Why Is My AMH So Low? Causes and What It Means

A low anti-Müllerian hormone (AMH) level usually reflects a smaller-than-average pool of growing follicles in the ovaries, and the single most common reason is age. But age is far from the only explanation. Ovarian surgery, endometriosis, autoimmune disease, chemotherapy, smoking, certain genetic conditions, and even the hormonal contraceptive you are currently taking can all push AMH down, sometimes temporarily. Understanding which of these applies to you changes what the number actually means for your fertility and your health.

What AMH Actually Measures

AMH is a hormone produced by the cells surrounding small, growing follicles in the ovary. Your blood level correlates strongly with how many of those growing follicles you have at any given time, which is why clinicians use it as a proxy for ovarian reserve.¹ The follicles that produce AMH are not the tiny dormant (primordial) ones sitting in storage. AMH expression kicks in once a follicle has been activated and starts developing through the early growth stages.² This distinction matters because a low AMH reading tells you about the active, growing portion of your follicle pool. It does not directly count how many dormant follicles remain.

Age Is the Biggest Factor

AMH declines steadily from the mid-twenties onward. In a large U.S. dataset of over 17,000 women, median AMH dropped by roughly 0.2 ng/mL per year through age 35, then slowed to about 0.1 ng/mL per year after that.³ A recent cohort study of nearly 23,000 women found that by age 36, the median AMH had already fallen below 1.2 ng/mL, and by 45, close to 96% of women met criteria for diminished ovarian reserve.⁴

The trajectory is not identical for everyone. A population-based longitudinal study found that the rate of decline accelerated after 40 but that individual women followed their own patterns rather than one universal curve.⁵ Two women the same age can have very different AMH levels simply because one’s ovarian reserve is naturally larger or depleting more slowly. If your AMH is low for your age, though, something beyond normal aging is worth considering.

Ovarian Surgery

Any operation that removes ovarian tissue removes follicles along with it, and AMH levels drop accordingly. This is well documented for cystectomy, the surgical removal of ovarian cysts. In one prospective study, AMH fell by about a third within three months of surgery, regardless of whether the cyst was an endometrioma or another benign type.⁶ Having cysts on both ovaries made the drop worse. The degree of immediate decline also depends on the cyst type: endometriotic cysts caused roughly a 54% drop in the first week after surgery, while cystic teratomas recovered to about 83% of baseline by three months.⁷

Larger cysts (5 cm or more) are associated with a greater post-surgical AMH reduction, while smaller cysts may not shift the number significantly.⁸ If you have had any ovarian surgery in your history, that alone could explain a lower-than-expected AMH, especially if the procedure involved both ovaries.

Endometriosis

Endometriosis can lower AMH even without surgery. A systematic review and meta-analysis found that women with unoperated ovarian endometriomas had meaningfully lower AMH than women with healthy ovaries or other types of benign cysts.⁹ In a study comparing infertile women with endometriosis to those with male-factor infertility, the endometriosis groups had lower average AMH (around 2.5 ng/mL vs. 3.6 ng/mL) and roughly double the odds of having AMH below 1 ng/mL, whether or not they had undergone prior ovarian surgery.¹⁰

The mechanism seems to involve direct damage to the surrounding ovarian tissue by the endometriotic lesions themselves, independent of any surgical intervention. If you have been diagnosed with endometriosis, especially ovarian endometriomas, the condition may be contributing to your low AMH on its own.

Autoimmune Conditions

The ovaries are vulnerable to autoimmune attack. Several chronic inflammatory and autoimmune diseases have been linked to reduced ovarian reserve and lower AMH. A meta-analysis of women with systemic lupus erythematosus (SLE) found their AMH levels were significantly lower than those of healthy controls, and the effect appeared particularly severe in women who developed SLE in adulthood.¹¹

It is not just lupus. A study comparing women with rheumatoid arthritis, a spinal inflammatory condition called spondyloarthritis, and Behçet’s disease to age-matched healthy women found reduced AMH across the board.¹² Hashimoto’s thyroiditis and type 1 diabetes have also been flagged as potentially harmful to ovarian reserve.¹³ If you carry any autoimmune diagnosis and your AMH is low, the two may be connected, and it is worth mentioning to your reproductive endocrinologist.

