Heads up before we begin, we’re about to get technical because understanding your hormones in general––and specifically your AMH––can help you understand your fertility. Anti-mullerian hormone, also known as AMH, is a hormone produced by the cells in your ovarian follicles.
Your anti-mullerian hormone levels are one of the best indicators of ovarian reserve (or how many eggs you have). Your AMH is produced by your developing egg sacs, or ovarian follicles. AMH levels refer to the number of eggs remaining: The lower the AMH levels, the lower ovarian reserve or remaining ovarian follicles. A higher level of AMH in your bloodstream means you have a higher number of eggs in your ovaries. It’s important to keep in mind that this number gives you an idea of quantity, not quality.
Your AMH levels decline naturally as you age, so low levels in a young person could be a sign of premature loss of fertility due to a depleted ovarian reserve. Having low AMH levels usually means a lower antral follicle count, which is another way a doctor can measure your ovarian reserve. Antral follicles are the developing follicles in the ovaries –– usually measured and detected by transvaginal ultrasound. AMH is produced by antral follicles less than 8 mm in size.
But, it’s not as simple as ‘low is bad and high is good.’ Your AMH levels can be part of a diagnosis of polycystic ovary syndrome (PCOS). PCOS is one of the most common reproductive disorders out there and it can be characterized by the presence of many small ovarian follicles. Folks with PCOS often have high levels of AMH, and this can actually prevent ovulation, leading to infertility. PCOS can also complicate a pregnancy, increase your risk of diabetes, cardiovascular disease and endometrial cancer. Many of these associated diseases can be treated or prevented so an early diagnosis of PCOS can be incredibly helpful in understanding your fertility and health in general!
Your AMH levels can help you prepare for fertility treatments, such as IVF (in vitro fertilization). Ovarian stimulation is the stage of IVF in which you're given drugs to –– you guessed it –– stimulate your ovaries to mature multiple eggs at once, instead of the normal one per cycle. The number of eggs that can be retrieved from your ovaries during IVF depends on your ovarian reserve –– which your AMH levels clue you into. If you have low levels of AMH, it's harder to predict how you'll respond to ovarian stimulation. Low AMH can also mean that you may have to do more than one cycle of IVF to get enough eggs to fertilize. Understanding your ovarian reserve can help you plan financially, mentally and physically for the possibility of multiple cycles.
Remember how AMH levels don’t reflect egg quality? That’s important to remember in IVF as well; having more eggs at the IVF egg retrieval provides an opportunity for a greater number of eggs to fertilize and develop into embryos. But, more eggs does not always mean more embryos. This is because not all of the eggs we produce are viable, or healthy; you could find yourself with a high number of eggs, but not a high number that will fertilize or produce embryos. Your AMH level is also a crucial data point if you’re considering freezing your eggs. If your tests come back with lower levels of AMH, you might want to freeze sooner rather than later and you might need to undergo more than one cycle of freezing to gather enough eggs (or consider getting pregnant sooner rather than later). If your AMH comes back normal or high but you plan on putting off having kids until a later age, you might want to think about freezing your eggs now because your chances of a successful round of egg freezing are good. Understanding the current status of your ovarian reserve can help you make an informed decision as to when is the best time to freeze your eggs. (Keep in mind that freezing your eggs is not an insurance policy for future fertility.)
Knowing and understanding your AMH levels isn’t going to give you all the answers about your fertility present and future. It will, however, give you the information you need to have conversations with your doctors about next steps. Knowing your AMH levels allows you the ability to start planning –– whether that means freezing your eggs, preparing for multiple rounds of IVF, or considering a timeline for a pregnancy down the road. We’re here for any questions you might have –– and your Modern Fertility test will give you the rundown of your AMH levels and what they might mean for you.