Your AMH level is NOT a Fertility Test!

If I were ever to create merchandise for my clinic, the first item would undoubtedly be a t-shirt, maybe even a hat or a mug, emblazoned with the phrase: Your AMH is NOT a fertility test! This is a message that so many people need to hear because, unfortunately, there is a lot of confusion surrounding Anti-Müllerian Hormone (AMH) and its role in fertility.

My name is Dr. Lucky Sekhon, and I am a practicing Reproductive Endocrinologist here in New York City. In my practice, I frequently encounter patients who have been misled by this misconception. Just the other day, I saw a patient in her late 30s who had been told by another fertility specialist that it would be nearly impossible for her to conceive on her own due to her low AMH levels. This patient still had regular periods and hadn’t been trying to conceive for very long. Yet, she was given a devastating prognosis based solely on her AMH, which is both inaccurate and unnecessary.

If you are not undergoing, or planning to undergo, a treatment such as IVF that depends on the quantity of eggs that can be stimulated from an ovary to be successful, then you should not be looking at your AMH level as a predictor for your ability to conceive on your own! In fact, if you are trying to conceive on your own or undergoing treatments such as IUI, I believe that checking your AMH levels regularly may do harm than good.

Understanding What AMH Really Measures

AMH is a hormone produced by the small follicles in a woman’s ovaries. It is used as a marker of ovarian reserve, which essentially refers to the quantity of eggs remaining in the ovaries. However, it’s crucial to understand that AMH levels are not a direct measure of fertility.

AMH levels can give us some insight into how a patient might respond to ovarian stimulation during fertility treatments like in vitro fertilization (IVF). If AMH is low, it may mean that the ovaries might not respond as robustly to stimulation, potentially resulting in fewer eggs being retrieved during an IVF cycle. On the other hand, a high AMH level might indicate a higher yield of eggs. But—and this is a big “but”—AMH does not predict the quality of the eggs or your ability to get pregnant on your own or through IUI.

The AMH Misconception

The most significant misunderstanding around AMH is the idea that it can predict your ability to conceive. This simply isn’t true. AMH is a measure of egg quantity, not egg quality. And when it comes to unstimulated conception, quality is far more important. Every cycle, a woman ovulates one egg, and it’s the quality of that egg, not the quantity of eggs left in the ovaries, that determines the likelihood of conception.

The Gumball Machine Metaphor

I was having a debate with my husband Bobby on this very topic last week and he actually came up with a metaphor of a gumball machine to explain AMH in relation to fertility that I actually think works (I also happen to love gumballs). Think of your ovaries like a gumball machine, and the eggs within them as the gum balls. Every time you turn the knob precisely one ball comes out. It doesn’t matter how many gumballs remain in the machine, you will never get more than one gumball coming out of the machine. Taking the metaphor a step further, how satisfying a gumball is to the eater (usually me), has nothing to do with the quantity of gumballs inside of it, but rather the properties of the gumball itself. As long as there remain gumballs in the machine, that’s all that matters. Each month, your ovaries produce exactly 1 egg, the quality of that egg bears little relationship to your ovarian reserve!

Numerous studies, including large, well-designed ones, have shown that AMH levels do not predict the chances of conceiving, whether on your own or through fertility treatments like intrauterine insemination (IUI). For instance, a study published in The Frontiers of Endocrinology in 2020 involving over 4,388 women found that serum AMH levels have poor predictive value for natural pregnancy. This finding aligns with what we see in clinical practice: women with low AMH can and do conceive on their own!

When *does* AMH Matter?

AMH has its place in fertility treatment, particularly in the context of IVF, where understanding ovarian reserve can help tailor treatment protocols. For instance, if we know a patient has low AMH, we might choose a more aggressive stimulation protocol or discuss the option of egg freezing at an earlier age. In cases where AMH is high, it may be a sign of polycystic ovary syndrome (PCOS), which might influence the approach to treatment.

However, using AMH as a definitive test of a woman’s fertility is inappropriate and can cause unnecessary distress. This is especially true for women who have previously frozen eggs. If a patient froze a good number of eggs in her early 30s, her AMH levels years later are even less relevant. The eggs she froze remain viable, regardless of her current AMH level!

The Real Message

It’s time we, as a field, stop telling women that their ability to get pregnant is dictated by their AMH levels. This hormone is a piece of the puzzle, but it is by no means the whole picture. Fertility is influenced by a multitude of factors, including age, egg quality, sperm quality, and the health of the reproductive system overall.

For those who have been told that their low AMH means they will struggle to conceive, I urge you to seek a second opinion. Remember that AMH is just one measure, and it doesn’t tell the whole story. Regular menstrual cycles are a good sign that you are ovulating, which is the most crucial factor for natural conception.

In summary, while AMH can provide valuable information in specific contexts, it is not a fertility test. It does not dictate your ability to conceive naturally, and it should not be used to scare or discourage women who are trying to get pregnant. Instead of focusing solely on AMH, we should be looking at the bigger picture of a woman’s reproductive health.

If you’d like to learn more about other fertility hormones like AMH, please check out some related blog posts here. If you stumbled upon this page and found my information useful, please follow me on Instagram where I regularly post content debunking fertility misinformation and myths.

If you are interested in booking a consultation with me at my New York City office, you can submit an appointment request here.

References

Tal, R., Seifer, D. B., Grazi, R. V., & Malter, H. E. (2015). The value of anti-Müllerian hormone in the prediction of spontaneous pregnancy: a systematic review and meta-analysis. Fertility and Sterility, 103(2), 322-330.e2. doi:10.1016/j.fertnstert.2014.10.041