What is a good AMH level for IVF? A doctor’s Q&A

AMH (anti-müllerian hormone) can be a helpful indicator of how many eggs you have in reserve, in your ovaries (your ovarian reserve). It’s easy to get a bit obsessed with levels, however, so we asked Dr Drew V. Tortoriello, Medical Director at the globally-renowned Sher Fertility Solutions clinic, NYC, for the 101. Keep reading for Dr Tortoriello’s expertise on: 

• AMH levels, and what’s ideal for IVF 
• Normal AMH levels at 40 years old, and under 
• High and low AMH levels, and how these affect fertility and treatment

Plus, lots more. Anti-müllerian hormone can be a really helpful indicator, but can easily end up as a red herring in your fertility journey – especially if we get our levels back, start a frantic google search, and end up combing a forum thread for nuggets of insight. 

If you do love insight-rich fertility content, we recommend making Sher Fertility Solutions your go-to. From their blog to in-person consults with Dr Tortoriello and team, you’ll be tapping into a global authority on all things fertility and assisted reproductive technology (ART). They’re at the forefront of modern fertility medicine in 2023, and pioneers in specialist fields of support. 

Read up on our implantation dysfunction mini series for an idea of the breadth and depth with Sher Fertility Solutions. It’s truly groundbreaking, life-changing and authoritative stuff.

AMH, explained

AMH (anti-müllerian hormone) is the hormone released by cells in our ovaries, during our reproductive years. AMH can be a helpful indicator of how many eggs we have in our ovaries – you’ll have heard this referred to as the ‘ovarian reserve’. 

First things first, AMH is all about your ovarian reserve, and numbers. It isn’t an indicator of egg quality, although both will likely play a part in the protocol you and your doctor go for, when building your fertility care plan. 

Our AMH gradually increases from birth, up until around age 25, where it tends to peak. From this point, AMH levels then gradually decline as we get older, flattening out completely at menopause. 

What’s age got to do with it?

You’ll be fed up with hearing it, but quite a lot. AMH levels do decline significantly around 10 years after peaking – usually after age 35. This triggers a steady decline in ovarian volume (again, the number of eggs you have in your ovaries). For those of us heading into our forties – or already there – Dr Tortoriello says, ‘normal AMH levels at 40 are, for most women, between 1-1.5 ng/mL, but there’s a very large degree of overlap.’ 

If you are in that textbook age 40+ with an AMH level at 1-1.5 ng/mL, IVF can still absolutely be successful. Remember, AMH is about quantity, not quality. 

Concerned about AMH? Skip straight to Sher Fertility Solutions and connect with the team today. An initial chat will help point you in the right direction, from AMH levels to immunology, PCOS and more. 

So, AMH can be a good indicator of how many eggs you’re working with. But it’s a mistake to read AMH test results in isolation, and use them to determine your fertility potential. AMH doesn’t tell you and your doctor about the quality of your eggs, it just indicates the quantity.  

AMH levels, therefore, can help to: 

• assess ovarian reserve (the number of eggs in your ovaries) 
• predict your response to ovarian stimulation, during IVF treatment
• build a protocol and IVF cycle that best-suits your situation 

You can have an AMH test on any day of your menstrual cycle. 

What is a good AMH level for IVF?

Dr Tortoriello says, ‘your response to IVF stimulations is important. The more oocytes (eggs) we can retrieve, the more normal embryos we’re likely able to produce. AMH is a marker of egg reserve, and for the women I support in practice, I like to see values at least 1.5 ng/mL or higher. 

That’s the baseline, for me. But understandably, patients like to understand where their AMH levels sit within the average range. This can look like: 

• AMH lower than 0.5 ng/mL: very low (indicating low ovarian reserve)
• AMH lower than 1.5 ng/mL: low to normal (indicating declined reserve) 
• AMH at 1.5 ng/mL or higher: optimal (indicating good reserve) 
• AMH higher than 3.5 ng/mL: high (indicating potential for OHSS during IVF)

The sweet spot we’re looking for, from this table, is AMH at 1.5 ng/mL or higher, which we tend to see best results with, during IVF stimulation.’

What can I do about my AMH?

Age isn’t something we can change. So we’d encourage everyone reading up on AMH to see it as just another indicator in the overall picture of their fertility. No point stressing about your AMH level, when age plays such a major part in where it sits! 

Remember too, there isn’t an international standard for AMH levels. How your results are assessed will depend on your care team, so ask all of the questions you need to, when working things through with your doctor. 

The very best thing you can do to support your AMH levels is to double-down on your whole-body health and wellness, while on this fertility journey. We love an actionable checklist, just to know we’re doing all of the things at home. 

A few key bits of research to look into and read up on (in-between appointments) are:

• smoking (as always, we’d say get rid – smoking is linked to decreased AMH levels)
• supplements – supplementation is unlikely to move the needle on AMH levels, but this small study concludes supplementation with selenium and vitamin E can increase AMH, AFC (antral follicle count) and MOV (mean ovarian volume) in women with OPOI (occult premature ovarian insufficiency)
• your medications – studies increasingly show a potential link between certain medications (including metformin and hormonal birth control) and decreased AMH levels, so be sure to chat your meds list (past and present) through with your doctor

A note on vitamin D – research has shown that vitamin D may be a positive regulator of AMH production, and that vitamin D deficiency may ‘confound’ (confuse) clinical decisions based on AMH. So, make sure you’re being tested for vitamin D deficiency, alongside your AMH, and chat this factor through with your care team. 

Is it possible to get pregnant with high AMH levels?

Dr Tortoriello says, 

‘It’s very possible to get pregnant with a high AMH level – in fact, it might be easier because with a high AMH level one would expect that you could produce a very good number of mature eggs in any one IVF stimulation cycle. Women with PCOS have excellent IVF pregnancy rates and often very high AMH levels, sometimes as high as in the teens.  

The important caveat is that your egg response might border on excessive, creating a risk for ovarian hyperstimulation syndrome (OHSS), a condition of severe bloating and dehydration, that can be dangerous.

Depending on other factors, most people with high AMH levels can do what we call ‘gentle ovarian stimulation’ and perhaps IUI. But if there are concomitant issues, or suspected egg quality problems, then IVF is best. Chat to your doctor – or connect with me and the team for expert support with all-things AMH.’

What about low AMH levels?

By ‘low’, we’re talking about less than that 1.5 ng/mL threshold. For patients concerned about low levels, Dr Torteriello says, ‘low AMH levels indicate low egg reserve, and this is a harder problem to contend with. Low egg reserve in young women, however, (under age 35) is often eminently treatable because although you may get fewer eggs, their quality (chromosomal normalcy) tends to be quite good. 

Connect with your doctor and get their thoughts on your results. Sher Fertility Solutions are on standby too, for a second opinion – we regularly treat patients with low AMH at age 35 and over, with a completely unique protocol which looks at fertility and IVF potential from all sides, not just those AMH levels.’

Book a consultation with Sher Fertility Solutions, for clarity on AMH, how it affects IVF, and a protocol tailored to your situation.