When it comes to fertility assessment, the focus is on the result of the AMH test. We believe that a more nuanced view is essential. The reality is that Anti-Mullerian hormone (AMH) levels alone do not define fertility, and to truly understand ovarian reserve and reproductive potential, you must consider anti-Mullerian hormone levels, antral follicle count (AFC) and age, all together.
Let’s understand how interpreting AMH in context helps guide fertility decisions and treatment planning and why AMH isn’t destiny.
Meaning of AMH?
Anti-Mullerian hormone (AMH) is a hormone produced by small/antral follicles in the ovaries. The anti-müllerian hormone test is a simple blood test that estimates the remaining egg supply. Medical experts commonly use the AMH test as a marker of ovarian reserve.
Because every woman is born with a fixed pool of eggs, the number gradually declines with age. AMH helps to estimate how many eggs might still be available. But it does not reflect egg quality, nor does it guarantee natural conception.
What AMH Actually Measures
The AMH test measures the concentration of this hormone in blood, reflecting the pool of small growing follicles, a proxy for how many eggs may eventually be selected. In that sense, it offers insight into the potential egg quantity, not necessarily the health or quality of the eggs themselves.
Because laboratories use different assays and reference ranges, results can vary. That is one reason why simply quoting a number can be misleading if not interpreted in relation to age and other ovarian reserve markers.
Normal & Low Anti-Mullerian Hormone Level AMH Test Explained
Normal AMH levels depend heavily on age and lab standards. Here are general guidelines:
- For women in their 20’s, AMH levels may range higher, indicating a stronger ovarian reserve.
- As women age, anti mullerian hormone levels typically decline.
- As women get older, levels under approximately 1.0-1.1 ng/mL are often viewed as lower, suggestive of diminished ovarian reserve (low egg count) and above 4.0 ng/mL are potentially linked to PCOS.
- Younger women (20s-early 30s) usually have higher normal levels (e.g., 2.0-6.0 ng/mL), while older women (40+) often have lower levels (e.g., <1.0 ng/mL is common).
Still, low AMH does not necessarily rule out natural conception, especially when other indicators are favorable.
AMH and Age: Understanding the Relationship
Age remains the single most important factor influencing fertility. The same AMH value can mean something entirely different at different ages. For example, an AMH of 2.5 ng/mL may signal abundant reserve at 26, but more modest reserve at 38. That difference strongly impacts how a fertility specialist interprets results and plans treatment.
The Indian data shows that even among women under 35, a notable proportion (about 14.5%) has low AMH (< 1.1 ng/mL). This underscores a critical point that ovarian reserve can decline earlier than expected in some women. Relying solely on age or a single AMH reading can therefore be misleading.
Why AFC Matters and Why AMH Isn’t Enough
An antral follicle count (AFC) is a count of small follicles via transvaginal ultrasound that offers another dimension of insight. Because AFC estimates how many follicles are visible now, it complements AMH’s hormonal estimate. Clinical guidance recommends combining AMH and AFC for the most accurate assessment.
One study showed a moderate positive correlation between AMH and AFC in women with low ovarian reserve.
Yet this relationship is far from perfect. Some women with normal AMH levels may show low AFC; others with lower AMH may have a reasonable AFC. This variation makes it clear that AMH alone should not dictate fertility decisions.
Interpreting AMH, AFC, and Age – What It Means for You
At Luma fertility, we advise patients to view AMH results as part of a broader picture. AMH helps to:
- Estimate expected response to ovarian stimulation (useful in IVF treatment or egg-freezing).
- Predict potential egg yield rather than guarantee success.
- Help decide on the timing of treatment or the start of family planning.
A lower-than-average AMH for age does not necessarily indicate a negative outcome. It may suggest a need to plan early, but it does not necessarily preclude natural conception or successful fertility treatment, especially when AFC and other fertility markers are favorable.
Should I Get an AMH Test?
If you are planning to start a family, delaying pregnancy, or considering fertility treatments, particularly after the age of 30, an AMH test along with an AFC scan can be helpful. Especially for women with risk factors like past ovarian surgery, endometriosis, etc. Early assessment helps create a personalized fertility plan.
Even in low AMH, it does not dictate destiny. What matters is interpreting results in context and aligning them with your reproductive goals.
Need Help Deciding What is Right for You?
At Luma fertility we believe that numbers are only one part of the story. Whether you are just beginning to explore parenthood or considering IVF or just want to know more about your fertility, our team is committed to providing nuanced counselling and designing an individualised plan, guided by your AMH, AFC, and age factors. Let’s connect and find what is best for you.
FAQs
Q: What does a normal AMH level mean?
A: A normal AMH level means a healthy ovarian reserve, that you likely have a reasonable number of eggs remaining, but does not guarantee pregnancy or egg quality.
Q: If my AMH is low, does that mean I can’t conceive naturally?
A: Not necessarily. A low AMH level may reflect fewer eggs, but many women with lower AMH conceive naturally. Other factors, including AFC, egg quality, and general health, also matter.
Q: Can I rely on AMH alone to decide when to have a baby?
A: No, because AMH doesn’t show egg quality and may vary across labs; combining AMH test, AFC scan, and age gives a more accurate fertility picture.
Q: Does a high AMH mean high fertility?
A: A high anti-mullerian hormone level may indicate a strong ovarian reserve or conditions like PCOS, but it does not guarantee healthy eggs or a successful pregnancy.
Q: How often should I test AMH and AFC?
A: Most experts recommend a one-time assessment before beginning fertility planning or fertility treatment.
