AMH Levels and Fertility

What is AMH and How Does it Impact Fertility?

Dr. Jolene BrightenPublished: Last Reviewed: Balancing Your Hormones, Fertility, Preconception & Fertility Leave a Comment

If you are struggling with fertility issues, you’ve probably had your AMH tested, especially if you are over 35. Anti-Mullerian hormone (AMH) levels give clues about reproductive health, ovarian function, and success with fertility treatments. 

This article will cover everything you need to know about AMH levels and fertility. Plus, I’ll cover how to improve AMH levels naturally with nutrition, lifestyle change, and supplements for low AMH.

Keep reading to get answers to your burning questions, such as:  

  • What does anti-Mullerian hormone do? 
  • What is a good AMH level to get pregnant?
  • How can I increase anti-Mullerian hormone? 

If you’ve had trouble conceiving or want to do everything possible to have healthy eggs, this article is for you! 

What Does Anti-Mullerian Hormone Do?

Follicle-stimulating hormone (FSH) is a hormone made in the brain that signals ovarian follicles to grow and mature. Each follicle has an egg inside, and as it grows, it produces AMH. AMH is a hormone measured in the blood, and levels correlate with the number of growing follicles in each menstrual cycle. 

AMH is a marker of ovarian reserve, which is the number of eggs a woman has in her ovaries. Based on our current understanding, women are born with all the eggs she will ever have — millions of them —  which diminish over the reproductive years. 

Anti-Mullerian Hormone Test

An anti-Mullerian hormone test is one piece of infertility and ovarian reserve testing. It’s important to remember that it’s only one marker and your doctor will consider many other factors to determine  your whole fertility picture.   

Read this article for more information on hormone testing and the best time to test hormone levels.

Normal AMH Levels by Age

Normal AMH Levels by Age

AMH levels peak with high reproductive potential in the mid-twenties and then start to decline, with the lowest levels seen in the early 40s and into menopause. Normal AMH levels for women are between 1 and 4 ng/mL. 

Unfortunately, there isn’t an international standard for AMH test levels and interpretation, so different practitioners may offer different optimal ranges. However, levels predictably decline with age

According to the Cleveland Clinic, normal AMH levels by age are: 

AgeIdeal AMH Level
25> 3.0 ng/mL
30> 2.5 ng/mL
35 > 1.5 ng/mL
40> 1.0 ng/mL
45> 0.5 ng/mL

High AMH

High AMH levels, defined as levels above 4.0 ng/mL, may be a sign of polycystic ovarian syndrome (PCOS). To better understand the connection between AMH and PCOS, please read this article. The remainder of this article will focus primarily on low AMH and fertility. 

Low AMH

Low AMH is defined as levels between 0.5 and 1.0 ng/mL, levels below 0.5 ng/mL are considered very low. 

Besides age, low AMH levels might result from:

  • Menopause or early menopause, otherwise known as primary ovarian insufficiency (POI)
  • Cancer or the effects of cancer treatments, including radiation and chemotherapy
  • Genetics 
  • Endometriosis
  • Hypothalamic amenorrhea (absent menstrual cycles due to hypothalamus signaling)
  • Lifestyle factors such as smoking (discussed below) 

AMH and Fertility

Low AMH signals diminished ovarian reserve, but it doesn’t tell you anything about egg quality, or how healthy your eggs are. It’s also not necessarily an accurate predictor of fertility status, since you may still be able to conceive naturally with a low AMH. Many factors affect fertility, and many are within your control. So, keep in mind that even if AMH is low, it doesn’t mean you can’t get pregnant. 

AMH is a helpful tool in reproductive medicine. If you are freezing your eggs or going through IVF (in vitro fertilization), AMH can help estimate how many eggs you can capture in a cycle. Improving AMH levels correlates with improved IVF outcomes, especially in women thirty five and older undergoing fertility treatments. 

AMH is also used to help a provider assess the risk of ovarian hyperstimulation syndrome (OHSS), which is a condition in which is when the ovaries become very enlarged and fluid shifts into the 

Understanding Ovarian Reserve

AMH testing is used to evaluate functional ovarian reserve, which is the collective developing follicles that have the potential to reach ovulation. 

You can think of your ovarian reserve as a sort of oocyte (egg) savings account. We reach menopause when we’ve essentially “spent all of our eggs” from our savings account. Because of this, AMH testing may help a provider predict natural or medically induced menopause.  

Ovarian reserve decreases naturally with age and responds to environmental, physiological, hormonal, and genetic factors. 

Risk of Miscarriage

Low AMH may correlate with an increased risk of miscarriage. One study found women who conceived naturally and had a very low AMH (at or below 0.4 ng/mL) had double the rate of miscarriage compared to those with an adequate AMH (at or above 1.0 ng/mL). The increased risk was seen around 6 to 7 weeks of pregnancy. The study suggests low ovarian reserve (measured by low AMH) increases miscarriage risk at any age. 

Other studies have shown there to be a decreased risk of miscarriage with improved AMH.

For more about the causes and signs of miscarriage, check out this article. 

What is a Good AMH Level to Get Pregnant?

