Lab result explainedHormonesLast updated November 10, 2026

AMH test: normal range by age, and what low or high anti-Mullerian hormone means

Anti-Mullerian hormone (AMH) · Ovarian reserve testing (AMH, with FSH, estradiol and antral follicle count) · reported in ng/mL (multiply by 7.14 for pmol/L)

Anti-Mullerian hormone (AMH) is made by the small, growing follicles in the ovaries, each of which contains an immature egg, so the level in your blood reflects roughly how many eggs are left in the pipeline, which is what ovarian reserve means. The AMH test is reported in ng/mL. It falls steadily with age, from a typical 3 to 4 ng/mL in the mid-twenties to about 1 ng/mL at 40 and under 0.5 by 45, and becomes undetectable a few years before menopause. There is no single normal range; the result is read against your age and, for fertility treatment, against the number of eggs a clinic expects to retrieve.

AMH is used for three main things: predicting how an ovary will respond to the stimulation drugs used in IVF and egg freezing, identifying diminished ovarian reserve or premature ovarian insufficiency, and, since the 2023 international guideline, as an alternative to ultrasound in diagnosing polycystic ovary syndrome in adults, where levels are typically two to three times higher than average. It is also checked after chemotherapy or ovarian surgery to gauge how much reserve remains.

What AMH does not do is predict whether you can get pregnant naturally. In a study of 750 women aged 30 to 44 trying to conceive, those with a low AMH (under 0.7 ng/mL) were just as likely to be pregnant within 12 months as those with normal levels, because natural conception needs one good egg a month rather than many. AMH tells you about quantity, not egg quality, and it says nothing about your tubes, uterus or partner. A low result in someone not planning IVF is a reason for a conversation about timing, not a verdict.

AMH at a glance

  • What it is: a hormone from small ovarian follicles; the blood level tracks how many eggs remain (ovarian reserve). Reported in ng/mL; multiply by 7.14 for pmol/L.
  • Typical levels by age: 20–24 about 2.5–5 ng/mL; 25–29 about 2–4; 30–34 about 1.5–3; 35–39 about 1–2; 40–44 about 0.3–1; over 45 under 0.3. Labs and assays differ.
  • Low AMH: under about 1.0 ng/mL predicts a poor response to IVF stimulation (fewer eggs); under 0.3 to 0.5 is very low; undetectable levels usually mean menopause is within a few years.
  • High AMH: above about 4 to 5 ng/mL is common in PCOS and in younger women, and predicts a strong, sometimes excessive, response to IVF drugs (risk of ovarian hyperstimulation).
  • AMH does not predict natural fertility, egg quality or the chance of miscarriage; women with low AMH conceive naturally at the same rate as women with normal AMH.
  • Next step: read it with your age, an antral follicle count on ultrasound and day-3 FSH; stop hormonal contraception for 2 to 3 months before testing if the result will change a decision.

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What AMH measures

A woman is born with all the eggs she will ever have, stored in primordial follicles that are slowly recruited to grow throughout life. As a follicle grows from the primordial stage to a small antral follicle of 2 to 8 mm, its granulosa cells secrete AMH into the blood; once it is selected to ovulate, AMH production stops. Because the number of these small growing follicles is proportional to the size of the remaining egg store, AMH acts as an indirect count of the eggs left. Its biological job is to slow the recruitment of further follicles, which is one reason PCOS, with many small arrested follicles, produces so much of it.

The lab measures AMH with an immunoassay. Older manual assays and the newer automated ones (Roche Elecsys, Beckman Access) are calibrated differently and the newer ones read somewhat lower, so results from different labs or from several years apart are not interchangeable; use the reference range on your own report. Fasting is not needed. Unlike FSH, AMH varies only modestly across the menstrual cycle (by around 10 to 20 percent), so it can be drawn on any day, although many clinics still test early in the cycle alongside FSH and estradiol.

