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What is AMH and Why is it Important?

If you’re a regular in the fertility space, you have probably seen many women get their AMH, or Anti-Mullerian Hormone, levels tested. While AMH is a common hormone to have tested when trying to conceive, there is a misconception about what AMH levels actually mean.

Many women associate AMH with egg quality, when actually AMH tests for egg quantity. Egg quality has to do with the genetic makeup of an egg - something essentially impossible to test for with a hormone-based test. 

But there’s a reason AMH testing is so common - it can provide important information about ovarian reserve!

What is AMH?

AMH is a hormone secreted by premature follicles (follicles that are not yet ready to release an egg). Women are born with approximately 1-2 million follicles, but as they age, their number of follicles decreases. By puberty, the number of follicles a woman has is down to about 400,000.

Each cycle ~1,000 follicles are recruited to mature an egg, but only one egg actually matures and ovulates. The 999 other follicles die. 

AMH levels can be used as a biomarker for ovarian reserve, or how many follicles a woman has left. A normal AMH level can be anywhere from 0.7 to 2.0 ng/mL. Low AMH levels (less than 0.7 ng/mL) can be a sign of low ovarian reserve, usually seen in women nearing menopause. On the other hand, high AMH levels (greater than 3.0 ng/mL) can be a sign of PCOS.

Do I need to know my ovarian reserve?

Generally speaking, testing AMH and knowing your ovarian reserve is up to you and your doctor. For women trying to conceive later in life, it can give you a good idea of how many eggs you have left. For others, knowing their ovarian reserve is another great piece of information to empower them! There are however a few specific cases where testing AMH is especially helpful. 

As we mentioned, high AMH can be a sign of PCOS. Women with PCOS have cysts that develop on their ovaries. These cysts are actually egg containing follicles which have not developed to full maturity. These immature follicles produce AMH just as other follicles would, leading to elevated levels. 

The other important case for AMH testing is women undergoing in vitro fertilization (IVF). In an IVF cycle, AMH levels are used to predict the success rates of that cycle. The goal in any IVF cycle is to mature about 15 eggs - much more than the one egg that matures during a natural cycle. The higher the AMH, the more eggs can be matured, and the more mature eggs, the better chance a woman has at a successful retrieval and pregnancy.

In fact, studies have shown that women with a higher AMH level (but still in the “normal” range) have a higher chance of a live birth at the end of IVF.

AMH is only indicative of success rates for IVF, not if you are trying to conceive naturally, since in a natural cycle only one egg is released at a time. If you are TTC naturally AMH likely won’t give you a ton of information about your chances of success. But if you’re concerned about having PCOS or would just feel better knowing your AMH is normal, we recommend consulting your doctor. 

What if I’m trying to conceive naturally?

 

If you are TTC naturally, you still want to give each egg the best chance at conception and resulting in a live birth. While knowing your AMH level may not be as helpful as other information in this case, there are other measures you can take to ensure your body is prepared for conception.

That’s where Proov comes in! Proov is the first and only FDA cleared PdG test kit that confirms ovulation. PdG is the urine metabolite of progesterone, which is produced by the empty follicle after ovulation has occurred. PdG is only metabolized in urine when progesterone is also present in blood. 

While a single positive Proov test confirms ovulation, four positive Proov tests on days 7-10 after suspected ovulation confirm “successful” ovulation. This means that hormone levels post ovulation were elevated for a long enough period of time to support implantation, should conception occur. Successful ovulation means that an embryo has the best possible chance at survival.

Testing AMH and PdG levels are simple ways to arm yourself with as much information as possible, allowing you to be the best possible advocate for yourself in your fertility journey!