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It’s no secret that here at Modern Fertility, we’re big fans of anti-Mullerian hormone (AMH), and the insights that knowing about your AMH level through a simple blood test can unlock. While AMH is great for understanding your ovarian reserve (aka egg count), menopause timing, and responses to egg freezing and in vitro fertilization (IVF) treatments, there are things that an AMH test can’t necessarily help you understand — and one of those things is your current chances of conception (particularly if you’re someone with regular menstrual cycles).
Scientists in reproductive medicine have been searching far and wide for variables that predict your time to pregnancy and your chances of conceiving in any given cycle or any given month, and based on what we know so far, three things are clear:
- Predicting these things with high levels of accuracy is really tricky.
- For the majority of people, there’s no single “good” or “ideal” AMH level if you’re trying to conceive. But your AMH can help you understand the presence or absence of underlying conditions, like PCOS and POI, that may make conception trickier.
- Your AMH can also help you go after your reproductive goals more broadly by giving you an estimate of menopause timing and your overall reproductive window (aka when you have the ability to get pregnant).
In this post, we’ll give you the breakdown of what AMH is and why it matters, the current state of the science on AMH and your chances of getting pregnant *right now*, and how AMH can help flag reproductive health-related conditions that have real implications for your chances of conception.
(Searching for a comprehensive guide on all things AMH? We’ve got you covered.)
Quick refresh: What’s AMH?
AMH is a hormone of many talents. Here are a few important things to know about it.
1. AMH plays a role in sexual differentiation.
During fetal development, AMH plays a key role in sexual differentiation — meaning the processes that result in differences used to assign someone “female” or “male” at birth. More specifically, in “male” fetuses, high levels of AMH cause the breakdown of the Mullerian ducts (this is why the hormone is called anti-Mullerian hormone). These ducts are tiny structures which, if left in place, go on to develop into the fallopian tubes, ovaries, uterus, and parts of the vagina.
2. AMH is produced by the antral follicles (the ones that haven’t fully developed yet).
A little later during fetal development, AMH starts getting produced by fetuses with ovaries by their granulosa cells in the antral and preantral follicles, which are follicles that have started developing but haven’t fully developed yet. Because AMH is directly produced by these developing ovarian follicles, and the number of these developing follicles are directly proportional to *all* eggs, AMH is a good indicator of ovarian reserve, or the number of eggs someone has left (lower AMH = fewer eggs).
Countless studies have found tight correlations between AMH levels and the number of eggs seen on ultrasounds of the ovaries (see here, here, and here). It’s worth noting, though, that AMH levels are not linked to egg quality — which is also an important factor in conception and pregnancy.
3. AMH decreases over time.
As people with ovaries age, their number of follicles and consequently, their AMH levels, decrease. By the time we hit menopause, both follicle count and AMH levels hit their floor, and conception is no longer possible. But AMH levels can vary quite a bit among people of the same age, and the rate of decline also differs among individuals — which is why keeping tabs on *your* AMH levels and how they’re changing over time can help you keep tabs on your fertility, and ultimately, make more well-informed choices about your reproductive health and goals.
Depending on your birth control and cycles, a hormone test panel can measure up to seven important reproductive hormones — including AMH. You’ll see where your AMH is today *and* be able to track any changes over time for science-backed data points as you plan for your reproductive future.
What can you learn from AMH as it relates to your chances of conception?
Though it doesn’t seem like AMH can predict current chances of conception for the majority of people based on what’s currently been published (which we’ll discuss below), it can be a marker for reproductive health conditions that themselves may affect your chances of conception, whether it be with assisted reproductive technology or without. We’re looking at you, polycystic ovary syndrome (PCOS) and primary ovarian insufficiency (POI).
AMH and polycystic ovary syndrome (PCOS)
PCOS is a condition that affects an estimated 1 in 10 people with ovaries, and is associated with irregular periods and irregular ovulation, enlarged ovaries with above-average numbers of developing follicles, and symptoms of high androgen production (like excess body hair). Though AMH isn’t part of the diagnostic criteria for PCOS and there’s no agreed-upon cutoff for levels that for sure indicate PCOS (though some researchers suggest a cutoff of around 5 ng/mL), AMH levels are on average significantly higher among folks with PCOS (seen here, here, here, and here).
Because conception is only possible during the fertile window of a cycle where ovulation happens, ovulating regularly and being able to pinpoint when ovulation is happening (by using ovulation predictor kits, for example) is super important. Because people with PCOS don’t ovulate as often or as regularly, conception gets a bit trickier. Population-level data backs this up: at any given point in time people with PCOS are more likely to say they’re TTC, and it takes them a longer time to conceive. That said, there are several different treatments (like ovulation-induction meds) and procedures (like IVF) that can help people with PCOS achieve their reproductive goals.
AMH and primary ovarian insufficiency (POI)
Primary ovarian insufficiency (POI) is when ovarian function steeply declines before the age of 40. People with POI do not ovulate regularly and do not get regular menstrual cycles, though they may spontaneously ovulate or get a period once in a while. Because their ovarian function has decreased, people with POI may experience symptoms of low estrogen like vaginal dryness, bone loss, and hot flashes. AMH levels are also significantly lower among people with POI, and may be a helpful indicator of whether someone has this condition.
