Feedback Friday: Low AMH

Dear Eggsperts–Hello! My friend mentioned that I should reach out to you. I’m undergoing IVF. I’m just getting started. My AMH is only .0247. I’m afraid of that number and what it means for my fertility future.–Troubled in Tampa

Dear Troubled–Since you are starting in vitro fertilization (IVF), we know you have already had a lot of testing and have been trying to get pregnant for a while now. One of the most important things your fertility doctor wants to know is how much and which combination of medication to give you to safely stimulate your ovaries to produce eggs for retrieval and fertilization. This is where ovarian reserve testing comes in.

Since a woman is born with all of her eggs, and we lose eggs every month, we look for ways to test how many eggs are left in the ovary at the time you wish to start treatment. This also is a reflection of the quality of the remaining eggs. Anti-mullerian hormone (AMH) is one of the tests that can be done to assess ovarian reserve. Unlike other blood tests that fluctuate throughout the menstrual cycle, AMH can be drawn at any time.

Enter blackboard for the science lesson portion of this reply. ARE YOU READY?!

A follicle is a fluid filled sac where an egg is growing and maturing;
Granulosa cells are cells in the follicle that surround the egg;
AMH is produced by granulosa cells;
As women age, the number of eggs (therefore follicles) decreases and the AMH level is lower
AMH gives us an idea of how well a woman will respond to ovarian stimulation medications
Punchline: Your age and ovarian reserve testing results, in combination, will help your doctor decide how much medication should be used to stimulate eggs to grow, will give an idea of how many eggs may be expected, and an idea of how successful your IVF cycle may be.

Some women have more rapid reduction of eggs/follicles than expected and this will also lead to a decrease in AMH values. Also, AMH value is a general reflection of how many follicles (and therefore eggs) remain in the ovary. It does NOT tell us an exact number of remaining eggs.

Depending on the laboratory used, normal AMH values are above 1-2 ng/mL. High AMH values, or values above 2, are a different scenario that the Eggsperts will talk about another time.

A low AMH, depending on your age, does NOT necessarily mean:

You are going into menopause,
You do not ovulate, or,
You can’t get pregnant.

….take it from one us who conceived naturally with a very low AMH after doing 2 rounds of IVF!

BUT, an AMH value below 1 (even more so with an AMH <0.1) would suggest 3 things to us:

You will likely have only a few eggs retrieved (maybe even none)
You may need maximal dose medications for stimulation of your ovaries
- You may also be offered minimal stimulation protocols. With a very low AMH, we anticipate few eggs. Minimal stimulation may achieve the same low number of eggs, but with a lower financial cost.
Your chance of pregnancy after IVF is lower than would otherwise be expected for women your age
- If you don’t respond well to stimulation medications, your cycle may be cancelled before eggs can be retrieved
- Your greatest chance for pregnancy may be using donor eggs (eggs from a young woman with normal AMH values), if this is an option for you

We hope we met your Eggspectations—An Eggspert

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Disclaimer: All of the comments on this page are for basic information only. They are based on the opinions and expertise of the authors and are not meant to provide a substitute for medical care or specific treatment recommendations. Each person is unique and requires individualized diagnosis and treatment plans. Any specific questions should be directed to your personal healthcare provider.

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