Recent studies have provided new insights into the role of antimüllerian hormone (AMH) in female fertility. AMH, produced by granulosa cells in ovarian follicles, serves as a marker of ovarian reserve—the quantity of remaining eggs. Traditionally, while AMH has been used to assess ovarian reserve, its direct relationship with natural conception has been debated. However, emerging research indicates that lower AMH levels are associated with reduced odds of conception and longer times to achieve pregnancy.

A study published in Fertility and Sterility examined the association between AMH levels and time to pregnancy. The researchers analyzed data from 3,150 women aged 21 to 45 who were attempting to conceive. Participants provided blood samples to measure AMH levels and tracked their menstrual cycles and conception attempts using a digital application. The findings revealed that women with lower AMH levels had a decreased likelihood of conception compared to those with normal or higher AMH levels. Specifically, low AMH levels were linked to a lower chance of conception, with an adjusted odds ratio of 0.77. This association persisted across all age groups, suggesting that AMH is a significant predictor of fertility potential. 

Further analysis indicated that the probability of conception was highest around the fourth menstrual cycle of attempting to conceive, regardless of AMH levels. However, women with low AMH levels had consistently lower probabilities of conception at each cycle compared to those with normal or high AMH levels. For instance, at cycle four, the conception probabilities were 11.2% for low AMH, 14.3% for normal AMH, and 15.7% for high AMH levels. These findings underscore the importance of AMH as a biomarker in reproductive counseling, aiding in the planning of reproductive timelines. 

It’s important to note that while low AMH levels are associated with reduced fertility, they do not preclude the possibility of natural conception. Many women with low AMH levels can and do conceive naturally, especially if other factors such as regular ovulation and good overall reproductive health are present. Therefore, AMH should be considered as part of a comprehensive fertility assessment rather than a definitive predictor of infertility.

In clinical practice, AMH testing is valuable for assessing ovarian reserve and guiding fertility treatments. For women considering assisted reproductive technologies like in vitro fertilization (IVF), AMH levels can help predict ovarian response to stimulation. Higher AMH levels often correlate with a better response to ovarian stimulation, while lower levels may indicate a need for adjusted treatment protocols. However, it’s crucial to interpret AMH levels alongside other clinical findings and patient history to make informed decisions.

Age remains a critical factor in fertility, often outweighing the influence of AMH levels. As women age, both the quantity and quality of their eggs decline, leading to decreased fertility. The studies highlight that within each age category, higher AMH levels are associated with better odds of conception, but advancing age still significantly impacts fertility outcomes. Therefore, while AMH provides valuable information, it should be considered in the broader context of a woman’s age and overall reproductive health.

For women with low AMH levels, early consultation with a fertility specialist is advisable. Such consultations can provide personalized assessments and guidance on fertility preservation options, such as egg freezing, or alternative conception methods, including IVF. Lifestyle modifications, such as maintaining a healthy weight, avoiding smoking, and managing stress, can also support fertility. It’s essential for women to have open discussions with their healthcare providers to understand their individual fertility profiles and make informed decisions about family planning.

In conclusion, while low AMH levels are linked to reduced odds of conception and longer times to achieve pregnancy, they are not definitive indicators of infertility. AMH is a valuable tool in assessing ovarian reserve and guiding fertility planning, but it should be interpreted within the context of other factors, including age, overall health, and lifestyle. Women concerned about their fertility should seek comprehensive evaluations and personalized advice from healthcare professionals to make informed decisions about their reproductive health.

Sources

5 February 2025. Contemporary OB/GYN

• Low antimüllerian hormone levels linked to reduced odds of conception

2 July 2024. Fertility and Sterility

• Antimüllerian hormone levels are associated with time to pregnancy in a cohort study of 3,150 women