Several things push AMH down without changing the egg store. Combined hormonal contraception, including the pill, patch, ring and hormonal IUD in some studies, lowers AMH by about 20 to 30 percent while in use, recovering 2 to 3 months after stopping; pregnancy and breastfeeding lower it; current smoking, obesity and vitamin D deficiency are associated with modestly lower values. Recent ovarian surgery and chemotherapy lower it by removing or damaging follicles. AMH is also used in men and children: in boys it is made by the testes and confirms the presence of testicular tissue.

Normal range for AMH

Reference ranges vary between labs and by age, sex and pregnancy. Use the range printed on your own report.

GroupTypical range (ng/mL (multiply by 7.14 for pmol/L))Notes
Age 20–24, typicalAbout 2.5–5.0 ng/mLApproximate central ranges from large fertility-clinic series; individual values vary widely and labs differ. Values above 5 are common in PCOS.
Age 25–29, typicalAbout 2.0–4.0 ng/mLMedian roughly 3 ng/mL.
Age 30–34, typicalAbout 1.5–3.0 ng/mLMedian roughly 2 to 2.5 ng/mL; the decline accelerates after 35.
Age 35–39, typicalAbout 1.0–2.0 ng/mLMedian roughly 1.5 ng/mL.
Age 40–44, typicalAbout 0.3–1.0 ng/mLMedian under 1 ng/mL; many women are below 0.5 by 44.
Age 45 and overBelow 0.3 ng/mL, often undetectableUndetectable AMH on a sensitive assay in the late 40s usually means the final period is within 1 to 3 years, though individual prediction is imprecise.
Low ovarian reserve (IVF prediction)Below about 1.0–1.2 ng/mLBologna criteria use 0.5–1.1 ng/mL; POSEIDON uses 1.2 ng/mL. Predicts fewer eggs retrieved, not whether the eggs are healthy.
Very lowBelow 0.3–0.5 ng/mLExpect a poor response to stimulation; premature ovarian insufficiency is considered if periods are irregular or absent and FSH is high under age 40.
High (possible PCOS or strong responder)Above about 4–5 ng/mLTypical of PCOS, though cut-offs depend on the assay and age and AMH alone does not diagnose it. Above 3.5 ng/mL predicts a higher risk of ovarian hyperstimulation during IVF.

High AMH

A high AMH means there are more small growing follicles than average for your age. In a woman in her twenties with regular periods that is simply a large egg store and a good outlook for egg retrieval. The most common clinical reason for a high AMH is polycystic ovary syndrome, where follicle growth stalls at the small antral stage and the ovaries carry two or three times the usual number of them, each contributing AMH; levels above 4 to 5 ng/mL are typical and values of 10 or more occur. AMH in PCOS tends to run higher when ovulation is more disrupted and androgen levels are higher.

The 2023 international PCOS guideline allows AMH to stand in for an ultrasound count of follicles in adults when the other criteria (irregular ovulation and signs or blood tests of excess androgen) are present, but it stresses that AMH alone does not make the diagnosis, that the cut-off depends on the assay and the age of the woman, and that it should not be used in adolescents, whose AMH is naturally high. A high AMH with regular cycles and no androgen excess is not PCOS.

For fertility treatment, a high AMH is a double-edged result. It predicts a strong response to stimulation and a good number of eggs, but above about 3.5 ng/mL it also predicts a higher risk of ovarian hyperstimulation syndrome, so clinics use lower drug doses and different trigger strategies. Very rarely, an extremely high AMH in an older woman or a woman with a pelvic mass comes from a granulosa cell tumor of the ovary, which makes AMH directly and uses it as a tumor marker.

Common causes

  1. Polycystic ovary syndrome

    The leading cause; AMH is typically 2 to 3 times higher than in women of the same age without PCOS because of the excess of small arrested follicles. Levels fall modestly with weight loss and with treatments that restore ovulation.

  2. Younger age and a naturally large egg store

    Levels above 4 ng/mL are common and normal in women under 30. Adolescents have the highest values, which is why AMH is not used to diagnose PCOS before adulthood.