Optimal AMH levels for pregnancy are between 1.0 and 4.0 ng/mL. Younger women may be higher in the range, whereas women in their late 30s and early 40s will be lower in the range naturally. 

How Do Women Optimize AMH Levels?

Many factors influence AMH levels, ovarian reserve, and egg quality. A comprehensive plan to improve fertility includes nutrition, lifestyle change, and supplementation. 

As we dive into the list of what can help AMH, know that these are all important steps for future dads or sperm donors to take as their habits impact pregnancy outcomes too.

Nutrition Considerations

What you eat provides nutrition for hormone balance, antioxidants to protect fragile eggs, and the nutrients required to grow a baby. Start with a base of nutrient-dense whole foods and layer on strategies to ensure you meet all your needs. 

Learn more about my fertility diet for women here, and get your free seven-day meal plan and recipe guide here

While this is an area where we need more research, what you eat does impact your AMH. This means you can take steps to improve AMH with dietary shifts.

For example, one study found that fast food consumption was associated with a lower AMH, while another study found that full fat dairy was associated with reduction in the rate of ovarian reserve loss. 

Lifestyle Changes

Nutrition is foundational for fertility, and many other changes to your lifestyle support improved fertility and AMH levels. 

Interestingly, some research has shown that a pregnant woman’s habits, specifically caffeine intake, can have a negative impact on her developing daughter’s AMH. The good news is, vitamin supplementation was shown to have a positive impact on AMH. There’s been no conclusive research at this time to suggest that caffeine use has a negative impact on your AMH outside of the in utero effects.

Endocrine Disruptors

Endocrine-disrupting chemicals are industrial chemicals that interfere with the body’s hormone production. Changes in hormones affect fertility. In addition, environmental toxins increase oxidative stress in the body and negatively impact egg quality.

For example, bisphenol A (BPA) is one of the most widely used chemicals in receipts, plastics, canned foods, and drinking water. BPA exposure impacts reproductive capacity and may cause decreased follicles in the ovaries. Interestingly, a new study suggests that astaxanthin, an antioxidant found in wild salmon, improves follicle development and egg maturation by providing protection against BPA induced oxidative stress.

To combat the effects of environmental toxin,first, decrease exposure to endocrine disruptors as much as possible. And second, support your body’s elimination of the environmental toxins you are exposed to by employing detox practices. In the case of fertility, we also want to increase antioxidants in the diet and through supplementation to counter the effects of toxins you can’t control. 

Smoking

The impact of cigarette smoking on AMH levels has been known for some time. A 2010 study suggests that active smokers of late reproductive age had AMH levels 44% lower than non-smokers. More recent research indicates heavy and long-term smoking decreases ovarian reserve. 

If you don’t smoke, don’t start. If you do, get the help you need to quit—not just for fertility, but for your overall health too. 

Vitamin D and AMH Levels

Alcohol

Alcohol is yet another substance that may affect fertility. Alcohol affects hormone balance and may increase estrogen levels and decrease progesterone production. Alcohol consumption affects ovulation and menstrual cycle regularity

While it can pose a risk to your fertility at any age, if you’re under 37 years old, this is one modifiable risk factor that may be posing the biggest risk to your fertility.

If you’re going through IVF, know that research has shown alcohol before and during IVF procedures is associated with lower pregnancy rates. 

It’s well-known that avoiding alcohol during pregnancy supports healthy fetal development, but giving up booze while planning for pregnancy might be helpful too. 

Obesity

Obese women (BMI equal to or greater than 30) are at a higher risk for fertility and pregnancy challenges, although the relationship between weight and AMH specifically hasn’t been established

In a Canadian study, women between 18 and 40 years old with obesity and infertility were given a lifestyle program, including sessions with a dietitian and kinesiologist. Participants received education about alcohol, tobacco, nutrition, and other health topics. The women who received lifestyle support had more spontaneous pregnancies and needed fewer fertility treatments than the control group, demonstrating the power of simple healthy habits on fertility. 

Often weight loss can be more complicated than implementing lifestyle change, as hormones play a significant role. If you desire to lose weight and get pregnant, please read Why Hormonal Imbalance Can Make Weight Loss Difficult and Why Eat Less and Exercise More is Bad Advice for Women for more guidance. 

Stress Management

It’s well-known that stress can affect your period. Research now suggests that higher perceived psychological stress affects AMH levels, with higher stress correlating with lower AMH levels in women seeking fertility care. 

Embarking on a fertility journey can add stress to your life, so paying extra attention to calming your nervous system and practicing self-care during this time is important. Build skills now that will carry you into the new stresses of motherhood. 

Yoga

Yoga is a helpful practice and is known to lower stress, anxiety, and burnout. In addition, yoga therapy is useful for reducing anxiety in women with fertility challenges. It’s widely accessible and can be practiced in a local class or in the comfort of your home. 

Acupuncture

Acupuncture is another treatment approach, supportive of fertility and stress management. Women who receive acupuncture along with fertility treatments like IVF have higher-quality embryos and better pregnancy rates. Acupuncture also supports healthy estrogen and progesterone levels. 