Chemotherapy and Other Gonadotoxic Treatments

Chemotherapy drugs damage the follicles directly, and AMH often drops sharply during treatment. A systematic review confirmed that cancer patients have significantly lower AMH after chemotherapy compared to age-matched controls, reflecting real follicle loss rather than a temporary suppression of the hormone.¹⁴ The extent of the damage depends on the specific drug regimen. Alkylating agents are especially harmful, while other regimens are less destructive. In breast cancer patients, AMH decline after chemotherapy pointed to direct damage to the growing follicles.¹⁵ For some women AMH partially recovers after treatment ends, but for others the loss is permanent. If you have undergone any cancer treatment, that history is likely relevant to your current levels.

Genetic Factors

Some women are genetically predisposed to a smaller or faster-declining follicle pool. A systematic review identified multiple genes associated with diminished ovarian reserve, including mutations in FMR1, polymorphisms in genes involved in follicle growth signaling, and differences in how AMH and related hormones are expressed.¹⁶ The best known of these is the FMR1 premutation, carried by roughly 1 in 200 women, which puts carriers at risk for early ovarian insufficiency.¹⁷ Family history can be a clue: if your mother or sisters went through early menopause, a genetic component is plausible.

Smoking

Active smoking appears to directly harm the growing follicle pool. In women aged 38 to 50, current smokers had 44% lower AMH values than women with no smoke exposure, while former smokers showed no significant difference from non-smokers.¹⁸ That finding suggests the damage may target the actively growing follicles rather than the dormant reserve, and that quitting may stop further damage. A separate study in women seeking fertility care found a dose-response pattern: for every additional cigarette smoked per day, the odds of diminished ovarian reserve rose by about 8%.¹⁹ If you currently smoke, it is one of the few modifiable contributors to low AMH.

Hormonal Contraceptives Can Temporarily Lower Your Reading

This is one of the most underappreciated sources of a misleadingly low AMH. Current users of hormonal contraceptives had roughly 25% lower AMH levels than non-users in a large study, yet former users showed no meaningful difference from women who had never used them, confirming the effect is reversible.²⁰ A population study of over 42,000 women found that the suppressive effect varied by method: the combined oral contraceptive pill lowered AMH by about 17% on average, while the hormonal IUD had essentially no effect.²¹

The suppression was disproportionately larger at lower AMH percentiles. A woman whose true AMH is already on the low end could see her reading drop by roughly a third while on the pill, potentially pushing her into a “diminished reserve” classification that does not actually reflect her underlying follicle count.²¹ If you had your AMH tested while on hormonal contraception, the result may be significantly lower than your true baseline. Some clinicians recommend waiting at least a few months after discontinuing before drawing blood for AMH, and one analysis found that women under 30 who waited two to three years after stopping long-term hormonal contraception had notably higher measured AMH than those tested within two years of stopping.²²

Race, Ethnicity, and Vitamin D

AMH reference ranges are not identical across racial and ethnic groups. Multiple studies have found that Black and Hispanic women tend to have lower AMH than age-matched white women, while Chinese women show higher AMH before age 25.²³ The reasons are not fully understood but may involve differences in the rate of follicle activation, body composition, and genetic factors.²⁴ This matters practically because most AMH reference ranges were established in predominantly white populations. A “low” result by those standards may be perfectly normal for you.

Vitamin D status is another variable that gets overlooked. The AMH gene promoter contains a vitamin D response element, and at least one study found that vitamin D levels correlated positively with AMH in women, raising the possibility that vitamin D deficiency could make AMH readings look worse than the underlying follicle count warrants.²⁵ Whether correcting a vitamin D deficiency meaningfully raises AMH is still being studied, but it is another reason a single low number should not be read in isolation.

Test-to-Test Variability

AMH is more stable across the menstrual cycle than older hormones like FSH, but that does not mean it never fluctuates. One study found a median cycle-to-cycle variation of over 44%, which was large enough that about 20% of patients were reclassified between “normal responder” and “poor responder” categories on a second test.²⁶ Factors like BMI, ethnicity, and smoking contribute to inter-individual variability as well.²⁷ If you got one low reading and are panicking, repeating the test in a subsequent cycle is reasonable before drawing firm conclusions.

