High AMH And Still Unable To Conceive? Doctor Shares Possible Causes

The pregnancy journey is unique for each couple, and those trying to conceive often undergo several medical tests. One important marker in this process is the AMH value, or Anti-Mullerian Hormone. AMH is a protein produced by small follicles (fluid-filled sacs) in the ovaries that contain immature eggs. It is primarily used to assess ovarian reserve, providing a snapshot of the remaining quantity of eggs in a woman's ovaries.

How AMH affects chances of getting pregnant

1. High AMH levels

• Elevated AMH levels typically indicate a good ovarian reserve. Women with high AMH levels usually have more eggs available, which can enhance their chances of conceiving.
• AMH is a critical predictor for IVF success because it indicates how well the ovaries will respond to stimulation drugs. Higher levels typically result in more eggs being retrieved.

2. Low AMH levels

• Lower AMH levels suggest a diminished ovarian reserve, meaning fewer eggs are available for conception. Women with low AMH may face challenges in getting pregnant, as the quantity and quality of eggs decrease with age and lower AMH levels.
• Low levels may suggest a shorter timeframe to conceive, while normal levels indicate a healthier reserve for the current age.

Challenges associated with high AMH

Some women may find it difficult to get pregnant despite a high AMH value. "High Anti-Mullerian Hormone (AMH) levels generally indicate a higher ovarian reserve, but research shows that elevated AMH does not always translate into improved fertility. One of the most common causes is Polycystic Ovary Syndrome (PCOS), where AMH is often 2-3 ( 4.5ng/mL approx ) times higher than average (less than 4.5ng/mL). Studies suggest that in PCOS, excess small antral follicles produce more AMH, which may disrupt follicular maturation and ovulation, leading to irregular cycles or anovulation despite a high egg count," explains Dr. Astha Dayal, Director, Obstetrics & Gyneacology, CK Birla Hospital, Gurugram.

Another possible factor is poor egg quality. AMH indicates the quantity, not the quality, of your eggs

"While AMH reflects quantity, it does not assess oocyte competence. Research indicates that metabolic dysfunction, insulin resistance, or chronic inflammation, often seen in PCOS, may impair egg quality and implantation potential."

"High AMH has also been associated in some studies with reduced ovarian responsiveness during assisted reproduction, potentially affecting endometrial receptivity. Additionally, infertility may stem from non-ovarian causes such as tubal blockage, male factor infertility, thyroid disorders, or uterine abnormalities, which are independent of AMH levels," Dr. Dayal adds.

While AMH is an important factor, it alone does not predict one's ability to conceive naturally. Women with low AMH can sometimes conceive naturally or with assisted reproductive technologies (ART), as conception can still be possible with fewer eggs if those eggs are of good quality.

Understanding AMH value

AMH levels naturally peak around age 25 and decline until menopause. Values are measured in nanograms per millilitre (ng/mL).

Normal AMH levels generally range between 1.0 ng/mL and 3.0-4.0 ng/mL, indicating a healthy, average ovarian reserve. Low AMH is typically defined as below 1.0 ng/mL, suggesting a reduced ovarian reserve, while high AMH, often exceeding 3.0-4.0 ng/mL, can indicate a high ovarian reserve, frequently associated with PCOS.

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