Anti-Müllerian Hormone (AMH)
AMH (anti-Müllerian hormone) is a hormone produced by small, growing follicles in the ovary.1 A follicle is the small fluid-filled sac that holds an egg. A blood test for AMH gives an approximate count of the small follicles growing at the time of the test.1 AMH varies less across the cycle than FSH or estradiol. Modern laboratory tests still show that it can shift within one cycle and from one cycle to the next.2 AMH is an estimate of the current follicle pool. The level may change when a treatable cause is identified and addressed.3
AMH measures how many follicles are present. It does not measure egg quality or the function of ovulation.4 In natural conception, the body develops one dominant follicle each cycle.5 A review of 11 studies with 4,388 women found that AMH is a poor predictor of natural pregnancy.6 In a study of women trying to conceive naturally, women with low AMH were not less likely to conceive.7 A low AMH is a reason to ask why and to begin the workup promptly.
What does a low AMH mean? AMH became a key measure because IVF depends on growing many follicles at once.8 Natural conception works with one egg per cycle. A low AMH means fewer follicles. Ovarian reserve is the size of the follicle pool. In women under 38 with low ovarian reserve, IVF embryos were as likely to have normal chromosomes as embryos from women with normal reserve.9
An RRM clinician asks a different question: is this follicle maturing well? The size of the pool helps guide the workup. Restorative care has its own outcome record. A 2018 study followed 403 couples who had already tried IVF an average of 2.1 times. The women had an average age of 37.2 years. With restorative care, 32.1 percent had a live birth after adjustment for couples who left treatment early. Before that adjustment, the figure was 18.4 percent.10
A low AMH result is a clue. The next question is what is lowering it. Age is one factor.11 Surgery on the ovary, such as removal of endometriosis cysts, can lower AMH.12 Vitamin D also plays a role. In pooled studies of women without polyendocrine metabolic ovarian syndrome (PMOS), formerly polycystic ovary syndrome (PCOS), vitamin D supplements raised AMH.3 Pooled studies also found that AMH rose in the short term after DHEA, an adrenal hormone, in women with low reserve.13 A change in AMH does not equal a change in the chance of pregnancy. AMH does not reliably predict that chance.6
AMH can also be elevated. In PMOS / PCOS, many small follicles accumulate without maturing. This pattern raises AMH considerably.14 A high level can indicate stalled follicle growth that warrants closer evaluation.15
AMH is one part of a fuller workup. NaProTechnology protocols may use AMH alongside an AFC (antral follicle count), cycle chart patterns, timed hormone tests, and a follicle maturation study. AMH also matters for men. Before birth, Sertoli cells in the testes produce AMH. In boys, this AMH stops the growth of the ducts that would otherwise form a uterus.1 For this reason, AMH can help assess Sertoli cell function in a male factor evaluation.16
Cited in this entry
- Dewailly D, Andersen CY, Balen A, Broekmans F, Dilaver N, Fanchin R, et al. The physiology and clinical utility of anti-Müllerian hormone in women. Human Reproduction Update. 2014. https://pubmed.ncbi.nlm.nih.gov/24430863/
- Melado L, Lawrenz B, Sibal J, Abu E, Coughlan C, Navarro AT et al. Anti-müllerian Hormone During Natural Cycle Presents Significant Intra and Intercycle Variations When Measured With Fully Automated Assay. Frontiers in endocrinology. 2018. https://pubmed.ncbi.nlm.nih.gov/30542322/
- Moridi I, Chen A, Tal O, Tal R The Association between Vitamin D and Anti-Müllerian Hormone: A Systematic Review and Meta-Analysis. Nutrients. 2020. https://pubmed.ncbi.nlm.nih.gov/32481491/
- Cedars MI Evaluation of Female Fertility-AMH and Ovarian Reserve Testing. The Journal of clinical endocrinology and metabolism. 2022. https://pubmed.ncbi.nlm.nih.gov/35100616/
