Antimüllerian hormone (AMH) is another commonly misunderstood fertility tests.
If women are not contacting me depressed because their FSH levels are HIGH, they are contacting me depressed because their AMH levels are LOW . They fear they will never become pregnant.
In a previous article, Pregnancy and FSH Levels: Understanding The Most Crappy Fertility Test, I explained how the FSH test is one of the worst fertility tests in existence. The second worst test is the AMH test.
The only reason the AMH test is the second worst test is because FSH was discovered first in the 1920’s. We have had a much longer time to depress women by needlessly testing their FSH levels!
In comparison, AMH was discovered in the 1940’s but the importance of AMH evaluating egg health and predicting fertility was not fully understood until we started performing in-vitro fertilization (IVF) in the 1980s.
This article will educate readers about AMH.
This is one article in a series of articles written to better educate women about their menstrual cycles and the tests commonly used by fertility experts. The hope is these articles will help women better understand fertility testing and be able to better evaluate their fertility.
If you are reading this article for the first time then you should check back with our Tubal Reversal Blog and read future fertility articles as they are published.
In the first blog article, I reviewed the menstrual cycle as simply as I possibly could:
Problems getting pregnant? Understand your menstrual cycle!
Antimüllerian Hormone: What the heck is this hormone?
Antimüllerian hormone is commonly shortened to AMH.
AMH: Easy explanation
AMH is produced by the eggs in the ovary. As the egg count decreases the AMH levels decrease. If your AMH level is low then your residual egg count is low.
AMH: More detailed explanation
A woman has the most eggs she will ever have in her ovaries before being born, while she is a baby in her mother’s womb.
Approximately half-way through fetal development (20 weeks gestation), a female baby has approximately 8 million eggs!
That baby girl will have her egg count drastically decreased to approximately 500,000 by the time she goes through puberty (so around the age of 12).
So if you are depressed because you are getting older and losing eggs….you should have really been depressed when you went through puberty because it was then that you lost the most eggs in the shortest time period ever in your entire life!
Why does this happen? We don’t know. It is how the human body works. Scientist are constantly trying to learn more about why and how we age. Losing eggs and declining fertility as women get older is one area of aging actively being studied.
Can you run out of eggs?
Each month a woman’s ovaries recruit about 100 eggs for ovulation and 1 of those eggs (sometimes 2 and you get twins) can be released each month. The eggs that are not released will die and get absorbed by the ovary. So starting at puberty, each month you lose about 100 eggs. This means each year you lose about 1,200 eggs.
When you go through menopause your ovaries stop releasing eggs.
If you begin puberty at age 10 and have menopause at age 50 then you have 40 years of releasing eggs.
This means over 40 years you lose about 48,000 eggs (assuming you never get pregnant or take hormonal birth control….these two things save and protect your eggs). So even if you start puberty with the estimated number of 500,000 eggs and lose 100 eggs each month…then you only lose 48,000 eggs during your reproductive life time. This means you still have 450,000+ eggs at the time of menopause!
So how can you be running out of eggs?
The problem is not running out of eggs. The problem is the eggs age as the woman ages. Older eggs are less likely to fertilize and result in pregnancy. This is because of aging effects which we don’t fully understand.
We have digressed slightly….back to AMH.
The eggs cells are surrounded by supporting cells that nurture the egg. This cells are called granulosa cells. The granulosa cells and the egg form a team called a follicle. Follicles support the eggs until they are called up for duty. The follicles produce Antimüllerian hormone (AMH). AMH hormone seeps into the blood and the levels of AMH can be measured.
As you age…you lose eggs as described above. As you lose eggs you lose follicles. As you lose follicles you lose AMH production and your AMH levels decrease.
So as you lose follicles and eggs…basically as you get older….you lose the things which make AMH. This means your AMH levels decrease as you get older.
AMH levels naturally decrease with age.
Drivers License Test Predicts Natural Fertility
Sounds fancy huh? Measure your AMH levels to test your egg count and quality!
Instead of asking your doctor for an AMH test…you should do the Drivers License test. Take out your driver’s license and check the date of birth and calculate your age.
- If you are over 43 you are going to have a harder time (not impossible) getting naturally pregnant.
- If you are under age 43 you should have an easier time getting pregnant.
So…I have just shown you how to avoid an unnecessary trip to the doctor, a needle in your arm, and an expensive, unnecessary blood test!
Your age can predict chances of natural fertility just as well….if not better than an expensive lab test.
If the AMH test is so great….then why don’t doctors use it when women request birth control?
- Low AMH you dont need any birth control.