  3. Granulosa cell tumor of the ovary

    Rare tumors that secrete AMH and inhibin; values can be very high, and AMH is used to monitor for recurrence after removal.

  4. Assay and timing effects

    Older assays and some sample-handling conditions read higher; results from different labs are not interchangeable. Levels drift up slightly around ovulation in some women.

  5. Hypogonadotropic states

    In hypothalamic amenorrhea from low weight or over-exercise, AMH is usually normal or mildly raised despite absent periods, which helps distinguish it from ovarian insufficiency, where AMH is very low.

  6. Stopping hormonal contraception

    AMH rebounds by 20 to 30 percent over 2 to 3 months after stopping the pill, so a result shortly after stopping can look higher than one taken while on it.

Symptoms that can go with it

  • Often none; a high AMH by itself causes no symptoms
  • Irregular, infrequent or absent periods with PCOS
  • Acne, oily skin, excess facial or body hair, or scalp hair thinning from androgen excess
  • Difficulty conceiving because of infrequent ovulation
  • Weight gain and difficulty losing weight, with insulin resistance
  • Abdominal swelling, pain or postmenopausal bleeding, which with a very high AMH prompts imaging for a granulosa cell tumor

Low AMH

A low AMH means fewer small growing follicles, and therefore a smaller remaining egg store, than average for your age. What counts as low depends on what you are asking. For IVF or egg freezing, a value under about 1.0 to 1.2 ng/mL predicts that fewer eggs will be retrieved per cycle (often fewer than 4 to 5), and under 0.3 to 0.5 predicts a poor response, which changes the drug protocol and the expectations for each cycle. A low AMH does not predict the quality of the eggs that are retrieved, which depends mainly on age, and live birth rates per embryo are similar at a given age whether AMH is low or normal.

For natural conception the picture is different. Large studies have found that women with low AMH who have regular cycles conceive naturally at the same rate as women with normal AMH, because ovulating one healthy egg a month is what matters. Where a low AMH does carry weight is in timing: it suggests the fertile window may close sooner than average, so someone who wants children later may be advised not to wait, and someone who has been trying for 6 to 12 months may be referred sooner. It is also useful after chemotherapy or ovarian surgery to show how much reserve survived.

A very low or undetectable AMH in a woman under 40 with irregular or absent periods and a high FSH points to premature ovarian insufficiency, which needs assessment for causes (genetic, autoimmune, treatment-related) and discussion of hormone replacement. In a woman in her late 40s with changing cycles, an undetectable AMH simply confirms that menopause is approaching, usually within 1 to 3 years, although it cannot give a date.

Common causes

  1. Age

    The dominant factor. AMH roughly halves between 25 and 35 and again between 35 and 40, and most women are under 0.5 ng/mL by 45 as the follicle store runs down.

  2. Premature ovarian insufficiency

    Loss of ovarian function before 40 in about 1 percent of women; AMH is very low or undetectable with FSH above 25 to 40 IU/L on two tests. Causes include Turner syndrome and other genetic conditions, FMR1 premutation, autoimmune oophoritis and chemotherapy, and many cases are unexplained.

  3. Chemotherapy and pelvic radiation

    Alkylating agents such as cyclophosphamide destroy primordial follicles; AMH falls sharply during treatment and recovers only partially, more in younger women. It is used to assess fertility after cancer treatment.

  4. Ovarian surgery, especially for endometriomas

    Removing an endometrioma cyst wall takes healthy ovarian tissue with it; meta-analyses show AMH falls by about 30 to 40 percent after cystectomy, more when both ovaries are operated on.

  5. Hormonal contraception

    The combined pill and other hormonal methods suppress small-follicle activity and lower measured AMH by about 20 to 30 percent while in use, without reducing the egg store; levels recover within 2 to 3 months of stopping.

