Welcome to Her Fertility, the podcast for women navigating infertility who want to feel like themselves again while they do it. I'm your host, Jess Tims, researcher, educator, and somatic practitioner, and I've been exactly where you are. I know what it feels like to be in the waiting, in the not knowing, in the relentless hope and grief of this journey, and I know there is a way to move through it fully alive without losing yourself in the process.
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 welcome back to the Her Fertility Podcast. Today's Dear Jess question is, "Dear Jess, what does AMH actually tell me about my fertility?"
And I love the way this question is worded because if anybody has ever gotten an AMH result that they didn't want, then you know the feelings of pressure and surprise that come with an AMH result. And so I love the way this is worded, and I'm going to walk you through AMH in a, maybe a different way than you normally hear it talked about.
Because I really feel like this is an opportunity to kind of unpack and demystify AMH. Because A- AMH, AMH in a way that you might not have heard it before. Um, because- Because, because AMH is one of those numbers that can suddenly feel incredibly important. You get your blood work back, you see your AMH, maybe somebody tells you it's low, maybe somebody tells you it's high.
And before anyone has really explained what that number means, you might already be researching it, and suddenly that one number from one blood test feels like a prediction of your entire fertility future. And while it is important, it is only important within the context of what it can tell you. let's walk through this together so that if you are feeling surprised, overwhelmed, or maybe just curious about AMH, you have a new framework to work with. You have a step-by-step framework to work with so that you can use AMH for the data that it actually gives you and not for the predictive value that we usually put within AMH.
So first, let's talk about what AMH actually is. AMH stands for anti-MĂĽllerian hormone, and it is a hormone that's produced by the cells surrounding the small developing follicles in your ovaries. So yes, women are born with all of the follicles that they will ever have. So you're not generating new eggs, unlike male sperm that's being generated month after month.
Women have all of the eggs that they will ever have at birth. But those eggs are not like eggs in an egg carton. They are follicles, and what that means is they are not mature eggs until One or a few get chosen for ovulation, and that's when they mature into what we would think of as, like, an egg to be fertilized for conception.
So the hormone AMH is produced from the cells surrounding these follicles in each of your ovaries. And when you ... And, and we can measure someone's AMH level through a blood test, and so it can tell you a little bit about ... And, and so your fertility team, and so your physician can make a conclusion about your ovarian reserve based on the amount of hormone that is registered.
So the idea is that the higher the AMH, the more follicles you would have because the more follicles you have, the more hormone is being produced. And vice versa, the lower the AMH number, then the less follicles there are produ- producing the hormone. And that's the general idea. Now, we could break this down a little bit further.
Now, and And, and so AMH is our current best marker for estimating somebody's ovarian reserve or estimating how many eggs you have in your ovaries. As of recording this podcast, there is no way for science to tell us exactly how many eggs you have. We can't, like, open the egg carton and count them. We can, however, use AMH as well as an ultrasound to see, like, the health of the ovary and see that, yes, there's follicles there.
We just can't count how many are actually there. And so AMH is used as an estimate. But I wanna be really specific about what ovarian reserve means, because ovarian reserve is, is primarily about the quantity. We are talking about the potential number of eggs that you have. It is not the same as egg quality.
It is also not a direct measurement of how fertile you are. And I think that those distinctions are incredibly important because most women will hear, like, "Your AMH is low," and what the brain will translate that into is, "My fertility is low," or, "My chances of becoming a mother is low." And those are not equivalent statements.
understanding what AMH is actually telling us is really important. And one of the useful places that AMH is used is when you are using fertility treatment. Because if you're preparing for IVF, then your reproductive endocrinologist is gonna want some idea of how your ovaries may respond to the stimulation medications.
And so they will use AMH to estimate whether you have, you know, a lower, an average, or a higher ovarian response. And that information can really help with treatment planning. It can give your endocrinologist expectations around how many eggs might potentially be retrieved. And so this is really useful information to have.
And most, if not all, fertility clinics require that AMH be part of your testing before you do treatment. But notice we're talking about potential. We're talking about quantity. We are not saying anything about the end goal of, like, will you actually get pregnant? Those are two different things, and AMH cannot determine whether or not you will or will not get pregnant.
