AMH (Anti-Müllerian Hormone)

AMH comes from the granulosa cells around the smallest follicles in your ovary, the ones still years away from ovulation. Their number determines how much AMH ends up in your blood, and that number is why AMH is used as an estimate of ovarian reserve.

For anyone measuring hormones in the context of performance and recovery, one property sets AMH apart: these small follicles grow outside pituitary control. AMH is gonadotropin-independent. In practice that means two things. First, you do not have to plan around cycle day 3, as you do with FSH, LH and estradiol: AMH can simply ride along with the blood draw you are doing anyway. Second, AMH does not respond acutely to a heavy training week, a competition or a bad night, while the rest of your hormone panel may well do so.

That makes AMH a stable background value in a panel otherwise full of moving numbers. It is an estimate of supply, not of form on the day.

One important limitation: AMH counts follicles, it does not judge them. The value says nothing about the quality of your eggs, and that quality is mainly related to your age. A reassuring number is therefore not a guarantee.

The result is usually given in µg/l, which is numerically the same as the ng/ml used in the international literature. If a lab reports in pmol/l, 1 µg/l is roughly 7.1 pmol/l.

Among female athletes the idea circulates that training hard burns through the egg supply and that AMH makes this visible. That picture is wrong, and it is worth being precise about what AMH does and does not do in a sports context.

Low energy availability, the core problem behind relative energy deficiency in sport, disrupts signalling from the hypothalamus. The result is a low LH, a low estradiol and a cycle that becomes irregular or stops. That is where it plays out. AMH reflects the follicle supply and moves far less in that story. Where a lower AMH is nonetheless seen alongside an absent cycle, it is attributed to the loss of hormonal drive to growing follicles, not to an egg supply burned through by training.

Two practical conclusions follow. A normal AMH does not rule out relative energy deficiency: you can have a perfectly good AMH and at the same time a disrupted cycle, bone loss and lagging recovery. And a low AMH is not proof that your training volume has done damage. Anyone wanting to know whether training load is affecting the hormonal system looks at the cycle itself and at LH, FSH and estradiol, not at AMH.

Where AMH does count heavily is in planning. The value predicts well how the ovaries respond to stimulation, and that is exactly the information needed when egg freezing or an IVF pathway comes into view, for example to time it around a sporting career. A low value makes a modest yield more likely; a high value raises the chance of an over-response.

What AMH does not predict is a spontaneous pregnancy. In women without a fertility problem, a low value barely reduces the chance of conceiving within six to twelve cycles. So treat AMH as a planning number, not as a countdown clock.

The practical advantage of AMH is that the test does not have to work around anything. You can draw on any cycle day and you do not need to fast, so AMH can ride along with the hormone panel you are having done anyway, without a separate appointment. That is a real difference from FSH and estradiol, which belong around cycle day 3 and therefore do dictate your planning.

Nor do you need to adjust your training calendar for it. AMH does not respond acutely to a heavy block, a competition or a bad night, so you do not have to wait for a rest day to get a representative value.

Testing is particularly useful when you are thinking about freezing eggs or about children alongside a sporting career, when your cycle has been irregular or absent for more than a few months, or before and after ovarian surgery. Removing an endometriosis cyst often lowers AMH, because healthy ovarian tissue goes with it; a measurement beforehand therefore gives a valuable starting point.

If you use combined hormonal contraception, say so. It suppresses AMH by roughly a quarter on average, and most strongly in those whose values are already low. Your result then underestimates your true reserve.

AMH declines with age. The figures below come from a cohort of nearly 23,000 women and serve as orientation, not as a cut-off.

The spread within each age group is wide and the figures were measured with one specific assay. Because AMH tests are not standardised, your laboratory may use different absolute values. If you follow the value over time, stay with the same laboratory.