 in 10 women. It may be marked by high levels of AMH in your test results, which can mean that you have a high number of eggs but that you ovulate irregularly or infrequently .
- If youre at risk for primary ovarian insufficiency . POI is the loss of ovarian function before age 40, and impacts 1 in 100 women. Its marked by extremely low or undetectable AMH levels in your test results.
Well get into these a bit more in the sections below.
Why Amh Is A Reliable Marker Of Ovarian Reserve And What It Can Tell You
Studies have shown that AMH is the best and most reliable way to measure ovarian reserve, even for women who havent yet experienced infertility. Why? AMH is produced by the preantral and antral follicles in ovaries in women who are undergoing fertility treatments as well as women who arent. Its just part of our biology, so it can tell us a lot about the female reproductive system. Preantral and antral follicles are the developing follicles in your ovaries in other words, they correlate with the number of eggs available for ovulation.
Why does understanding our ovarian reserve matter? Women with lower levels of AMH for their age are likely to have a shorter reproductive window than women with normal levels of AMH for their age.
According to Prof. Scott Nelson, whos considered one of the leading experts on AMH , Its well-established in the medical community that women with a low ovarian reserve have a shorter reproductive life-span and earlier age of menopause. When women enter the menopause at an earlier age, it impacts their total fertility across their lifespan and potentially their ability to complete their desired family size.
It only takes one healthy egg to make a baby, so low ovarian reserve doesnt necessarily mean you wont be able to get pregnant. But it is helpful to know how AMH impacts the female reproductive system, and why your reproductive years might be shorter than you realized.
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What Is A Normal Amh Level
Interpretation of anti-mullerian hormone levels and chances for conception
There are some problems involved with interpretation of AMH hormone levels. Because the test has not been in routine use for many years, the levels considered to be normal are not yet clarified and agreed on by all experts.
The table below has AMH interpretation guidelines from the fertility literature and from our experience. Do not get carried away with the cutoff values shown here. For example, the difference between a 0.9 and a 1.1 ng/ml test result puts a woman in a different box in this table but there is very little real difference in fertility potential. In reality, it is a continuum and not something that categorizes well.
|Very Low||Less than 0.5 ng/ml|
More will be learned regarding anti-mullerian hormone levels and outcomes as we continue to use the AMH fertility test and study the relationship between AMH hormone values and fertility, ovarian responsiveness, chances for IVF success, etc.
What Are The Differences Between Amh And Fsh
AMH and follicle-stimulating hormone are markers for assessing fertility. FSH stimulates the follicles in the ovaries to grow and develop during the menstrual cycle. The granulose cells, which surround the eggs inside the follicles, produce AMH.
Higher levels of AMH show a higher number of eggs, while lower levels indicate a lower number of eggs.
In comparison, high FSH levels usually indicate a low number of eggs. The brain signals the ovary to produce more FSH if the egg supply becomes low.
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Low Amh Levels And Infertility
1) Premature Ovarian Failure
Premature ovarian failure is the loss of reproductive or hormonal function in the ovaries. Also known as premature menopause, POF is typically caused by chromosomal defects. An individual with POF has very low AMH levels .
Endometriosis occurs when the uterine lining grows outside of the uterus. This disorder is often comorbid with premature menopause. Patients with endometriosis exhibit AMH depletion at a rate much faster than healthy women .
3) Gonad Failure
Cancer patients who have gone through extensive exposure tochemotherapy and radiotherapy are much more prone to losing eggs faster than normal, which is reflected by low AMH levels .
AMH testing can be especially useful in this situation if measured before the treatment. It has immense clinical implications because can help assess risk for infertility and predict chemotherapy-related risk in regard to future fertility .
4) Autoimmune Disorders
Low AMH levels are also associated with various autoimmune disorders :
What The Amh Test Cant Do
Recently, there has been some debate about who should have this screening test. A woman who undertakes the test, even though she is not trying to conceive may find herself in a dilemma. A test result that is not in the normal range for her age may cause considerable concern. Much of this worry is unnecessary.
