The Anti-Mullerian Hormone (AMH) is considered THE hormone to determine ovarian reserve for women experiencing fertility struggles. If your AMH is low, you may have been told it will be hard to conceive, or that your egg quality is poor and there’s nothing you can do about it. The reality is that low AMH isn’t the final say in your ovarian reserve.
What is AMH?
AMH is a hormone secreted by maturing egg follicles and the more maturing egg follicles present, the more AMH is released. Women with polycystic ovaries have a higher AMH level for this reason—though it’s not necessarily a good thing.
AMH levels give insight into how many eggs are currently maturing. They don’t indicate whether you have a low amount of eggs or give insight into the total number of eggs in the ovary. AMH levels change throughout your cycle. As your body makes the switch from preparing for ovulation to the the post-ovulation phase, AMH levels go up and then back down. After ovulation, your body focuses on progesterone production and preparing the uterus for implantation instead of maturing eggs which means higher AMH. But, at the beginning of your cycle your body is ramping up hormones to prepare for ovulations which means higher AMH. Having low AMH levels doesn’t always mean you have poor egg quality.
Measuring AMH levels
A lot of doctors say it doesn’t matter when you measure AMH. Since those levels fluctuate, timing actually does matter. If you decide to test your AMH levels, it’s best to test for it at the beginning of your cycle around day three or four. Hormonal birth control also affects AMH levels because it shuts down your ovaries. If you’re on hormonal birth control or have been on it within the last six months, AMH levels will be lower than usual.
It’s important to note that AMH might not be the same for every woman. A woman who naturally produces higher AMH might have the same number of maturing follicles present as a woman who naturally produces lower AMH. This makes it difficult to judge whether your AMH levels are impacting your fertility. To get an accurate reading, you would need to measure your AMH over time and have ultrasounds and other tests done.
Normal AMH Levels
Truly low AMH levels depend on your age and what doctor or lab you use. Generally, less than .5 ng/ml is considered low but I’ve also seen .3 ng/ml as the cut off for low. It’s likely that if you are younger than thirty-five .5 ng.ml should be the cut off and .3 ng.ml if you’re older than thirty-five. .5-1.5 ng/ml is considered low normal, 1.5-3 ng.ml is normal and greater than 3ng/ml is considered high and a possible indicator of PCOS.
You’re more likely to hear that low AMH levels are concerning from a traditional doctor or reproductive endocrinologist because low AMH indicates that you only have a few eggs maturing in your ovary. This isn’t considered ideal if you’re planning to try IVF. With IVF, the goal is to collect as many eggs as possible so it wouldn’t be worth it if you only have a few. However, this doesn’t mean you can’t get pregnant naturally. If you have AMH that means you also have maturing follicles. This means you can ovulate a mature egg and get pregnant. You don’t need more than one egg when you’re trying to conceive naturally.
Improving your AMH levels
If you’ve been told you have low AMH for your age and it concerns you, the good news is that you can change it! Studies show that AMH is actually affected by smoking and other environmental toxins like pollution and pesticides, low vitamin D status, and stress. It’s also been clinically shown that poor circulation, diet, and low DHEA may have an effect on AMH levels.
Here’s what you can do if you want to improve your AMH levels.
Reduce your toxic load
- Stop smoking if you smoke (seek help if you need it, your future baby is worth it)
- Get an air purifier for your home especially if you live in the city
- Eat organic as much as possible
- Avoid using pesticides and herbicides in your home and yard
- Clean up your cleaning and beauty products
All of these affect your liver’s ability to clear toxins from the body which can affect your AMH levels.
Check your vitamin D
Get your vitamin D levels checked at least twice a year. Anything below 50 ng/ml is considered low. Ideally you want to be above 70. If your vitamin D levels are low, get out in the sun without sunscreen to expose your skin to as much sun as possible (without burning). Sun exposure is the best way to get vitamin D. When this isn’t possible—especially during the winter—you can supplement with vitamin D. It’s best to take a liquid vit d3/k2 supplement with a meal that contains fat for better absorption. Consult your doctor or other practitioner to determine how much you should supplement.
Reduce your stress
I know—it’s annoying to hear “just relax and you’ll get pregnant.” Obviously, that’s an understatement but stress impacts fertility and AMH levels. Reducing and mitigating stress is key. Say “no” to what you can, ask for help, and practice stress relieving tactics like going for walks, meditation, and yoga. Consider adding adaptogen supplements like reishi mushroom. Stress can also lead to low DHEA levels so you can consider supplementing with DHEA as you work on reducing stress. Just remember, it’s important to consult a qualified practitioner if you’re considering supplementing with DHEA.
Increase Circulation
If our ovaries aren’t getting the blood flow they need to bring in oxygen and nutrients to the cells, it’s difficult for the ovaries to mature eggs. You can increase circulation using castor oil packs, low heat from a rice warming pillow, cold showers, yoga, Mayan Arvigo abdominal massage, and acupuncture.
Eat balanced meals
If you’re eating foods that are low in nutrients or experiencing blood sugar imbalance, your body isn’t going to be able to provide your ovaries with the nutrients it needs to mature follicles. The occasional treat won’t ruin your AMH levels but it’s important to keep your meals balanced and full of nutrient-dense foods. In general, aim for three meals a day that contain a balance of non-starchy veggies, complex carbs, high quality protein, and healthy fats.
While AMH is not the best indicator of your overall ovarian reserve it helps shed light on what’s going on in your body so you can make changes if necessary. Just remember, if you have low AMH, you’re not doomed to infertility and IVF isn’t your only option. In fact, trying naturally may be the better way to go for women with low AMH.
No matter what, you have the power to improve your fertility!