AMH and Natural Conception: What Does the Latest Research Tell Us?
What is AMH?
Anti-Müllerian hormone (AMH) is a protein produced by small antral follicles on the ovaries. It serves various important roles in the development and regulation of female reproductive processes. Traditionally, AMH has been used as a tool to monitor three things:
Ovarian Reserve: A woman is born with all the eggs that she will ever have, unlike men who continue to produce sperm their entire lives. A woman is born with over a million eggs and by puberty only has about 300,000 eggs remaining. Of the eggs remaining at puberty, only about 300 will be ovulated during your entire reproductive years and the rest will be lost to mother nature. AMH is often used as a marker of ovarian reserve as higher levels AMH indicate a larger pool of eggs are remaining and lower AMH value indicates a smaller pool of eggs are remaining.
Predicting Menopause: Very low levels of AMH (< 0.01 ng/mL) can help predict the time women will enter menopause. A study published in 2020 demonstrated that most women with a very low AMH have a high probability of entering menopause within 12 months (79% probability for women over the age of 51 and 51% for women under the age of 48).
Response to Ovarian Stimulation: In assisted reproductive technologies (ART) such as in vitro fertilization (IVF), AMH levels can help predict a woman's response to ovarian stimulation medications. Additionally, it can be used to gauge the anticipated number of eggs that may be retrieved in an IVF cycle. Women with lower AMH vales will typically produce a fewer number of eggs than expected. Women with higher AMH levels often have a higher egg yield during IVF.
Can AMH be used as part of the fertility assessment?
Whether or not AMH can be used as tool to predict your ability to conceive naturally has been a hot topic in the infertility world for years. In 2017, an article published in the Journal of the American Medical Association (JAMA) demonstrated that AMH did not impact your chance of natural conception. Meaning if you had a low AMH when you were just starting your trying to conceive journey, you did not have a lower cumulative probability of pregnancy. However, a recent abstract was published in Fertility & Sterility (F&S) suggesting that AMH levels may have some influence on natural conception. This abstract will be published at the upcoming ASRM conference in New Orleans October 16th, 2023.
What does the latest research tell us?
The biggest difference between the 2017 JAMA study and the 2023 F&S abstract is numbers. There were over four times as many participants in the 2023 F&S abstract (750 compared to 3307 participants)! This study was conducted using data from Modern Fertility Hormone Test. AMH levels were categorized as low, normal, or high, and various factors were considered, including age, BMI, parity, smoking status, and more. The data suggests that women with low AMH levels had a lower chance of natural conception compared to those with normal AMH levels, particularly in women with regular menstrual cycles. There was no significant difference in the chance of conception between women with high and normal AMH levels.
This is the first article to suggest that AMH may have a role in predicting fertility potential for women who are not yet trying to conceive. Additional research on this topic is needed to confirm the findings.
What does this mean for me?
This research suggests that AMH levels can play a role in natural conception and may be valuable information for healthcare providers when counseling women on fertility potential and identifying those at risk of reduced fertility. It's important to note that while AMH is a useful marker of ovarian reserve and can provide insights into fertility potential, it is just one piece of the puzzle. Fertility is influenced by a complex interplay of factors, including age, overall health, and lifestyle factors. Therefore, the interpretation of AMH levels should be done in conjunction with a comprehensive fertility assessment conducted by a healthcare provider.
If you are someone who has a low AMH and are just starting your trying to conceive journey or got this test done merely to assess your fertility potential, do not panic. This result does not define you! It is important to use this as valuable information and allow it to empower you to be more proactive about your fertility journey.