Does low AMH mean poor egg quality?

We have many patients who come to us to say that the doctors said that the AMH (anti-Müllerian Hormone) is too low. They get the impression, or sometimes have even been told that, because they have low AMH, they cannot get pregnant.

If you, too, have low AMH, you don’t necessarily have to worry: You can still get pregnant naturally with low AMH, and here’s why.

Is AMH a measure of egg reserve?

We at TCM Healthcare believe AMH is not a measure of egg reserve for the following reasons: 

1. The reference ranges of AMH are inflated

The NHS’s PCOS web page estimates that 10% of women have polycystic ovary syndrome, commonly also referred to by its abbreviation, PCOS. PCOS sufferers usually have high AMH.

The reference ranges for AMH are constructed by randomly selecting women from different age groups and then measuring their AMH. Since 10% of women have PCOS with high AMH, they would have been included in the sample, skewing the measured average ranges up — a true AMH reference range should not include women with PCOS. The reference ranges are therefore inflated and not valid. The same problem applies with the reference range for the hormone Testosterone for women too (See my blog on PCOS).

The AMH result is expressed as a number. If you only interpret your AMH result by referring to the reference ranges given and the ranges are inflated, one of two things would happen:

1. You will be told that you have low AMH and the only option is IVF. But as the reference ranges are higher than what they actually are, you in fact do not have low AMH. You may also not need IVF. We’ll explain more about this further down this blog.
2. You will be told that your AMH is normal, when, in fact, it is too high. High AMH is a form of hormonal imbalance, which negatively impacts egg quality. However this is often ignored. The cause of infertility i.e. poor egg quality, remains undetected.

In our practice, we see this on a daily basis. Since the basis of decision making is not correct, decisions that follow are often incorrect too. Some patients spend years going through IVF and other treatments without knowing what their real issues are. You can find their stories in their testimonials and in Google reviews about us.

2. AMH can go up, sometimes quite significantly

The orthodox view is AMH is a measure of egg reserve and it declines with age. In over 20 years of clinical experience in fertility at TCM Healthcare, we know this is not the case in some women. When we looked at some of our patients’ medical history closely, we found that they had lower AMH earlier on. In some cases, their AMH levels were significantly lower before e.g. AMH at 5 pmol/L in May 2022 and 10 pmol/L in December 2023. It is highly unlikely, or even impossible, for one’s egg reserve to double in 18 months,. The more feasible explanation is that this patient has PCOS, and her condition is getting worse over time. 

Does AMH impact natural pregnancy?

While many think higher AMH levels are conducive to getting pregnant naturally, scientific evidence does not support this. Recent research reports that higher AMH levels do not equal greater natural pregnancy success, and have no bearing on IUI success rates when there is neither hormonal stimulation nor egg collection (see our resource page for more details).

AMH therefore tells us little about the chance of natural pregnancy: That is, however low your AMH level is, it has no impact on pregnancy.

Does low AMH impact egg quality?

The simple answer is that it does not impact egg quality if it is low. The reason is that AMH — at normal levels — does not impact your menstrual cycles: It does not make your cycles longer, shorter or go missing. Hormones like FSH, LH and oestradiol are much more likely to impact your periods, and so, your egg quality.

However, if your AMH is too high, it is likely to impact your egg quality adversely. This is because high AMH is associated with PCOS and PCOS is a hormonal imbalance condition. If your hormones are imbalanced, your egg quality will be affected negatively.

Does AMH impact ovulation?

Low or normal AMH levels do not impact on ovulation as AMH is a stable hormone and does not govern your cycles. AMH can only affect egg quality in PCOS cases, where AMH is elevated. High AMH is also associated with anovulation (no ovulation). When this happens, your egg quality is highly likely to be poor.

Does AMH impact periods?

We often get questions from our clients about whether having low AMH and regular periods is something they should worry about.

We explain to these patients that, if their goal is natural pregnancy, they need not worry: Their low AMH level has no impact on natural pregnancy and that having regular periods is a good sign.

AMH generally does not impact on periods unless you have PCOS. PCOS patients are likely to have high AMH and high testosterone, and they often have irregular or missing periods as symptoms of the condition. This means that high AMH is strongly associated with irregular periods, so natural pregnancy isn't affected by having low AMH and regular periods.

What is AMH then?

If AMH is not a measure for egg reserve, and high AMH is associated with PCOS, how should AMH be used and correctly interpreted when trying to get pregnant?

We believe that AMH is a measure of how many eggs an ART (assisted reproductive technique, like IUI or IVF) clinic can collect in an ART cycle. High AMH means a good number of eggs can be collected under stimulation while low AMH means a low number of eggs would be collected. 

It can also be viewed through the question: For which purpose are we using AMH? A low AMH may not be good for something like IVF, but it doesn’t rule out achieving natural pregnancy, so long as you’re having regular periods, as normal AMH makes little difference on egg quality. We at TCM Healthcare have worked with women who have really low AMH to naturally increase their AMH levels to help maximise their IUI and IVF chances, and also help women to get pregnant naturally by reducing their abnormally high AMH, through the use of traditional Chinese medicine.

Why is AMH often regarded as an important measure for fertility?

It may be because fertility clinics are mainly about egg collection. Women are often told that their AMH is low (because of the skewed reference ranges we talked about earlier). Women may then infer that natural pregnancy is not an option for them. This is, of course, wrong, but is a conclusion many women arrive at — or are told.

This is unfortunate and many women seem to become worried about their AMH unnecessarily. When they have contacted us at TCM Healthcare, some have even been in tears. We have to explain to them the same things about AMH as we’ve talked about here, that:

• AMH level has little to do with ovulation
• AMH has little to do with natural pregnancy
• AMH level does not determine egg quality, unless it is too high, which means egg quality is likely to be poor
• Egg quality is paramount
• Egg quality is strongly associated with some key hormones — and imbalance of hormones lead to poor egg quality
• Egg quality can be improved because hormones can be improved

Check out our next blog where we will talk about what determines egg quality and how egg quality can be improved.

To test your AMH, please click here.