Summary
Anti-Müllerian Hormone (AMH) is produced by the small developing follicles in the ovaries and reflects the size of the remaining egg supply — a woman's ovarian reserve. Unlike FSH and oestradiol, AMH is stable across the menstrual cycle, so it can be measured at any time. It is widely used in fertility assessment, IVF planning, and investigating PCOS.
AMH is secreted by the granulosa cells of small, early-stage ovarian follicles. The more of these follicles a woman has, the higher her AMH — making it a good indicator of how many eggs remain. AMH declines with age and becomes very low or undetectable around menopause.
A low AMH suggests reduced ovarian reserve and may indicate a shorter fertile window or a lower response to ovarian stimulation in IVF. A high AMH is often seen in PCOS, where there are many small follicles.
Importantly, AMH reflects egg quantity, not egg quality, and does not predict natural fertility in any single cycle. It is most useful for fertility planning and predicting response to IVF, and should be interpreted alongside age and other factors.
What It Is
AMH is a dimeric glycoprotein of the TGF-β superfamily, secreted by granulosa cells of preantral and small antral follicles. Its level is proportional to the number of these follicles and therefore to the resting follicle pool (ovarian reserve). AMH also inhibits the recruitment of primordial follicles and modulates FSH sensitivity.
Because it is produced by follicles independent of the cyclical gonadotropin surges, AMH remains relatively stable across the menstrual cycle — a key advantage over FSH and oestradiol. It declines progressively with age, becoming undetectable near menopause.
Reference ranges are age-dependent and assay-specific; broadly, < 5.4 pmol/L suggests low reserve, 15–40+ pmol/L is reassuring in reproductive-age women, and markedly high levels are associated with PCOS. Units may be reported in pmol/L or ng/mL (1 ng/mL ≈ 7.14 pmol/L).
Functions
Ovarian reserve assessment
AMH reflects the remaining egg supply — the primary marker of ovarian reserve in fertility assessment.
IVF response prediction
Predicts how the ovaries will respond to stimulation during IVF, guiding treatment protocols and dosing.
Cycle-independent testing
Stable across the menstrual cycle, AMH can be measured on any day — unlike FSH and oestradiol.
PCOS assessment
Often markedly elevated in PCOS, reflecting the large number of small ovarian follicles.
Reference Ranges
Anti-Müllerian Hormone (AMH)
Measured in pmol/L| Status | Range (pmol/L) | Range (ng/mL) | What it means |
|---|---|---|---|
| Low reserve | < 5.4 | < 0.8 | Low ovarian reserve — fewer remaining eggs; may indicate reduced IVF response. |
| Satisfactory | 5.4–25 | 0.8–3.5 | Satisfactory ovarian reserve for reproductive-age women. |
| High | 25–40 | 3.5–5.6 | High-normal reserve — good response to ovarian stimulation likely. |
| Very high | > 40 | > 5.6 | Very high — associated with PCOS and a risk of ovarian hyperstimulation in IVF. |
AMH ranges are strongly age-dependent and assay-specific — interpret against age-matched values. AMH indicates egg quantity, not quality, and does not predict natural conception in a single cycle.
Symptoms of Imbalance
AMH itself causes no symptoms; it is used to assess ovarian reserve rather than to explain symptoms.
- Often no symptoms — detected on fertility testing
- May accompany irregular or shortening cycles in late reproductive years
- Difficulty conceiving
- Approaching menopause
- Often no symptoms — detected on testing
- May accompany PCOS features: irregular periods, acne, hirsutism
- Higher risk of ovarian hyperstimulation during IVF
Causes of Imbalance
- Advancing age (natural decline)
- Diminished ovarian reserve
- Premature ovarian insufficiency
- Previous ovarian surgery
- Chemotherapy or radiotherapy
- Approaching menopause
- Polycystic ovary syndrome (PCOS)
- Younger age (naturally higher reserve)
- Granulosa cell tumours (rare)
FAQs
AMH reflects your ovarian reserve — roughly how many eggs you have remaining. A higher AMH suggests a larger egg supply and usually a better response to fertility treatment; a lower AMH suggests a reduced reserve. However, AMH measures egg quantity, not quality, and does not predict whether you will conceive naturally in any given month. It is most useful for fertility planning and guiding IVF, interpreted alongside your age.
Yes — this is one of AMH’s main advantages. Because it is produced by small follicles independently of the cyclical hormone surges, AMH remains relatively stable throughout the menstrual cycle and can be measured on any day. This makes it more convenient than FSH and oestradiol, which must be tested early in the cycle.
A high AMH usually reflects a large number of small ovarian follicles, which is characteristic of polycystic ovary syndrome (PCOS). In the context of IVF, a very high AMH predicts a strong response to ovarian stimulation but also a higher risk of ovarian hyperstimulation syndrome, so treatment is adjusted accordingly. A high AMH is generally reassuring about egg quantity.
No. A low AMH indicates a reduced egg supply, but women with low AMH can and do conceive naturally — it only takes one healthy egg. AMH does not measure egg quality or guarantee the outcome of any cycle. It is best viewed as one piece of information for fertility planning, particularly useful if you are considering the timing of trying to conceive or fertility treatment.
References
- Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve. Fertil Steril. 2020;114(6):1151–1157. View source
- Dewailly D, et al. The physiology and clinical utility of anti-Müllerian hormone in women. Hum Reprod Update. 2014;20(3):370–385. View source
- Iliodromiti S, et al. The predictive accuracy of anti-Müllerian hormone for live birth after assisted conception. Hum Reprod Update. 2014;20(4):560–570. View source