It doesn't tell you about your egg quality. It really only is an estimate for the potential number of follicles that you have. And I wanna say that really clearly, especially right after our recent episode about egg quality because I think that because socially we tend to understand AMH as a measure of, like, eggs, and that can get kind of blurry with egg quantity and egg quality.
But a lower AMH does not mean that you have poor quality eggs. Also, a higher AMH does not mean that you have high quality eggs. And so they're two very different pieces of your fertility puzzle. And
And so if you've res- and I just-- and so I want ... And, and so if you've, and so if you've been looking at your low AMH and thinking, "Oh, well, my eggs must be bad," then I want you to separate those two things. This isn't what AMH is telling you. Also, a low AMH is not telling you that you cannot get pregnant naturally.
This is probably one of the most important things that we don't discuss enough. Because with a low AMH reading, there tends to be an urgency attached to getting pregnant because the assumption is if your AMH is low, then you have just a few eggs remaining, and so it is of the essence that you do something about that.
And while I understand that logic, there are also pieces of the puzzle that work against that logic. And so it is-- And I, and so I, and I say that not to poke holes in the argument or argue against what your practitioner is saying. I'm gonna g- And I'm going to give you some additional questions that you can ask your practitioner so that you get clarity on your specific case, because everybody's fertility case is different and unique, and it is essential that you understand why your practitioner is making the recommendations that they are making, especially if there's some type of time pressure or time urgency being put behind it.
but low AMH does not necessarily mean that you can't get pregnant naturally. It is
And, and there's research that looked at ovarian reserve markers that found that they are actually a poor predictor of somebody's short-term ability to conceive without fertility treatment. And so it doesn't mean that AMH is meaningless. It just means that we need to use AMH in the way that it was designed to be used, in a way that the data is actually useful.
So if we're asking, "How might my ovaries respond to IVF stimulation?" Then AMH can absolutely be quite useful. But if we're asking, "Will I get pregnant naturally?" AMH cannot give us a yes or a no. And that's why we need to start asking more targeted questions to get more information. And And be- and before I get to the questions themselves, just kind of a bigger...
And before I get to the questions themselves, this is really where numbers can become emotionally dangerous or sticky because fertility testing creates this really interesting situation where we receive a number or, like, a result, and because that number looks so precise, it feels very definitive. So maybe your AMH is, like, 0.7 or maybe it's a 1.2 or, like, a 3.4.
Whatever your number is, there are, like, decimal points involved. There's a reference range next to it. Maybe there's even, like, a little red flag in your portal beside your result. And so psychologically, that can feel like certainty. But a precise number doesn't necessarily mean that we have a precise prediction.
A precise measurement and a precise prediction are not the same thing. And so your AMH result can be an accurate laboratory measurement and still not be able to answer every question that you are asking about your fertility. And I think that this is where women can start to carry a lot of that, like, fear and worry that the test was never actually designed to answer.
And this is one of the more frustrating parts about female fertility because we don't have the testing that we wish we did, right? Like, we can't tell you exactly how many eggs you have. We can't tell you what the quality of those eggs are, and so we're using our best guess to estimate, but that is a prediction.
And so let's talk about low AMH and high AMH, AMH. So let's talk about low AMH and then high AMH because I don't know, whoever asked this question, which bucket you live in. So I'll give you my perspectives on both, and then we'll talk about the questions that you can use to get more clarity for your own case.
And so a very low AMH can absolutely be clinically important. And I don't wanna pretend that that number doesn't matter. It is a point-in-time analysis. And especially during a fertility treatment, a low AMH may suggest that your ovaries could produce fewer eggs in response to stimulation, and that can affect the conversation around your IVF expectations, your treatment planning.
But even a very low AMH is not the same thing as you cannot get pregnant. It's also not the same thing as there's no point in trying.
And there is professional fertility guidance that specifically cautions against using an extremely low AMH by itself to deny someone IVF treatment. And so we need to be able to hold both of these things at once, where the information can matter and this information is not the whole story. And I cannot tell you the number of times, either in the support group or with clients that I've worked with, where a low AMH resulted in them being, like, kicked out of their clinic.
And to me, that is not a fair assessment of somebody's full fertility picture. And so let's talk about high AMH, and then I'm gonna give you some questions that you can ask if you find yourself in that boat. a high AMH isn't necessarily better either. So AMH, again, is just information. It's not a fertility grade.