- Hodgen GD, Kenigsburg D, Collins RL, Schenken RS Selection of the dominant ovarian follicle and hormonal enhancement of the natural cycle. Annals of the New York Academy of Sciences. 1985. https://pubmed.ncbi.nlm.nih.gov/3925837/
- Lin C, Jing M, Zhu W, Tu X, Chen Q, Wang X, et al. The value of anti-Müllerian hormone in the prediction of spontaneous pregnancy: a systematic review and meta-analysis. Frontiers in Endocrinology. 2021. https://pubmed.ncbi.nlm.nih.gov/34721287/
- Steiner AZ, Pritchard D, Stanczyk FZ, Kesner JS, Meadows JW, Herring AH et al. Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age. JAMA. 2017. https://pubmed.ncbi.nlm.nih.gov/29049585/
- Broer SL, Mol BW, Hendriks D, Broekmans FJ The role of antimullerian hormone in prediction of outcome after IVF: comparison with the antral follicle count. Fertility and sterility. 2009. https://pubmed.ncbi.nlm.nih.gov/18321493/
- Morin SJ, Patounakis G, Juneau CR, Neal SA, Scott RT, Seli E Diminished ovarian reserve and poor response to stimulation in patients <38 years old: a quantitative but not qualitative reduction in performance. Human reproduction (Oxford, England). 2018. https://pubmed.ncbi.nlm.nih.gov/30010882/
- Boyle PC, de Groot T, Andralojc KM, Parnell TA. Healthy singleton pregnancies from restorative reproductive medicine (RRM) after failed IVF. Frontiers in Medicine. 2018. https://pubmed.ncbi.nlm.nih.gov/30109231/
- Seifer DB, Baker VL, Leader B Age-specific serum anti-Müllerian hormone values for 17,120 women presenting to fertility centers within the United States. Fertility and sterility. 2011. https://pubmed.ncbi.nlm.nih.gov/21074758/
- Younis JS, Shapso N, Ben-Sira Y, Nelson SM, Izhaki I. Endometrioma surgery: a systematic review and meta-analysis of the effect on antral follicle count and anti-Müllerian hormone. American Journal of Obstetrics and Gynecology. 2022. https://pubmed.ncbi.nlm.nih.gov/34265271/
- Yin WW, Huang CC, Chen YR, Yu DQ, Jin M, Feng C. The effect of medication on serum anti-müllerian hormone (AMH) levels in women of reproductive age: a meta-analysis. BMC Endocrine Disorders. 2022. https://pubmed.ncbi.nlm.nih.gov/35698127/
- Teede H, Misso M, Tassone EC, Dewailly D, Ng EH, Azziz R, et al. Anti-Müllerian hormone in PCOS: a review informing international guidelines. Trends in Endocrinology and Metabolism. 2019. https://pubmed.ncbi.nlm.nih.gov/31160167/
- Pigny P, Merlen E, Robert Y, Cortet-Rudelli C, Decanter C, Jonard S et al. Elevated serum level of anti-mullerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. The Journal of clinical endocrinology and metabolism. 2003. https://pubmed.ncbi.nlm.nih.gov/14671196/
- Benderradji H, Prasivoravong J, Marcelli F, Leroy C Role of Anti-Müllerian Hormone in Male Reproduction and Sperm Motility. Seminars in reproductive medicine. 2024. https://pubmed.ncbi.nlm.nih.gov/38914117/
Authoritative references
How other clinical authorities define this term. RRM Academy curates these verbatim or under fair use so the medical consensus is visible alongside our RRM-contextualized definition above.
- MeSH D054304
A glycoprotein that causes regression of MULLERIAN DUCTS. It is produced by SERTOLI CELLS of the TESTES. In the absence of this hormone, the Mullerian ducts develop into structures of the female reproductive tract. In males, defects of this hormone result in persistent Mullerian duct, a form of MALE PSEUDOHERMAPHRODITISM.
- NCI Thesaurus C101737
Muellerian-inhibiting factor (560 aa, ~59 kDa) is encoded by the human AMH gene. This protein plays a role in the development of the male reproductive system.
- Wikipedia Anti-M%C3%BCllerian_hormone
Anti-Müllerian hormone (AMH), also known as Müllerian-inhibiting factor (MIF), is a protein that in humans is encoded by the AMH gene.
This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.