- High AMH you need birth control
The reason they don’s use an AMH test to see who needs birth control is because the AMH test is not reliable when predicting natural fertility.
AMH: Music at A Party
You can think of AMH like music at a party.
When the party is really rocking….the music will be heard all around the neighborhood. This is similar to when you are younger and your AMH levels are high.
As the party progress, people start to get tired and leave. The music usually will slow down a bit. This is similar to what happens to AMH as you get older. The neighbors still hear the music and because it is late they may even call the cops on your party.
After the cops come and bust the party up at 3am, everyone goes home and the music stops. This is what happens to AMH levels in your perimenopausal and postmenopausal years.
Your AMH levels get really low. The party is over!
AMH Levels And The Concept of ‘Ovarian Reserve’
Fertility doctors like to test AMH levels because it lets them know approximately how many healthy follicles (early eggs) remain in the ovary. This is important because it lets fertility doctors know which woman is more likely to have pregnancy success with IVF treatment.
The more healthy follicles… the higher your AMH… the less IVF hormonal stimulation you will need.
The less healthy the follicles… the lower your AMH… the more IVF hormonal stimulation you will need.
The higher your AMH levels then the more healthy follicles remaining in your ovary. The lower your AMH levels then the less healthy follicles remaining in your ovary.
AMH and Ovarian Reserve
Fertility doctors like to test AMH and measure ovarian reserve. What is ovarian reserve?
Good Ovarian Reserve: If you have a lot of ovarian follicles remaining…then you have a good amount of healthy ‘reserved’ eggs
Low Ovarian Reserve: If you have a small number of ovarian follicles remaining… then you have a lower amount of healthy ‘reserved’ eggs
If you have good ovarian reserve, then you have a lot more healthy follicles in your ovary and your ovary will respond with more eggs and require lower doses of hormonal IVF medication. Your chances of IVF success are better than a woman with low ovarian reserve.
If you have low ovarian reserve, then you have less healthy follicles. You will require higher doses of hormonal IVF medication. Your chances of IVF success will be lower than a woman with higher ovarian reserve. Your ovaries will require higher doses of hormones to produce a smaller amount of eggs for retrieval. Your ovaries may not respond at all and no eggs may be able to be retrieved.
You can make it complicated and focus on your AMH level … or you can make it easy and focus on your age. As you get older you should expect your AMH level to decrease.
In my opinion, age is just a good a predictor as AMH. The older you get the harder it is to become pregnant. The younger you are then the easier it is to become pregnant.
Why do we need a blood test to demonstrate what we already know to be true?
Are AMH Levels Important?
Knowing your AMH levels is only important if you (all three should exists):
- Are considering IVF
- Have never been naturally pregnant
- Are older than 35
If you are wanting to become naturally pregnant then you don’t need an AMH test.
AMH levels do not predict the future. Although this sounds all well and good, you should remember as all women age they will lose eggs/follicles. This is a natural fact. As eggs/follicles are lost AMH levels decrease as one becomes older.
AMH levels are more predictive of who will have better chances of getting pregnant with IVF. AMH levels do not predict natural pregnancy.
So if you are not going to have IVF…then AMH is a complete waste of time.
If your AMH is low you are only going to get depressed.
If you AMH is high…it does not mean you will get pregnant…and you are only testing yourself into a false sense of security.
General Points About AMH Testing
The American College of Obstetrics and Gynecology published a Committee Opinion in 2019 reviewing the most current information about AMH testing based on the most up to date medical research: ACOG Committee Opinion No. 773: The Use of Antimüllerian Hormone in Women Not Seeking Fertility Care.
The following information is the most important information to understand AMH testing. These are recommendations all medical professionals should be following as of 2019/2020.
The top paragraphs are the medical terminology. The bullets points underneath are my attempt to translate medical terminology into easily understood, common every day English!
AMH: Not a good test in women with proven fertility
Serum AMH level assessment generally should not be ordered or used to counsel women who are not infertile about their reproductive status and future fertility potential.
- AMH tests should not be ordered in women have have not had problems getting naturally pregnant in the past.
- AMH test should not be used to counsel previously fertile women about their chances of future natural pregnancy.
AMH: Only helpful in predicting whose ovaries are better responders
Although serum AMH levels are a known predictor of ovarian response to exogenous gonadotropin stimulation in infertile women undergoing assisted reproduction cycles, the use of AMH in women with presumed fertility is limited by a lack of international assay standards and differing assay methodologies.
- AMH is helpful in infertile women (women who have never been pregnant) because the AMH test predicts whose ovaries will respond better to hormonal medications during IVF treatment.