About 5%-10% of people with POI will spontaneously ovulate and conceive. Though the success of fertility treatments like IVF is much lower among people who have POI as compared to people who don’t, it is an option to consider for people with POI looking to boost their chances of conception as much as possible. Talking through your options with a reproductive endocrinologist can help you decide whether IVF treatment, with its lower success rates for people with POI, is a good option for you.
AMH and your overall reproductive goals
Knowing whether you have very high or very low AMH levels can help you understand whether you may have a condition (like PCOS or POI) that may make getting pregnant in the short term trickier. AMH can also help you understand a second variable that’s super important when thinking about your reproductive goals: the length of your reproductive window (aka your time before menopause, where pregnancy is possible).
AMH has been studied as a predictor of menopausal timing. Levels of AMH decrease as the number of eggs you have left decreases, and both AMH levels and ovarian reserve bottom out around menopause.
Understanding where your AMH levels are can give you insight into your potential menopause timing, which is a *crucial* piece of info for people thinking through how many kids they may want to have and when. (You can also check out our Timeline Tool, which we built to help support people through these sorts of decisions.)
According to Prof. Scott Nelson, who’s considered one of the leading experts on AMH (and who’s also part of the Modern Fertility Medical Advisory Board), “It’s well-established in the medical community that women with a low ovarian reserve have a shorter reproductive life-span and earlier age of menopause. When women enter the menopause at an earlier age, it impacts their total fertility across their lifespan and potentially their ability to complete their desired family size.”
So while for most people, their AMH level won’t help them predict how long it will take them to get pregnant, it may help them get a sense of how much longer their reproductive window is or if they’ll experience early menopause — which can help you make decisions to best achieve your reproductive goals, particularly if those goals include having several kids.
Can AMH help you predict your chances of conceiving today?
A handful of studies have looked at whether someone’s AMH level predicts how long it takes them to conceive outside of the context of medically-assisted reproduction (i.e., without things like IVF cycles) and have largely converged around the same answer: AMH does not predict how long it takes people to get pregnant or have a live birth.
While one of the first studies addressing AMH and time to pregnancy did identify a link, research groups (including the original one) have since tried to replicate the findings and haven’t gotten the same results:
- A 2012 study of 186 couples found no differences in the percent of people pregnant after six cycles of TTC when comparing people with “normal” and “low” AMH (where “low” = the bottom 20% of all AMH values). What the study did find is that people in the highest AMH bin (the top 20% of all AMH values) were less likely to conceive in those six cycles. (Like we mentioned earlier, high AMH can be a marker of conditions associated with less frequent and less regular ovulation like PCOS.)
- Instead of looking at pregnancy rates within a given timeframe, we can also look at how long it took people to get pregnant, and if this is related to AMH. Three studies (here, here, and here) found no link between AMH levels and how long it took couples to conceive. The highest cut-off for low AMH in these studies was 1.0, while the lowest cut-off for high was 3.4 ng/mL. This “high” cut-off likely is too low to capture the subset of participants who had PCOS, who are generally less likely to ovulate regularly (and therefore, take longer on average to conceive).
- About six years after the original paper suggesting a link between an AMH and chances of getting pregnant in the first six months of TTC was published, the same group of researchers published findings on a new, larger study aiming to answer that same question. Among 750 people trying to conceive, there was no association between AMH and the chances of conceiving in six months. Specifically, people who had an AMH below 0.7 or above 8.5 ng/mL didn’t differ in their likelihood of conceiving at six or twelve months, relative to people who had an AMH between 0.7 and 8.5 ng/mL. One important thing to note is that the researchers excluded anyone who had a diagnosis of PCOS, many of whom have high AMH levels and on average, a longer time to pregnancy.
- A 2018 study of 202 people who had previously been diagnosed with infertility did find a link between AMH and time to pregnancy — specifically, those with very low AMH (defined as < 1.19 ng/mL for people below 32, and <0.60 ng/mL for people 32 to 34) had a time to pregnancy that was about six months longer than that of people with “normal” AMH.
The take-home message here is that the literature has been mixed. But overall, based on these studies, if your AMH is not extremely low or extremely high, it won’t tell you much about how likely you are to conceive in the next six months, or how many months it will take you to conceive.
There are some caveats of these studies to point out:
- Perhaps most importantly, many of these studies differed in how they defined “low” or “high” AMH. It’s possible that very, very low levels of AMH (e.g., levels that are too low to be precisely measured by hormone testing panels) are predictive of chances of conception, but that most studies don’t use low enough cutoffs for “low” AMH to identify those with lower fertility, like people with POI.
- The same criticism applies for how different studies defined “high” AMH: the cutoffs for “high” AMH likely weren’t high enough to identify those with lower fertility there, like people with PCOS.
The bottom line on AMH and your chances of conception
Understanding your anti-Mullerian hormone levels, and how they’re changing over time, can empower you to make more informed decisions about your reproductive health and goals. What AMH test results can’t do, though, is tell you how likely you are to conceive in the short term, or how long it may take you to conceive if you started trying today. That being said, conditions like PCOS and POI that can be flagged through AMH measurements can affect your current chances of conception — and knowing about these conditions can help you determine the path forward that makes the most sense for you.
This article was reviewed by Prof. Scott Nelson, one of the leading experts on AMH and a Modern Fertility medical advisor.