If you are trying to conceive and gone down the “infertility road” a little way, then you may well have had your AMH levels checked. Many will call this your “ovarian reserve”, but as we explore further, it really isn’t that simple.
AMH stands for Anti-Mullerian Hormone. This hormone is produced by the granulosa cells, which are specific cells within a developing follicle.
Follicles take around 100 days to develop, and this must happen at a nice slow pace in order to reach ovulation. AMH is produced to prevent these delicate “pre-antral” follicles from being stimulated by Follicle Stimulating Hormone (FSH) too early. [Pre-antral means they they have left the “storage cupboard” but are now at the stage before they reach the final menstrual month where they will be competing for ovulation.]
The larger the follicles get, the more AMH they produce, until they are ready to be stimulated by FSH within the menstrual month.
Therefore, AMH levels can be used as an indicator of the number of antral or developing follicles you might have. However, this is not as simple as it sounds. It is not an indicator of dormant eggs you still have in “storage” i.e. total ovarian reserve.
In theory, if your AMH is low, this could mean that you don’t have many antral follicles coming up along the “production line”, and thus not producing as much AMH, but those that you do have could be a good size and of good quality. In contrast, you might have lots of antral follicles but not of a good size and not developing particularly well, and thus not producing much AMH.
So really, AMH is not a good indicator for determining your complete ovarian reserve. What it is useful for is for IVF clinics to gauge an idea of how many follicles they might be able to work with during an IVF cycle. But without considering other factors, a fully rounded picture cannot be seen.
Other factors to consider
Age is the main factor when looking at fertility. There will be a slow and natural decrease in AMH as we get older.
If you are a younger woman with low AMH for your age group, there are other factors to consider including vitamin and mineral deficiencies, blood flow to the pelvis, inflammation and autoimmune responses, contraceptive drugs, smoking/vaping, sleep quality, stress, infections. All of these factors can have a significant impact on the ovarian environment, and with improvements in place, AMH can rise.
My advice would be not to get fixated on AMH levels, and certainly do not look at them in isolation. Take a good look at both your own and your partner’s overall health and lifestyle, get support from an holistic practitioner. Take time to make improvements to your diet and lifestyle (remember the 100 days) to do everything in your power to improve that internal environment within which eggs are recruited and developed, within which sperm are created, and the uterine terrain in which they come together to create new life.
Other useful information
This is a great E-book if you want to know the answers to all the burning questions you have about low AMH: https://www.explaininginfertility.com/courses/LowAMH-ebook
This was a large study which measured AMH levels in a group of 1015 women who had no known fertility issues and who all had a proven level of fertility (conceived a child within 12 months of trying and carried to full term). Almost without exception, this presented those with low AMH were more likely to conceive. Thus, this research shows that it is possible to be naturally fertile with low AMH. https://pubmed.ncbi.nlm.nih.gov/24716733/
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