- AMH is not helpful in fertile women (women who have become naturally pregnant in the past) because testing is limited by too many different types of AMH lab tests with different procedures. The results are not standard and cannot easily be applied to all women.
AMH: Only helpful in predicting who will produce more eggs with hormonal medication
AMH levels in women having IVF or hormonal ovarian stimulation predict who will get good ovarian response (larger number of eggs with less hormonal medications) or predict who will get poor ovarian response (lesser number of eggs requiring larger doses of hormonal medication).
- Women with higher AMH should get more eggs and require less hormonal medication during IVF treatment or ovulation assistance.
- Women with lower AMH should get less eggs and require more hormonal medication during IVF treatment or ovulation assistance.
A Single AMH Test Does Not Predict Future Natural Fertility
A single AMH level assessment obtained at any point in time in a population of women with presumed fertility does not appear to be useful in predicting time to pregnancy.
- If you have not had trouble getting pregnant in the past then a single AMH test does not predict your future chances of naturally getting pregnant.
AMH Levels and Menopause
The use of AMH levels as a predictor of the onset of menopause is unsuitable for clinical practice at this time.
- AMH levels should not be used to predict menopause based on current medical research.
AMH Levels and PCOS
Currently, serum AMH levels are not part of the accepted diagnostic criteria for polycystic ovary syndrome (PCOS).
- AMH levels should not be used to diagnose PCOS
AMH and Fertility After Chemotherapy
More data on the use of serum AMH levels to predict postchemotherapy fertility and to guide fertility counseling in these patients are needed.
- AMH levels cannot predict a woman’s fertility or chance of future pregnancy is she has previously had chemotherapy treatment which could have damaged her eggs.
AMH Levels Have No Roll In Miscarriage Evaluation
Routine AMH testing for prediction of pregnancy loss is not recommended.
- AMH testing has no role in the evaluation of pregnancy miscarriage. You cannot predict if a pregnancy will miscarry or if future miscarriage will happen based on an AMH level
AMH Levels: The Take Home Message
AMH testing has no role in the evaluation of women who have never had trouble getting pregnant and who are trying to become natural pregnant, ie women trying to get pregnant after tubal reversal surgery.
AMH testing is only helpful in women who have never been pregnant before (women with a history of infertility) and who are considering ovarian stimulation with high dose hormones during IVF treatment.
Women with low AMH may require higher doses of hormonal medication and higher treatment costs, may have less mature eggs that can be harvested for pregnancy, may have a higher chances of IVF failure, and may have lower chances of pregnancy success when compared to women who have higher AMH levels.
AMH and Tubal Reversal
I specialize in tubal reversal surgery. I help women who have had tubal ligation procedures become pregnant again by reversing tubal ligation and removing the tubal blockage.
By definition, most of my patients have been pregnant in the past. They have proven natural fertility. Their potential for future fertility is not the same as infertility women requiring IVF treatment.
Many of my patients say, “I never had trouble getting pregnant in the past…all he had to do was look at me and I was pregnant!”
Since my patients have proven past fertility….then there is no need for an AMH testing of my patients. AMH testing in tubal reversal patients is a complete waste of time.
More Information About Dr Monteith
Dr. Charles Monteith is the Medical Director of A Personal Choice Tubal Reversal Center.
A Personal Choice is located in Raleigh, North Carolina. Patients travel from across the United States and around the world for affordable and sucessful outpatient reversal surgery.
Dr. Monteith specializes in reversing tubal ligation, Essure sterilization, and vasectomy. He does not offer In-Vitro Fertilization.
If you would like to see more pregnancy testimonials then visit: Tubal Ligation Reversal Pregnancy Testimonials
Dr. Monteith does not provide general medical advice over the internet…but if you have had a tubal ligation, are getting evaluated for IVF, and were told you can’t get pregnant because of a low AMH level and you want to have tubal reversal surgery then give A Personal Choice a call (919) 977-5050. and the staff can answer your questions about tubal reversal surgery.
If you want to send Dr. Monteith your tubal ligation records for a free review then this link will provide information on how you can send us records: Contact us to send tubal ligation records to see if you are a candidate for tubal reversal surgery
You are also welcome to visit our comprehensive reversal website: A Personal Choice: Tubal Reversal And Vasectomy Reversal Raleigh, NC
Don’t be discouraged…AMH levels do not predict who will or will not become naturally pregnant. AMH levels, just like FSH levels, are not a crystal ball. Your age is a much better predictor of likelihood of pregnancy.
- If you are having periods then you are ovulating (releasing eggs).
- If you are releasing eggs…then pregnancy is always possible.