The real problem with both AMH is that it doesnt help to assess egg quality or the quality of the ovaries. In this case, a woman may need a scan to assess the quality of the ovaries, the and also stimulation medication, in the form of IVF, to see how her ovaries respond.
While AMH is a good baseline screening test, there will be many women that have very low AMH levels but conceive in their first month of trying.
For the unsuspecting woman that has not even tried to conceive and discovers an alarmingly low result, there may be a benefit. It is to highlight the importance of making plans to have a baby.
One of the risks of finding a normal result however, is that a woman may be falsely reassured that her fertility is ok and delay a family for longer. Even women in their mid-40s can have a high result sometimes. But those eggs have been around for a long time, exposed to the same ageing process that affects the rest of our bodies. Therefore it gets harder to get pregnant and stay pregnant as a woman gets older.
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Should You Get An Amh Test
You will likely get an AMH test if you decide to visit a fertility specialist for assistance getting pregnant. Women who are under 35 and have been trying to get pregnant naturally for one year, or women over 35 who have been trying for six months, should see a fertility specialist if they do not have success.
Your doctor might also want to test your AMH if you are having symptoms of perimenopause or menopause. AMH levels can be used to predict when you are approaching and/or entering menopause, indicating that you are no longer fertile.
How To Increase The Chances Of Getting Pregnant If Amh Level Is Low
Low AMH basically means a low ovarian reserve, but it doesnt mean that its not possible to conceive naturally.
Its not possible to increase AMH levels. However, there are other things that health care providers advise that can boost the chances of conception.
Here are a couple things that may be helpful:
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Lifestyle Factors That May Influence Anti
The research into the lifestyle factors that affect AMH most has yielded mixed results. When the American Journal of Obstetrics & Gynecology rounded up the data, they found that smoking and birth control were the only lifestyle factors proven by multiple studies to decrease AMH.
While were on the topic of contraception, lets break down exactly what effect it has on AMH levels. Studies have shown that hormonal contraception may suppress AMH in some women meaning your level on birth control could be somewhat lower than it would be naturally. Despite this, AMH is still considered the best way to measure ovarian reserve and its still an incredibly important fertility biomarker. If you are on hormonal birth control and your level is lower than expected for your age, your doctor might recommend going off your birth control for a few months before testing again.
A recent large, population-based study conducted by the Journal of Clinical Endocrinology & Metabolism also looked into the effects of body-fat percentage, alcohol consumption, and physical exercise on AMH level, but no significant association was demonstrated.
Our research team is very interested in the lifestyle factors that influence AMH and were currently looking into how things like exercise levels, birth control, smoking, marijuana use, alcohol consumption, and caffeine all impact AMH.
Amh Testing Is Part Of A Comprehensive Female Fertility Workup
Our Dallas fertility center offers AMH testing because it enables physicians to obtain important information about a womans fertility potential. Unlike other blood tests used for ovarian testing, your physician can perform AMH testing at any time during your menstrual cycle.
AMH is a substance that is produced by granulosa cells in immature follicles in your ovaries. These primordial follicles contain your eggs that will eventually mature and present themselves for ovulation. Normal levels of AMH indicate that you have a healthy egg supply. However, low levels of AMH suggest that you may have a diminished ovarian reserve. High levels also present some fertility challenges.
If AMH testing reveals that you have low or high levels of AMH, it does not mean that it will be impossible for you to get pregnant. It merely suggests that it may be more difficult for you to conceive, and that you may need a more aggressive approach in your fertility treatment.
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Can Amh Levels Fluctuate
Yes, AMH levels fluctuate. Being told that you have low AMH levels may feel very disheartening, but many women get pregnant naturally despite this. The AMH tests dont tell the whole story because of the AMH fluctuation. Some months you may have higher levels of AMH compared to other months when you have lower AMH levels .