What Low AMH Means for Getting Pregnant

Here is where the science departs from the anxiety a low result creates. AMH tells you about ovarian reserve, which correlates strongly with how many eggs you are likely to produce during an IVF cycle. It does not tell you much about egg quality, and it is a surprisingly poor predictor of natural conception. A 2024 study of infertile women found no significant difference in the proportion of women with AMH below 0.7 ng/mL between those with unexplained infertility and those whose infertility was entirely due to a male partner. Low ovarian reserve markers did not predict worse odds of conceiving on their own.²⁸

For IVF specifically, low AMH does predict fewer eggs retrieved and higher cycle cancellation rates. In one study of women with very low AMH, about 15% of cycles were cancelled before egg retrieval. But among those who did reach retrieval, age mattered far more than AMH for pregnancy rates: women under 35 had a clinical pregnancy rate of 31% per retrieval, compared to about 10% in women 40 to 43, despite comparable AMH levels.²⁹ Even in extremely low AMH ranges, ongoing pregnancy rates per patient reached about 16 to 20%.³⁰ The bottom line is that low AMH makes IVF harder and less efficient, but it does not make pregnancy impossible, and your age at the time of the cycle has a larger impact on whether a retrieved egg becomes a baby.

AMH and Menopause Timing

Because AMH tracks the remaining pool of growing follicles, it can offer a rough forecast of when menopause will arrive. In one longitudinal study, women aged 35 to 39 with AMH below 0.20 ng/mL had a median time to menopause of about 10 years, while those in the 45 to 48 age group with the same low AMH reached menopause in roughly 6 years. Higher AMH levels pushed the estimated menopause further out at every age.³¹ Another study confirmed that combining AMH with age produced strong predictive accuracy for when menopause would occur.³²

That said, these are population-level statistics. On an individual basis, the prediction windows remain wide. A review of the evidence concluded that while AMH is clearly related to menopause timing, it is “insufficiently precise to inform on an individual’s journey of ovarian aging.”³³ A low AMH at 32 does not mean menopause at 38. It means your timeline is probably shorter than average, but no one can pin the date down with useful accuracy.

Can Supplements or Treatments Raise AMH?

No intervention has been proven to restore a depleted follicle pool. You cannot grow new eggs. However, a few supplements have shown modest effects on AMH levels and IVF outcomes in women with diminished ovarian reserve. A meta-analysis of oral supplements found that combinations of vitamins, coenzyme Q10 (CoQ10), and DHEA led to small but statistically significant increases in AMH, follicle counts, and the number of eggs retrieved during IVF, along with higher clinical pregnancy rates. The benefits were more pronounced when supplementation lasted longer than two months.³⁴

Among individual supplements, CoQ10 showed particular promise. A network meta-analysis comparing several interventions for poor ovarian responders undergoing IVF found CoQ10 had the best odds of improving live birth rates, while DHEA was strongest for embryo implantation and the number of eggs retrieved.³⁵ These are not miracle cures. The improvements are modest, and the evidence is still evolving. But for women about to enter an IVF cycle with low reserve, a conversation with your doctor about CoQ10 or DHEA supplementation is reasonable.

The Emotional Weight of a Low Result

Clinicians sometimes underestimate how much a low AMH result upends a patient’s emotional world. Qualitative research has found that receiving a low AMH result carries significant psychological impact, including anxiety, grief, and a feeling that time is running out.³⁶ In a large survey, nearly half of women who had AMH testing perceived their result as “low,” and that perception was linked to greater emotional distress, increased decisional regret about having been tested, and changes in reproductive plans like rushing into egg freezing or fertility treatment.³⁷

Some of those decisions may be entirely appropriate. Others may be reactions to a number that, as outlined above, can be temporarily suppressed by contraceptives, affected by vitamin D deficiency, inflated by test-to-test variability, or simply reflect a normal range for your ethnicity and age. If you are sitting with a low AMH result and feeling a sense of urgency, it is worth stepping back and confirming that the number was measured under ideal conditions, understanding exactly what it does and does not predict, and working with a specialist who can put the result into the full clinical picture before you change your life plans around a single blood draw.