It doesn't mean, like, you know, higher means you have an A+ and lower means, like, you have an F because high- very high AMH levels can be seen with women ... Because very high AMH levels are sometimes seen in women with conditions like PMOS. And so the goal isn't to just, like, chase the highest AMH number possible.
The goal is to understand what your result means within the context of your age, your menstrual cycle, your medical history, the ultrasound findings, your fertility history, and any fertility treatments that you are receiving and how your body has actually responded to that. And you can increase your AMH.
And so this is something that I think gets a little misunderstood also because we have to be careful about making increasing that number the goal. and I would be really cautious about anybody on social media who is promising you that a supplement, like a diet, a detox, a protocol will fix your fertility by raising your AMH because those are promises that are filled with a lot of holes.
And so if you are concerned about your result, of your AMH result, that is a conversation that you need to be having with your trusted fertility physician in the context of your complete clinical picture. And, and I don't mean And, and so the question isn't, well, how do I get this number higher? A more useful question would be, what does this number change about the decisions I need to make?
That's the question I want you to ask. If you have an AMH result that's been, like, sitting heavily on you, I want you to take that number, like, out of the quest- like, out of your picture for a moment, and then get clarity. Like, what question is the test being used to answer? Was your doctor evaluating your ovarian reserve?
Are you planning IVF and trying to estimate your ovarian response? Like, are you trying to understand your broader fertility picture? So what is the question that you are trying to answer with this test? Then you have the test, you get your AMH result, and then you can ask, " What does my AMH tell you about my specific situation?"
You can also ask, "What does it not tell you? Like, what do we still not know?" You can also get clarity on, "How does my age change how you interpret this result?" Also ask, "How does this fit in with my antral follicle count and the rest of my fertility evaluation?" And then also ask, "Does this result actually change what you would recommend that we do next, and why?"
Because fertility testing should ideally help us make informed decisions. It should not just give you another number to, like, worry about. Your AMH is absolutely information. It is not your prognosis. And I think that's what I want you to leave this episode really remembering, so that you, so that you can objectively look at your AMH and then use it and work with your practitioner to get a good understanding of why you're making the decisions you're making based on that data.
if you have been carrying your AMH around like it's your verdict, like it's the final thing, I want you to put it back where it belongs. It is one piece of information in a much bigger picture. You are not an AMH number. You do not need to turn that number into a prediction that your medical team probably never actually gave you, right?
Instead, I want you to get really curious. What does this tell us? What doesn't this tell us? And what, if anything, should we do differently because we know it now? That's where information becomes useful. and if you did get an AMH result that you do not love, and it is creating this dynamic in your mind or in your body that feels real, I don't wanna deny that, right?
Like, it can feel really scary. Then that's why I created the quiz. If you haven't taken it yet, go to the show notes. The quiz was designed to show you how you are responding to your infertility journey and how to use that as information on how to move forward. Because the way that you are responding to this, whether it's out of fear or whether it's out of, like, shutting down or whatever it is, it's unique to everybody.
But that response is actually information that you can use so that you can support yourself in the best way possible moving forward. And if you are to the point where you are getting an AMH test, then you likely have been on this journey for a little bit of time, and it might be wearing on you more than you know.
And the quiz is designed to really highlight the areas that you should be paying attention to so that you can support yourself in a way that feels true to you. Because this journey is unique to you, and you might already know this, but sometimes when you try what everybody else is trying, it just doesn't seem like a fit for you.
So go take the quiz and get some clarity. And if you have a question that you would like me to answer on a future Dear Jess episode, you can submit it anonymously through the link in the show notes. I read every question, and if you have a question, then there's likely somebody else that is wondering about it too
 Thank you for being here today. If you would like to submit an anonymous question for Dear Jess, please see the show notes for the link. I would love to support you with answering your question. And if you're ready to go deeper, the Her Fertility Support Portal is where this work continues. It's a monthly membership built for women who want to feel genuinely supported, not just medically, but emotionally, somatically, and in community with women who actually understand.
You can find everything at www.herfertility.support. And if today was your first time here, welcome. Come back. There's more where this came from. Until next time, give yourself love. You are doing more than you know.