Antioxidant Support

AMH levels speak to egg supply, but not necessarily egg quality. A mature egg is the largest cell in the body and contains the most mitochondria. In fact, some estimates report over 100,000 mitochondria or more may be present in a mature egg. This is why I always say, you must support your mitochondria to support your fertility. The egg is susceptible to oxidative damage, which can damage the cell and the DNA it contains. Antioxidants provide protection and improve egg quality. 

Melatonin

You probably think about melatonin in terms of sleep quality and circadian rhythm, but it’s also a critical antioxidant and plays a role in human reproduction. Supplemental melatonin promotes healthy egg quality and function, making it a supportive fertility supplement for women.

In patients taking a dosage of 3 mg nightly, there was a reduction in 8-OHdG, a marker of DNA damage. At this dosage, melatonin can be found in the follicular fluid, which is thought to reduce oxidative damage to the egg.

CoQ10

Coenzyme Q10 (CoQ10) is a vital antioxidant associated with cell membranes and mitochondria; it’s particularly critical for protecting the mature egg from oxidative stress and toxins. Supplementing with CoQ10 may improve egg quality

Among younger people with poor ovarian reserve, dosages of 600 mg daily initiated 2 months prior to egg retrieval during IVF have been shown to increase ovarian response, fertilization rate, and the number of high quality embryos.

Omega 3s

Omega 3 fats, especially EPA, found in cold water fish and fish oil, reduce inflammation and have many benefits for the body. It’s an important adjunct to taking prenatal vitamins during the preconception period and while trying to conceive, which is why it is part of our Pregnancy Support Kit

In one study it was found that women supplementing with omega-3 fatty acids had 1.5 times the probability of conceiving compared to those not taking omega-3s. It is possible, however, that women who supplement with omega-3 fatty acids have an overall healthier lifestyle, although the researchers did try to account for several of these variables.

One study has suggested omega-3 fatty acids do not have an impact on fertility, however, the study was limited by sample size and only measured omega-3 via the blood at the onset of the trial. The problem is this would not reflect omega-3 status throughout the cycle of egg development and ovulation. We certainly understand the positive impact of omega-3’s on women’s health and fetal development, so additional research is needed to understand the impact on AMH and fertility.

L Carnitine

L-carnitine, and its other form acetyl L-carnitine are amino acid derivatives that support female reproduction and egg quality. L-carnitine is the better choice for cellular energy production, and acetyl L-carnitine has better antioxidant properties. 

Fertility Supplements

In addition to the supplements mentioned above, fertility supplements include vitamins, minerals, and even hormones like DHEA. Read The Best Fertility Supplements for Women and The Best Prenatal Vitamins for more on this topic. 

I also review fertility supplements and dosages in the video below.

DHEA

DHEA is the hormonal precursor to estrogen. DHEA supplements are often suggested to women to improve fertility. Research suggests DHEA supplementation improves ovarian response in women with diminished ovarian reserve. Learn more about DHEA and dosages here

Vitamin D

Vitamin D is another critical prenatal supplement with many benefits. Vitamin D supplementation may even help improve AMH levels and ovarian reserve. Be sure to test vitamin D levels as part of preconception lab testing and adjust your vitamin D dose to maintain optimal blood levels. 

Vitamin D3/K2 by Dr. Brighten is a liquid vitamin D supplement that makes it easy to personalize your dose. 

Vitamin E & Selenium 

Vitamin E is an essential vitamin, and selenium is an essential mineral. Both have antioxidant actions and are important for hormone balance and reproductive health. It’s helpful to eat a diet rich in a wide variety of whole foods and take a quality prenatal vitamin. 

Prenatal Plus by Dr. Brighten contains optimal dosages of both nutrients in their preferred forms, along with all the other essential vitamins and minerals. Beginning Prenatal Plus by Dr. Brighten at least 3-6 months before trying to conceive helps build nutrient stores and support healthy eggs. 

Myo-Inositol

Research suggests that when myo-inositol (also known as inositol) is found in the follicular fluid, it has a positive impact on egg development, supports egg quality, and fertilization.

The dose most often used in research is 2,000 to 4,000 mg daily.

You’ll find 2,000 mg of myo-inositol in every dose of our Myoinositol Plus.

Folate

Folate, along with B12, are important for healthy cell division, which a fertilized egg does a lot of. If you’re looking to improve your fertility or trying to get pregnant, these should be part of your prenatal vitamins.

Learn more about folate vs folic acid here.

Takeaway

AMH levels provide a window into ovarian reserve. However, it’s important to remember that this number isn’t the whole story, as many other factors influence fertility and reproductive capacity. And most importantly, there are many ways to improve AMH levels and overall fertility, including nutrition, lifestyle change, and fertility supplements.

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About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is a women’s hormone expert and prominent leader in women’s medicine. As a licensed naturopathic physician who is board certified in naturopathic endocrinology, she takes an integrative approach in her clinical practice. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is the best selling author of Beyond the Pill and Healing Your Body Naturally After Childbirth. Dr. Brighten is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. She is a member of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian, Sports Illustrated, Elle, and ABC News. Read more about me here.