  6. Smoking

    Current smokers have lower AMH than never-smokers in several studies, with reductions of roughly a third to 40 percent in women in their late 30s and 40s, and reach menopause on average 1 to 2 years earlier; former smokers are closer to never-smokers.

  7. Endometriosis without surgery

    Endometriomas and extensive pelvic endometriosis are associated with lower AMH even before any operation, probably through inflammation and stretching of ovarian tissue.

  8. Obesity and vitamin D deficiency

    Both are associated with modestly lower AMH in observational studies; the effect of correcting them is uncertain.

  9. Pregnancy and breastfeeding

    AMH falls through pregnancy and stays lower while breastfeeding, then returns to the pre-pregnancy level.

Symptoms that can go with it

  • Often none; most women with a low AMH have regular periods and feel entirely well
  • Cycles becoming shorter (under 25 days) or more variable, an early sign of declining reserve
  • Difficulty conceiving, although low AMH alone is not usually the reason
  • Irregular or absent periods, hot flashes, night sweats, vaginal dryness or sleep disturbance if ovarian function is failing early
  • Low mood or anxiety, which often accompany the diagnosis as much as the hormone change
  • Poor response to fertility drugs, with few follicles seen on monitoring scans

Read it alongside

  • Antral follicle count (AFC) on transvaginal ultrasound — the other main reserve measure; a count under 5 to 7 is low, over 20 per ovary supports PCOS, and the two usually agree.
  • FSH on day 2 to 4 of the cycle — rises as reserve falls; above 10 IU/L is a sign of diminished reserve and above 25 to 40 on two occasions under age 40 defines premature ovarian insufficiency.
  • Estradiol on day 2 to 4 — a high early estradiol (over 60 to 80 pg/mL) can suppress FSH and hide a low reserve.
  • LH — an LH to FSH ratio above 2 supports PCOS when AMH is high.
  • Testosterone, free testosterone, DHEA-S and SHBG — androgen excess is one of the three PCOS criteria that a high AMH is read alongside.
  • TSH and prolactin — thyroid disease and high prolactin cause irregular cycles and are excluded before attributing them to reserve or PCOS.
  • Inhibin B — another follicle marker, now rarely used because AMH is more stable.
  • Vitamin D — deficiency is associated with lower AMH and is easy to correct, though the effect on AMH itself is uncertain.

What usually happens next

  1. Read the result against your age and against the reference range of the lab that ran it; a value that looks low on one assay may be mid-range on another.
  2. If you are on the pill, patch, ring or hormonal IUD and the result will change a decision, ask whether to repeat it 2 to 3 months after stopping, when levels have rebounded.
  3. Ask for an antral follicle count on ultrasound and a day-2-to-4 FSH and estradiol; the combination predicts IVF response better than AMH alone.
  4. If AMH is low and you are not ready for a pregnancy, ask about egg freezing sooner rather than later; the number of eggs retrieved per cycle falls with AMH and age, and more cycles may be needed.
  5. If AMH is very low under age 40 with irregular or absent periods, expect repeat FSH testing, a karyotype and FMR1 testing, thyroid and adrenal antibodies, and a discussion of hormone replacement for bone and heart health.
  6. If AMH is high with irregular periods, acne or excess hair, ask for androgen testing and an ultrasound, since AMH alone does not diagnose PCOS.

Diet, lifestyle and natural levers with evidence

What can move AMH once the cause is known. Nothing here replaces finding the cause.

Stop smoking

Moderate evidence

Smoking accelerates the loss of ovarian follicles. In a study of women aged 38 to 50, current smokers had AMH levels about 44 percent lower than never-smokers after adjusting for age, with former smokers close to never-smokers, and across cohorts current smokers reach menopause 1 to 2 years earlier. Stopping does not restore follicles already lost, but it slows the rate of further loss and improves the outcome of fertility treatment.