In addition, measurements of AMH can vary from lab to lab and from person to person. Even the way the blood is stored can affect the test results. It also does not necessarily predict the chances of conceiving using IVF.
Those with polycystic ovary syndrome often have raised levels of AMH so an AMH test may be less accurate in predicting ovarian reserve in those with PCOS.
When being tested, ask your doctor how much variability can be expected.
Who Performs An Anti
A healthcare provider, who is also called a phlebotomist, usually performs blood draws, including those for an Anti-Mullerian Hormone test, but any healthcare provider trained in drawing blood can perform this task. These samples are sent to a lab where a medical laboratory scientist prepares the samples and performs the tests on analyzers or manually.
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Amh Levels And Lifestyle Choices
A recent study has found a link between levels of AMH and lifestyle choices. AMH is a hormone produced by the ovaries and is a sign of ovarian reserve. The study found that women with high AMH levels were more likely to make healthy lifestyle choices, such as exercising regularly and eating a healthy diet.
The study also found that women with high AMH levels were less likely to smoke and were more likely to have a healthy BMI. This important finding shows that lifestyle choices can impact ovarian reserve. This means that women who make healthy choices now may be able to improve their fertility later on. If you want to improve your fertility, making healthy lifestyle choices is a good start.
How Do I Get An Amh Test
You will need to ask your GP for a referral to IVFAustralia for an AMH test. Then contact your nearest IVFAustralia clinic to have your blood taken. We analyse your results in our own specialised laboratory and send a copy of these results to your referring doctor.
If you are already an IVFAustralia patient your fertility specialist can organise an AMH test for you.
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What Is An Amh Test
An AMH test is a simple laboratory blood test that measures the hormone levels. It requires about 3 milliliters of blood. Because AMH levels do not change during the menstrual cycle, the test can be performed on any day. Reports usually come back within a couple of hours to a couple of days, depending on where the test is being performed.
There is no special treatment or diet regimen to follow to prepare for the test. However, it can be useful to coordinate other fertility treatments that are related to the day of the menstrual cycle with the AMH test.
The Implications Of Having Low Or Very Low Amh Levels
A low AMH level indicates a lower number of eggs than is expected for your age. Below you can find a table that outlines the AMH level cutoffs for different age groups according to the Beckman Coulter Access AMH assay.
|Below 0.08||Between 0.08 and 0.17|
There are no somatic symptoms proven to be associated with low levels of AMH. In addition, most evidence does not show a link between low AMH and the length of time it takes to get pregnant. The biggest consideration of low AMH is a potentially shorter reproductive window , and a lower chance of success in egg freezing and IVF, for people who choose to use these treatments.
If test results reveal that your AMH level is low and youre on the younger side, this could be a sign of a diminished ovarian reserve. Tracking your level over time will help you get a handle on the rate at which your ovarian reserve is declining and, while it is very rare, whether premature depleted ovarian reserve could be a possibility for you).
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Ovarian Reserve Testing Methods
Anti mullerian hormone is one potential test of ovarian reserve. There are other tests that are currently used for evaluation of the remaining egg supply. None of the tests are perfect, and fertility specialists will often use a combination of tests to try to get a better estimate of the size of the remaining egg supply.
Note: Anti mullerian hormone has also been referred to as mullerian inhibiting substance, or MIS.
What Your Amh Level Really Means
If youve ever looked into getting fertility testing, you might be familiar with AMH. AMH, or anti-Müllerian hormone, is a hormone secreted by the ovarian follicles, so the higher your level, the more follicles youre expected to have. AMH testing is typically used as an indicator of your egg count.
But if youre like many women, you might get the results of your AMH test and feel like, what now? Its super important to look at that number in context, to understand whether its high or low and what it really means for your chances of getting pregnant or the effectiveness of egg freezing or IVF.
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