What is AMH?
💡 AMH (anti-Müllerian hormone) = best single marker of ovarian reserve (egg supply). Produced by small ovarian follicles. Can be tested any day of cycle. Normal by age: 25–30 → 2–4 ng/mL; 35–40 → 1–2.5 ng/mL; >40 → 0.5–1.5 ng/mL. Low AMH = fewer eggs retrievable in IVF (but quality may still be good). High AMH = PCOS risk / OHSS risk. Used to personalise IVF stimulation dose.
Anti-Müllerian hormone (AMH) is a glycoprotein hormone produced by granulosa cells of small antral and pre-antral follicles in the ovaries. It is the most accurate and clinically practical single blood marker of ovarian reserve — the number of eggs remaining in the ovaries. AMH is used in every fertility workup to predict IVF response, personalise stimulation protocols, and guide counselling on reproductive timing.
🇮🇳 India Context: AMH is widely assessed and treated across major Indian fertility centres including Chennai, Mumbai, Bangalore, Delhi, and Hyderabad.
What are the key characteristics of AMH?
- Origin: granulosa cells of primordial, primary, secondary, and small antral follicles (2–6mm); produced continuously; does not fluctuate across the menstrual cycle (unlike FSH, E2, LH) — can be measured any day
- Normal ranges by age: 25–30 years: 2.0–4.0 ng/mL; 30–35: 1.5–3.5 ng/mL; 35–40: 1.0–2.5 ng/mL; 40–45: 0.5–1.5 ng/mL; >45: <0.5 ng/mL (approaching menopause); interpret in context of age — AMH 1.2 ng/mL at 38 is relatively good; at 28, it is low for age
- Low AMH: <1.0 ng/mL = reduced reserve (poor responder risk in IVF); <0.5 ng/mL = severely reduced; causes: age, endometriosis, prior ovarian surgery, chemotherapy, autoimmune POI, FMR1 premutation; does NOT mean unable to conceive — predicts quantity not quality
- High AMH: >3.5–5.0 ng/mL = high reserve / PCOS pattern; excessive follicle number → high OHSS risk in IVF; requires low-dose stimulation protocol and agonist trigger to prevent OHSS
- AMH vs FSH: AMH better early reserve marker (detects decline years before FSH rises); AMH cycle-stable (FSH varies Day to Day); both useful — use together; AMH declines from ~35 years, FSH rises from ~37–38 years
- Contraceptive pill effect: OCP suppresses AMH by 20–30% during use; wait 1–2 months after stopping pill for accurate baseline; levonorgestrel IUS (Mirena) does not affect AMH
- IVF dose individualisation: low AMH (<1.0) → high starting dose (300–450 IU/day); normal AMH (1–3 ng/mL) → standard dose (150–225 IU/day); high AMH (>3.5) → low dose (75–150 IU/day) + antagonist protocol
- AMH in males: AMH is also produced by Sertoli cells in males; used as a marker of Sertoli cell function; persistently measurable AMH in a biological male rules out vanishing testes syndrome; not routinely used in male fertility workup
How does AMH work?
Why does AMH matter in fertility?
AMH is the single most informative fertility test a woman can have — it provides an objective, quantitative measure of remaining egg supply that no other single test can match. Its cycle-independence (testable any day) and predictive accuracy for IVF response make it the foundation of every modern fertility workup. The most important clinical communication: low AMH is not a fertility death sentence. It predicts egg quantity, not quality. A 32-year-old with AMH 0.3 ng/mL can still conceive — her eggs are likely high quality, she simply has fewer of them. The urgency is around treating sooner rather than later.
What are related terms to AMH?
AMH Test (Anti-Müllerian Hormone)
The AMH Test is a simple blood test that measures the level of Anti-Müllerian Ho…
Low Ovarian Reserve (Diminished Ovarian Reserve)
Low Ovarian Reserve means a woman has fewer eggs than expected for her age. It i…
PCOS (Polycystic Ovary Syndrome)
PCOS is a common hormonal disorder where the ovaries produce too many male hormo…
FSH (Follicle-Stimulating Hormone)
FSH (Follicle-Stimulating Hormone) is produced by the pituitary gland. In women,…
FAQs about AMH
What is AMH and what does it measure?
AMH (anti-Müllerian hormone) is a protein hormone produced by the small follicles in the ovaries. It is the best available blood test for measuring ovarian reserve — the number of eggs remaining in your ovaries. Unlike other hormones (FSH, LH, oestradiol), AMH does not fluctuate significantly across the menstrual cycle, which means it can be tested on any day. A higher AMH means more eggs remain; a lower AMH means fewer eggs. AMH does not tell you about egg quality — only egg quantity.
What is a normal AMH level?
AMH levels decline naturally with age, so "normal" must be interpreted in the context of your age: Age 25–30: 2.0–4.0 ng/mL; Age 30–35: 1.5–3.5 ng/mL; Age 35–40: 1.0–2.5 ng/mL; Age 40–45: 0.5–1.5 ng/mL; Age >45: <0.5 ng/mL. A result is considered low if it falls significantly below the expected range for your age. Important: AMH 1.2 ng/mL at age 38 is reassuring; AMH 1.2 ng/mL at age 28 is concerning and warrants early fertility evaluation and egg freezing counselling.
Does low AMH mean I cannot get pregnant?
No — low AMH does not mean you cannot get pregnant. It means your ovarian reserve (egg supply) is lower than expected for your age, which has two main implications: (1) In natural conception: may take longer to conceive (fewer eggs available each cycle); (2) In IVF: fewer eggs are likely to be retrieved per cycle — you may need more IVF attempts for the same cumulative success rate. Crucially, AMH measures quantity, not quality. A woman with low AMH who is 32 years old has lower quantity but likely excellent-quality eggs. One good embryo is all that is needed for a successful pregnancy. The most important action with low AMH is to start trying or start IVF sooner rather than later.
Can the contraceptive pill affect my AMH result?
Yes — the combined oral contraceptive pill (OCP) suppresses AMH by approximately 20–30% while you are taking it. This is because the pill prevents follicle development, reducing the number of AMH-producing follicles. If you have an AMH test while on the pill, your result will be artificially lower than your true ovarian reserve. AMH returns to its natural level within 1–2 months of stopping the pill. To get an accurate AMH reading: ideally wait 4–8 weeks after stopping the OCP before testing. Note: the levonorgestrel IUS (Mirena coil) does not significantly affect AMH levels.
How does AMH affect my IVF treatment?
AMH is used to personalise your IVF stimulation protocol: Low AMH (<1.0 ng/mL): you are likely a "poor responder" — expect fewer eggs per retrieval (often 1–4); clinic will use higher FSH dose (300–450 IU/day); may use specialist poor responder protocols (DuoStim, POSEIDON guidelines); cumulative success with multiple cycles. Normal AMH (1–3 ng/mL): standard stimulation protocol (150–225 IU/day); expected 6–12 eggs. High AMH (>3.5–5 ng/mL): PCOS-type high responder — low stimulation dose (75–150 IU/day); GnRH antagonist protocol; agonist trigger to prevent OHSS; freeze-all strategy.
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