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Understanding AMH levels

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Diagram showing where AMH is produced in the ovary.

Infertility, egg quality and Anti-Mullerian hormone

When considering AMH results please bear in mind that the primordial follicles don’t produce AMH, thus your true ovarian reserve isn’t measured by AMH. It’s less a measure of ‘how many eggs do I have left’ and more a measure of ‘how many eggs am I currently recruiting‘?

If AMH levels can also be measured in men….why the heck is it being used to measure my egg reserve???

The diagrams given here are from Crespo et al. 2018 and La Marca et al. 2010. Email us if you want the links discussed in this post.

Note that the adrenal glands produce DHEA which has been shown to improve AMH results. Thus stress reduction (reducing adrenaline and cortisol over-production) can improve the adrenal capacity to make DHEA.

See also the 2017 study by Steiner et al. which concludes by stating “biomarkers indicating diminished ovarian reserve compared with normal ovarian reserve were not associated with reduced fertility.” .Dr Rosenwaks calls this study ‘elegant’. “All it takes is one egg each cycle…AMH is not a marker of whether you can or cannot become pregnant.” As quoted in a 2017 New York Times article discussing the study.

AMH is not a measure of how many eggs you have left in your ovaries.

AMH is relevant for ART/IVF specialists to determine whether synthetic FSH (eg. Gonal-F, Menopur) is going to be useful or not. AMH is used by specialists to predict how well (or not well) ovaries will respond to FSH stimulation. AMH is really only a predictor of how high or low a dose of FSH the ovaries might need in order to respond favourably. 💉

The quality of the egg is not determined by the level of AMH.

Also note that a recent study by Zheng and colleagues (2017) found that melatonin levels were positively correlated with follicle count and AMH levels.

(In layman’s terms, the more melatonin you make, the more follicles you produce and the more your AMH levels increase).

You all know about producing more of your own endogenous melatonin!! 💤