Anti Mullerian Hormone (AMH) Levels and Your Fertility

What AMH Has to Do With Ovarian Reserves, PCOS, OHSS, and IVF

egg carton with stack of broken shells next to unbroken brown eggs, metaphore for ovarian reserves
AMH levels can be used to diagnose PCOS and evaluate ovarian reserves, among other things.. AlkAmia / Getty Images

Anti-Müllerian hormone, or AMH, is an essential hormone in both men and women. During fetal development, AMH plays a role in the development of the sex organs. Later in life, AMH is produced in the testes of men and in the ovaries of women.

If you’re struggling to conceive, your doctor will likely order an AMH levels test. This is a female fertility test, even though AMH is also present in men. The reason why AMH levels are not tested in men is because research has not yet found a clear link between AMH levels and male infertility.

AMH levels in women, however, can give us insight into a number of female fertility issues.

This hormone can help your doctor make a PCOS diagnosis, evaluate your potential ovarian reserves, determine your risk of developing ovarian hyperstimulation syndrome (OHSS), and get insight into your potential for IVF success.

Keep reading to get all the details...

What Does AMH Have to Do With Female Fertility?

To understand AMH, it helps to have a general understanding of how the female reproductive system works.

If you’re not really sure, read this article first:

As you likely already know, a woman is born with all the eggs she will ever have. The number of these eggs diminish as a woman ages.

The ovaries contain all of these eggs. Every potential egg – or oocyte – is found inside a follicle. These follicles are tiny fluid filled sacks. The follicle goes through a number of stages before an egg is ovulated or released.

The follicular stages are:

  • the primordial stage
  • the primary stage
  • the secondary stage
  • the small antral stage
  • the pre-ovulatory stage
  • the ovulated stage

Your ovary is primarily made up of those in the primordial stage. Only some of these will ever advance through the stages.

When we talk about ovarian reserves, we are talking about the amount of primordial follicles – or potential eggs – left in the ovary.

Primordial follicles are too small to be be counted or seen, which makes measuring them impossible with today’s technology.

At any one time, several follicles are going through the stages of development. It takes many months for a follicle to go from the primordial stage to the ovulated stage. (Not every follicle will reach the ovulation point. Some will stop growing and absorb back into the ovary.)

AMH is produced inside the follicles, but depending on what stage the follicle is in, the amount of AMH produced is different. The highest levels of AMH are produced during the secondary and small antral follicle stages. After a follicle reaches 6 mm in size, the amount of AMH decreases.

The more follicles there are in the secondary or small antral stage, the more primordial follicles there are in the ovary. Higher AMH levels tells us that there are many secondary and small antral follicles.

Typically, the more follicles there are in these mid-follicle stages, the more primordial follicles that are left in the ovary.

This is how AMH gives us an idea of potential ovarian reserves.

How the Test Is Done?

AMH levels are measured via a blood test.

The AMH test can be done at any time during a woman’s cycle. This is unlike FSH level testing, which can only happen on Day 3 of the menstrual cycle.

With that said, since your doctor will likely test your AMH levels on the same day she tests your FSH levels, you’ll still probably do the test on Day 3 of your cycle.

The lab will report back to your doctor how much AMH is circulating in your blood.

What Levels Are Considered Normal?

Interpreting AMH levels results is partially dependent on the lab where the testing is done.

They also have to be considered along with your age. For example, an AMH level when you’re 23 may not imply the same fertility potential as that same result when you’re 38.

It’s important that your doctor review your AMH results with you, and you should ask him whatever questions you have about your results.

With that disclaimer, here are some general guidelines on AMH levels, according to some studies:

  • AMH levels less than (<) 0.5 ng/mL indicates poor ovarian reserves and likely poor response to fertility drugs
  • AMH levels less than (<) 1.0 ng/mL indicates ovarian reserves are limited and that response to fertility drugs may also be limited
  • AMH levels greater than (>) 1.0 ng/mL but less than (<) 3.5 ng/mL imply that ovarian reserves are good and that fertility drugs will stimulate a good amount of eggs
  • AMH levels greater than (>) 3.5 ng/mL indicates that ovaries may respond strongly to fertility drugs
  • AMH levels greater than (>) 10 ng/mL likely indicates polycystic ovarian syndrome (PCOS)

Generally speaking, high – but not too high – AMH levels is a good sign. It implies there are a good number of pre-antral follicles in development, which implies there is a good amount of eggs left in your ovaries.

