Low AMH: what it means, how age affects your eggs, and the treatment options
AMH (anti-Mullerian hormone) is a blood test that reflects how many eggs remain in the ovaries, which doctors call the ovarian reserve. A low AMH means fewer eggs are left than expected, not that pregnancy is impossible. It says little about egg quality, which depends mainly on age. The key message of a low result is: do not delay.
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This is the first video in Dr Mayur Pai's series on low AMH. He explains what the test measures, what low ovarian reserve means, and how age affects fertility. The second video, further down this page, covers the treatment options.
What is AMH?
AMH, or anti-Mullerian hormone, is made by the small follicles in the ovaries, the tiny fluid-filled sacs that each hold an immature egg. The more of these small follicles a woman has, the higher her AMH tends to be. So the level in the blood acts as a mirror of the egg reserve.
It is a simple blood test, and unlike some hormone tests it can usually be done on any day of the cycle. The result means most when it is read together with your age and with an ultrasound count of the small follicles, called the antral follicle count, done early in the cycle.
Two practical points. Hormonal contraceptive pills can lower the reading for a while, and results can differ a little between laboratories. So a single borderline value should be interpreted calmly, and sometimes repeated, rather than read in panic.
How does age affect the egg reserve?
A woman is born with all the eggs she will ever have, and every month a group of them is used up, whether or not she ovulates, and even while she is on the pill or pregnant. So the reserve shrinks with time, and faster from the mid to late thirties.
Age also affects quality, which AMH does not measure. As a woman gets older, more of her eggs carry chromosome errors, which slows conception and makes miscarriage more likely. Put simply, AMH tells us roughly how many eggs are left, and age tells us most about how good they are likely to be. That is why a younger woman with a low AMH is usually in a better position than an older woman with the same result. Our guide to fertility and age explains the age side in more detail.
What else can lower AMH?
- Earlier surgery on the ovaries, for example to remove cysts
- Endometriosis, especially the "chocolate cysts" it can form in the ovary
- Past chemotherapy or radiotherapy
- Smoking
- A family history of early menopause
Often, though, no particular reason is found. It also helps to know that a high AMH is common in PCOS, where the ovaries hold many small follicles. A high result is not automatically good news; it is simply read differently.
What does a low AMH not mean?
- It does not mean menopause has started. Many women with a low AMH still have regular periods and release an egg each month.
- It does not mean you cannot conceive. Pregnancy, including natural pregnancy, is still possible.
- It does not measure egg quality. That depends mainly on age.
- It is not the whole story. The same number means different things at different ages, which is why the doctor reads it alongside your full history and your husband's semen report.
What a low AMH does mean is that time matters more. Long gaps between tests, or repeating the same treatment again and again, cost more when the reserve is small.
What are the treatment options when AMH is low?
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In the second video, Dr Mayur Pai goes through the options. Which one fits depends on the wife's age, whether the tubes are open, the husband's semen analysis and how long you have been trying. Broadly, the choices are these:
- Trying naturally, for a short and defined time. For a younger woman who ovulates regularly, with open tubes and a normal semen report, timing intercourse to the fertile days can be reasonable for a limited period, with a clear date to review.
- Ovulation support with IUI. When the tubes are open and the sperm are reasonable, a few well-timed, scan-monitored IUI cycles may be tried first; see IUI when your AMH is low.
- IVF. When age is less on your side, the reserve is very low, or other factors are present, IVF makes the most of the eggs you have. The stimulation is planned around your reserve, fewer eggs may be collected, and sometimes embryos are collected and frozen over more than one cycle before a transfer; see how IVF works.
- When the husband's count is also low, the plan has to consider both at once; see low AMH and a low sperm count together.
Many medicines and supplements are sold with promises of raising AMH. No tablet can add eggs to the ovaries. Some supportive medicines are used in selected cases, but please do not start anything on your own; ask the doctor whether it makes sense for you. Stopping smoking, reaching a healthy weight and controlling any thyroid or sugar problem still matter, because they help the body respond to treatment.
Why does time matter?
A low AMH is a reason to plan promptly, not a reason to despair. Many women with a low reading go on to conceive. What helps most is not losing months: get both partners' tests done together, decide on a plan without long delays, and agree in advance on the point at which you will move to the next step if the first one does not work.
Where treatment happens
This guide is by Dr Mayur Pai, MBBS, MS (Obstetrics & Gynaecology), a fertility and laparoscopy specialist. Pai Hospital in Goa has its own operating theatre and its own IVF laboratory, so your blood tests, scans and treatment are planned by one team that sees the whole picture.
Questions, or ready to book?
If you have a question, send a WhatsApp message to +91 95185 02773 with your situation and any reports you already have. Consultations are by appointment, so please call Sheetal at our fertility reception on +91 95459 20817 to book a time. Consultations are held in Panjim, Margao, Mapusa and Vasco. This article is for education only and is not personal medical advice; please consult your doctor about your own situation.
Your questions
Can AMH be increased?
No medicine can add eggs to the ovaries, so the aim is to use the time and the eggs available well. Stopping smoking, a healthy weight and good control of any thyroid or sugar problem still help the body respond to treatment.
Can I get pregnant naturally with a low AMH?
It is possible, especially if you are younger, ovulate regularly, have open tubes and your husband's report is normal. A low AMH mainly means you should not wait too long before getting help if pregnancy does not happen.
Does a low AMH mean early menopause?
Not necessarily. It suggests the reserve is lower than usual for your age, and menopause may come somewhat earlier, but AMH cannot predict when. Many women with a low AMH still have regular periods.
On which day of the cycle should AMH be tested?
AMH can usually be tested on any day of the cycle. The ultrasound count of the small follicles, which is read along with it, is done early in the cycle, usually on the second or third day of the period.
Is IVF the only option when AMH is low?
No. Depending on your age, your tubes and your husband's semen report, trying naturally for a short time or a few cycles of IUI may be reasonable first. IVF is usually advised sooner when age or other factors mean time is short.
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This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.