I am a woman of reproductive age trying to conceive; my anti‑Müllerian hormone (AMH) level is 1.98 ng/mL—does this indicate a normal ovarian reserve and what fertility steps should I take?

AMH 1.98 ng/mL: Interpretation and Fertility Management

Your AMH level of 1.98 ng/mL indicates normal ovarian reserve for a woman of reproductive age, and you should proceed with attempting natural conception while monitoring your menstrual cycles. 1

Understanding Your AMH Result

Your AMH value falls within the normal range and does not suggest diminished ovarian reserve. Based on age-specific reference ranges used in clinical studies:

• Low AMH is typically defined as <1.0–1.1 ng/mL 2
• Medium AMH ranges from approximately 1.0–2.0 ng/mL 2
• Your level of 1.98 ng/mL places you at the upper end of medium or lower end of high AMH, depending on the specific assay used 2

AMH represents the best endocrine marker for assessing age-related decline in ovarian reserve in healthy women, as it reflects the pool of growing follicles that can potentially ovulate. 1, 3

Fertility Implications

Pregnancy potential: Your AMH level does not indicate reduced fertility potential. Studies examining AMH and natural fertility show that women with AMH values above 0.7 ng/mL have similar pregnancy rates after 12 cycles of attempting conception compared to those with higher values. 4

Miscarriage risk: Your AMH level is reassuring regarding miscarriage risk. Meta-analysis data demonstrates that women with low AMH (<1.0–1.1 ng/mL) face increased miscarriage risk (OR 1.35; 95% CI 1.10–1.66), but your level of 1.98 ng/mL places you outside this risk category. 2

Recommended Fertility Steps

Immediate Actions

• Attempt natural conception for 6–12 months if you are under age 35, or for 6 months if you are age 35 or older 5
• Track menstrual regularity as irregular cycles may warrant earlier evaluation regardless of AMH level 1
• Optimize preconception health including folic acid supplementation and addressing any underlying medical conditions

When to Seek Fertility Evaluation

Pursue fertility evaluation if:

• No pregnancy after 12 months of regular unprotected intercourse (if <35 years old)
• No pregnancy after 6 months of regular unprotected intercourse (if ≥35 years old)
• Menstrual irregularities develop
• Any symptoms suggesting ovarian dysfunction emerge 1

Additional Testing Considerations

While your AMH is reassuring, comprehensive fertility assessment includes:

• FSH and estradiol measured on cycle days 2–5 to complement AMH findings 1
• Transvaginal ultrasound with antral follicle count (AFC), which strongly correlates with AMH and provides additional ovarian reserve information 1
• TSH and prolactin to exclude thyroid disease and hyperprolactinemia as causes of potential ovulatory dysfunction 1

Important Caveats

Assay variability: Different AMH assay platforms (Gen II ELISA, Elecsys) can produce disparate absolute values, so your result should be interpreted using your specific laboratory's reference ranges. 1, 3 The lack of international standardization means that repeat testing should ideally use the same assay platform. 3, 6

Age-specific interpretation: AMH reference ranges are age-dependent, with values naturally declining with advancing reproductive age. Your result should be interpreted in the context of your specific age. 1

Limited predictive value for natural fertility: While AMH excellently predicts ovarian response to IVF stimulation, it has limited value in predicting natural conception rates or ongoing pregnancy in the general population attempting natural conception. 6, 4

AMH does not diagnose premature ovarian insufficiency: No recommendations exist for using AMH alone to diagnose premature ovarian insufficiency, as its diagnostic value in this context remains unestablished. 1