What does AMH (ovarian reserve) have to do with natural fertility success? Not a whole lot

Let’s start with what AMH means

AMH stands for “Anti-Mullerian Hormone”, which is a hormone produced by developing follicles (aka eggs). AMH is used as a measure of ovarian reserve, as it is secreted by the follicles in the ovaries. The idea is that the more follicles you have, the higher your AMH value will be and the higher your fertile potential. The more eggs you have, the later you’ll go into menopause. A low value means a low number of eggs remaining, which means less fertile potential. This is all to a reasonable extent because there’s a condition that causes a higher than normal AMH value, and is associated with poor fertility, and that condition is Polycystic Ovarian Syndrome.

AMH is a hormone test often included in a fertility work-up, and the result can scare the &*%$ out of you. We know we can’t change the number of eggs we are born with, so getting a low AMH result can be devastating.

But maybe we don’t need to know at all?

Maybe we don’t need to care about AMH for natural fertility?

Here’s why.

A study of 750 women conducted by the National Institutes of Health in 2017 has revealed that low AMH values do not significantly predict fertility outcome after 1 year of trying to conceive naturally. Here are the findings: after six cycles of attempting to conceive, results did not differ significantly between women with low levels (62% chance of conception) and normal levels of Anti-Mullerian hormone (62% chance). Even after after 12 cycles of trying, the difference in conception between high and low AHM was 82% versus 75%.

That’s pretty awesome news.

Even better news: the women in the study ranged from age 30-44. AMH is strongly correlated with age; in fact the reference ranges can be broken down by age in order to deem what is “normal”:

But what we are learning is that even into your late 30s and early 40s, when AMH seems to be lower, it is NOT a predictor of poor fertility outcomes. Unfortunately, after age 45 it’s a different story, low AMH (and age alone) are certainly associated with negative outcomes.

So what’s the purpose of testing AMH?

AMH is a very useful predictor of IVF success and oocyte yield from stimulating medications. It can be used to determine the most effective dose of injections. It can also be used to anticipate IVF outcomes.

AMH is one lab test, and one tiny piece of the very complicated fertility puzzle. If you’re doing a medicated IVF or IUI cycle, your ovarian reserve matters and so does measuring AMH. If you’re trying to get pregnant naturally, and in the first year of trying, ovarian reserve doesn’t matter so much.

Want to learn more about lab assessments and your fertile potential? Book an appointment.