But having a low AMH level doesn’t automatically mean you can’t get pregnant... and a high level doesn’t mean you have amazing fertility.

As it is with any one fertility test, AMH levels must be considered along with other fertility testing results, as well as lifestyle risks including your age, weight, and health habits.

How Can AMH Levels Determine Ovarian Reserves?

Ovarian reserves are generally understood as the amount of potential eggs you have left in your ovaries.

If your AMH levels are very low, this implies your ovarian reserves may also be low.

It’s important to know, though, that having poor ovarian reserves doesn’t mean you can’t get pregnant on your own or with fertility treatment.

AMH levels should be considered along with FSH levels, antral follicle count, your age, and whatever other fertility factors you and your partner are facing.

Read more about ovarian reserves:

How Can AMH Levels Be Used to Diagnose PCOS?

If your AMH levels are very high, this may mean you have polycystic ovarian syndrome, or PCOS.

In one study of women with high AMH levels, 97% of women with levels over 10 ng/mL had PCOS.

In PCOS, many follicles develop but then stop mid-development. These follicles neither reach ovulation nor just absorb back into the ovary. These “frozen” follicles appear on the ovaries as small, pearl sized cysts.

This is what causes the extra high levels of AMH.

What Can AMH Levels Tell You About IVF Treatment Success?

According to the research, low AMH levels indicate a higher risk of IVF cycle cancellation. The cycle may be canceled if the ovaries don’t respond to the fertility drugs.

However, low AMH doesn’t mean you can’t get pregnant if your ovaries do produce some eggs to be retrieved and fertilized.

Fewer retrieved eggs generally lowers your odds of pregnancy success -- but it doesn't eliminate your chances.

You shouldn’t be automatically disqualified from trying IVF treatment just because your AMH levels are low.

As long as you understand the emotional and financial risk involved, if you want to go ahead and try an IVF cycle, your doctor should allow you.

If your clinic will not agree, and you really want to try at least once IVF cycle, don’t give up. A different clinic may be able to help you. Some clinics specialize in helping women with low ovarian reserves.

If IVF with your own eggs isn't possible, speak to your doctor about egg or embryo donor IVF.

How Can AMH Levels Help Prevent Ovarian Hyperstimulation Syndrome (OHSS)?

High AMH levels increase your risk of developing ovarian hyperstimulation syndrome, or OHSS.

OHSS is when the ovaries overreact to fertility medication. Mild OHSS can be uncomfortable, but moderate to severe OHSS can be life threatening.

If your AMH levels are high, your doctor can choose to use lower doses of fertility drugs. They may also choose to use a different combination of fertility drugs, or different protocol, during an IVF cycle.

The goal is to get the ovaries to produce enough eggs – but not so many that it becomes a problem.

More that you should know:


Aleyasin A, Aghahoseini M, Mokhtar S, Fallahi P. “Anti-Müllerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART).” Acta Med Iran. 2011;49(11):715-20.

Anti-Müllerian Hormone. The Test Sample. Lab Tests Online.

Kuohung, Wendy, MD; Hornstein, Mark D., MD. “Evaluation of female infertility.”

Tal R, Seifer DB, Khanimov M, Malter HE, Grazi RV, Leader B. Characterization of women with elevated antimüllerian hormone levels (AMH): correlation of AMH with polycystic ovarian syndrome phenotypes and assisted reproductive technology outcomes. Am J Obstet Gynecol. 2014 Jul;211(1):59.e1-8. doi: 10.1016/j.ajog.2014.02.026. Epub 2014 Mar 2.

Test ID: AMH. Antimullerian Hormone (AMH), Serum. Mayo Clinic. Mayo Medical Laboratories.

Continue Reading