Vitamin D

Preliminary evidence

Vitamin D deficiency is consistently associated with lower AMH in observational studies, and granulosa cells have vitamin D receptors that regulate AMH production. A 2020 systematic review of supplementation trials found that correcting deficiency raised AMH modestly in women without PCOS in some trials and lowered it slightly in women with PCOS, with small numbers and inconsistent results. Checking and correcting a deficiency is reasonable; expecting a meaningful change in reserve is not.

DHEA before IVF in diminished ovarian reserve

Preliminary evidence

Some fertility clinics prescribe DHEA 75 mg a day for 6 to 12 weeks before IVF to women with low AMH. A Cochrane review of 17 trials found low-quality evidence of a small increase in live birth with androgen pre-treatment (DHEA or testosterone) but no consistent change in AMH or eggs retrieved, and later trials have been mixed. It is not a way to raise AMH outside a treatment cycle.

DHEA is a hormone with androgenic effects (acne, hair growth, voice change) and is not appropriate with hormone-sensitive conditions; use only under a fertility specialist's supervision.

Weight loss and exercise in PCOS

Moderate evidence

In women with PCOS and excess weight, losing 5 to 10 percent of body weight through diet and exercise restores regular ovulation in about half, and several lifestyle trials have recorded modest falls in AMH as ovulation resumes, consistent with fewer arrested follicles. The effect on AMH is small and inconsistent across studies; the effect on cycles, androgens and fertility is the reason to do it. In women with low AMH, weight loss does not raise it.

Time the test off hormonal contraception

Strong evidence

Hormonal contraception lowers measured AMH by about 20 to 30 percent while it is being used, enough to move a result from mid-range to low, and the egg store is unaffected. Levels recover within 2 to 3 months of stopping. Testing after that window, at any point in the cycle, gives the number that reflects reserve. No supplement, diet or herb has been shown to raise AMH in a woman with a genuinely diminished reserve.

When to see a clinician promptly

  • A very low or undetectable AMH under age 40, particularly with irregular or absent periods, hot flashes or night sweats: possible premature ovarian insufficiency, which needs prompt assessment and discussion of hormone replacement.
  • A low AMH when you have been trying to conceive for 6 months (over 35) or 12 months (under 35), for earlier referral to a fertility specialist.
  • A high AMH with irregular periods, acne or excess hair growth, for PCOS assessment, since untreated PCOS raises the risk of endometrial thickening, diabetes and heart disease over time.
  • A very high AMH with abdominal swelling, pelvic pain or bleeding after menopause, for imaging to exclude a granulosa cell tumor.
  • Sudden severe pelvic pain, vomiting, rapid weight gain or breathlessness during or after an IVF cycle, which can mean ovarian hyperstimulation syndrome and needs same-day assessment.
  • A low AMH after chemotherapy or ovarian surgery if you want children, so fertility preservation options can be discussed while reserve remains.

Frequently asked questions

What is a normal AMH level for my age?

There is no single normal range because AMH falls throughout adult life. Typical values are roughly 2.5 to 5 ng/mL in the early twenties, 2 to 4 in the late twenties, 1.5 to 3 in the early thirties, 1 to 2 in the late thirties, 0.3 to 1 in the early forties and under 0.3 after 45. Individual values vary widely around these, assays differ, and the reference range on your own report is the one to use. To convert to pmol/L, multiply by 7.14.

What AMH level is considered low?

For fertility treatment, under about 1.0 to 1.2 ng/mL is usually called low and predicts fewer eggs at retrieval; under 0.3 to 0.5 is very low. For natural conception there is no cut-off that predicts failure, because women with low AMH and regular cycles conceive at the same rate as women with normal AMH. A low AMH is mainly a reason to think about timing and to seek help sooner if you are trying.

Can I get pregnant with low AMH?

Yes. In a study of 750 women aged 30 to 44, those with AMH under 0.7 ng/mL were as likely to conceive naturally within 12 cycles as women with normal levels. AMH reflects how many eggs remain, not whether each month's egg is healthy, and age is a far better predictor of egg quality. Low AMH does reduce the number of eggs retrieved per IVF or egg-freezing cycle, so more cycles may be needed for the same result.

