Everything you need to know about your eggs and fertility

AMH: the most important marker for your egg reserve

You cannot directly count your eggs, but there is a blood test that provides a good estimate: the Anti-Müllerian Hormone, or AMH for short. It is produced by the cells surrounding the maturing follicles. The more active follicles present, the higher the AMH level. According to a systematic review from 2024, AMH is therefore considered the most reliable available marker for ovarian reserve.

Important for context: AMH measures egg quantity, not egg quality. It tells you approximately how many eggs are still present, not how good they are. Quality primarily depends on age and cannot be determined by a blood test.

Why AMH is not the same as fertility

This is the biggest misconception. A low AMH value does not automatically mean that you cannot get pregnant. Studies and the recommendations of the American professional society ACOG show that in women without fertility problems, AMH hardly predicts the chance of a natural pregnancy. Women with low and normal AMH get pregnant naturally with similar frequency. AMH is particularly meaningful when it comes to planning artificial insemination, as it predicts how the ovaries will respond to hormonal stimulation.

How to roughly interpret AMH values

AMH is measured in ng/ml and naturally decreases with age, particularly noticeably from about 36 years of age. There is no internationally standardized test, so reference values may differ between laboratories. As a rough guide, an AMH below about 1.2 ng/ml indicates a reduced egg reserve. The following classification does not replace a medical assessment:

• High (often over 3.5 ng/ml): can indicate a high reserve, but is also typical for PCOS.
• Normal (approx. 1.2 to 3.5 ng/ml): age-appropriate reserve.
• Low (below approx. 1.2 ng/ml): indicates a reduced reserve, no judgment about your fertility.

You should never interpret a single value in isolation. Doctors combine AMH with your age, FSH value, and the antral follicle count via ultrasound to get a complete picture.

The most important pitfall: the pill distorts your AMH value

This is the point most articles overlook, and it is crucial if you are currently using hormonal contraception. Studies consistently show that the combined birth control pill lowers measured AMH levels by about 20 to 25%. With the vaginal ring, the effect can be even greater. This means that if you take an AMH test while on the pill, the result may be lower than your actual reserve.

The good news: This effect is reversible. After discontinuation, AMH levels usually recover within a few months to a year. If your egg reserve is important to you, for example before a planned pregnancy or egg retrieval, it makes sense not to interpret the test directly while taking the pill, but to plan this with your doctor.

By the way: The old question of whether the pill saves eggs and thus postpones menopause can be clearly answered with no. Although the pill prevents ovulation, the follicles that mature in each cycle still undergo the natural degradation process (atresia). No eggs are saved, and menopause is not delayed.

What you can influence and what you can't

The number of your eggs is genetically determined and set by your age. No supplement, diet, or lifestyle can create new eggs or replenish your reserve. Be skeptical of products that promise this.

What you can influence is the environment in which your eggs mature, and thereby indirectly their quality and the regularity of your ovulation:

• Avoid smoking: Smoking demonstrably accelerates egg loss and can bring forward menopause.
• Keep metabolism balanced: stable blood sugar and insulin levels support regular ovulation.
• Reduce inflammation: through a balanced, nutrient-rich diet.
• Cover micronutrients: sufficient vitamin D, folic acid, and omega-3, especially when trying to conceive.
• Pay attention to sleep and stress: chronic stress can disrupt the hormone axis.

These measures do not change the number of your eggs, but they create better conditions for the ones you have.

When an AMH test is truly useful

An AMH test is not a routine screening for every woman. The ACOG explicitly advises against using AMH alone to assess future fertility in women without fertility issues. However, the test can be useful if:

• you want to assess your family planning timeline or are considering social freezing,
• you have been trying to get pregnant unsuccessfully for a long time,
• in vitro fertilization is planned and the stimulation needs to be dosed,
• risk factors for a reduced reserve are present, such as endometriosis, previous ovarian surgeries, or chemotherapy.

In all these cases: The value is one component, not a judgment. It belongs in the context of your age, your symptoms, and your life plans, ideally discussed during a medical consultation.

Conclusion

You are born with all the eggs you will ever have, and their number decreases throughout your life. This is a natural process, no cause for panic. Your AMH value gives you a good estimate of your ovarian reserve but says little about your actual chance of a natural pregnancy, and it is skewed downwards by the pill.

Instead of fixating on a single number, it is worth looking at the whole picture: your age, your cycle, your symptoms, and your life planning. If you want to know where you stand, a medically supervised diagnostic is the most reliable way to correctly assess your value.