What does a low Anti-Müllerian Hormone (AMH) level mean for my fertility?

Understanding Low Anti-Müllerian Hormone (AMH) Levels and Fertility

Low AMH levels indicate diminished ovarian reserve, which is associated with reduced fertility potential and possibly increased risk of miscarriage. 1

What is AMH?

• AMH is a glycoprotein produced by granulosa cells of small developing follicles in the ovary 2
• It serves as a biochemical marker that reflects the quantity of the ovarian follicular reserve 1
• Unlike other hormones, AMH levels are relatively stable throughout the menstrual cycle, though some fluctuations may occur 2, 3

Clinical Significance of Low AMH

• AMH below 0.7 ng/ml indicates incipient ovarian insufficiency 1
• An AMH level of 0.4 ng/ml suggests significantly diminished ovarian reserve 1
• Low AMH is associated with:
  • Reduced fertility potential 1
  • Potentially higher miscarriage risk (meta-analysis shows women with low AMH have increased miscarriage risk compared to those with medium/high levels) 4
  • Possibly higher rates of aneuploid embryos, contributing to pregnancy loss 1

Age-Dependent Interpretation

• AMH interpretation should be age-dependent, with more reliable indication of diminished ovarian reserve in women 25 years and older 1, 3
• AMH is inversely correlated with age in women ≥25 years 3
• For women under 25, AMH levels may fluctuate and should be interpreted with caution 3

Relationship to Other Fertility Markers

• AMH correlates with antral follicle count (AFC), which can be visualized by ultrasound 2
• Both AMH and AFC are predictors of ovarian reserve 1
• AMH reflects the growing follicular pool responsive to gonadotrophins, not necessarily the entire primordial follicle pool 5

Implications for Fertility Planning

• Low AMH may indicate:
  • Shorter remaining reproductive lifespan 3
  • Potential risk for premature ovarian insufficiency (POI) 4, 3
  • Reduced response to fertility treatments 6
• Women with diminished ovarian reserve may need closer monitoring and earlier referral to reproductive specialists 1

Management Considerations

• Laboratory evaluation of FSH and estradiol is recommended for women with suspected diminished ovarian reserve 1
• Women with irregular menstrual cycles and low AMH should be monitored for symptoms of premature ovarian insufficiency 1
• Fertility preservation options should be discussed promptly if future fertility is desired 1
• Gynecology, endocrinology, and/or reproductive endocrinology consultation is recommended for women with signs of POI 4

Important Caveats

• Different AMH assays may yield varying results, so values should be interpreted in the context of specific laboratory reference ranges 1
• AMH is not a perfect predictor of natural conception chances, as some women with low AMH can still conceive naturally 4
• AMH testing is particularly valuable for women who have undergone potentially gonadotoxic treatments such as chemotherapy or radiation 3