What AMH level suggests PCOS?

Women with PCOS typically have AMH two to three times higher than women of the same age without it, and values above 4 to 5 ng/mL are common. The 2023 international guideline accepts AMH in place of an ultrasound follicle count in adults when irregular ovulation and androgen excess are also present, but the cut-off depends on the assay and age, it should not be used in adolescents, and a high AMH on its own does not diagnose PCOS.

Does birth control affect AMH?

Yes. The combined pill and most other hormonal methods lower measured AMH by about 20 to 30 percent while in use, which can make a normal reserve look low. The egg store is not reduced, and levels return to baseline within 2 to 3 months of stopping. If the result will influence a decision about fertility treatment or egg freezing, repeat the test after that window.

Can you increase AMH naturally?

No supplement, diet or herb has been shown to rebuild ovarian reserve or reliably raise AMH in women whose reserve is genuinely low. Stopping smoking slows further loss, correcting vitamin D deficiency has produced small and inconsistent changes in trials, and DHEA before IVF has weak evidence for live birth but not for AMH. Stopping hormonal contraception, pregnancy or breastfeeding will raise a suppressed measurement back to its true level, which is not the same as increasing reserve.

Does AMH predict when I will reach menopause?

Roughly. AMH falls to undetectable levels a few years before the final period, and in the SWAN study an undetectable value on a sensitive assay in a woman in her late 40s meant a high probability of the final period within the next 1 to 2 years, while a measurable level made it unlikely within a year. The prediction is too imprecise to give a date for an individual woman, and professional bodies advise against using AMH to time contraception or counsel about menopause in women not seeking fertility care.

What day of the cycle should AMH be tested?

Any day. AMH varies by only about 10 to 20 percent across the menstrual cycle, far less than FSH or estradiol, so it does not need to be drawn on day 3, although many clinics test it then for convenience alongside FSH. Fasting is not needed. What does matter is being off hormonal contraception for 2 to 3 months if the result will change a decision, and using one laboratory for repeat tests.

References

  1. Anti-Müllerian hormone test. MedlinePlus, US National Library of Medicine (2023)View source
  2. Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertility and Sterility (2020)
  3. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 773: The use of antimüllerian hormone in women not seeking fertility care. Obstetrics & Gynecology (2019)
  4. Steiner AZ, Pritchard D, Stanczyk FZ, et al.. Association between biomarkers of ovarian reserve and infertility among older women of reproductive age. JAMA (2017)
  5. 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)
  6. Teede HJ, Tay CT, Laven JJE, et al.. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Journal of Clinical Endocrinology & Metabolism (2023)
  7. Ferraretti AP, La Marca A, Fauser BC, et al.. ESHRE consensus on the definition of poor response to ovarian stimulation for in vitro fertilization: the Bologna criteria. Human Reproduction (2011)
  8. Dólleman M, Verschuren WM, Eijkemans MJ, et al.. Reproductive and lifestyle determinants of anti-Müllerian hormone in a large population-based study. Journal of Clinical Endocrinology & Metabolism (2013)
  9. Plante BJ, Cooper GS, Baird DD, Steiner AZ. The impact of smoking on antimüllerian hormone levels in women aged 38 to 50 years. Menopause (2010)
  10. Finkelstein JS, Lee H, Karlamangla A, et al.. Antimullerian hormone and impending menopause in late reproductive age: the Study of Women's Health Across the Nation. Journal of Clinical Endocrinology & Metabolism (2020)
  11. Nagels HE, Rishworth JR, Siristatidis CS, Kroon B. Androgens (dehydroepiandrosterone or testosterone) for women undergoing assisted reproduction. Cochrane Database of Systematic Reviews (2015)
  12. 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)

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This page is educational and is not medical advice or a diagnosis. Lab results have to be interpreted together with your history, symptoms and other results by a clinician who knows you. Do not start or stop a supplement to change a lab value before the cause is known.