July 30: Fertility is often considered a concern only after the age of 35. However, fertility specialists are increasingly seeing women in their 20s diagnosed with low Anti-Müllerian Hormone levels. This can be alarming, but understanding what AMH represents is essential before drawing conclusions about fertility.
AMH is a hormone produced by small follicles in the ovaries and serves as a marker of ovarian reserve—the number of eggs remaining in the ovaries. It is important to note that AMH reflects egg quantity, not egg quality. A young woman with low AMH may still have good-quality eggs and can conceive naturally. Therefore, AMH should always be interpreted alongside age, menstrual history, ultrasound findings, and the overall clinical picture rather than in isolation.
Several factors can contribute to reduced ovarian reserve at a younger age. Genetics plays a significant role, particularly in women with a family history of early menopause or diminished ovarian reserve. Medical conditions such as endometriosis and certain autoimmune disorders may also affect ovarian function. In some cases, genetic conditions like Turner syndrome or Fragile X premutation can accelerate ovarian ageing.Previous ovarian surgeries, especially for endometriosis or ovarian cysts, may reduce ovarian reserve by removing healthy ovarian tissue. Additionally, chemotherapy and radiation therapy can significantly impact fertility, making fertility preservation an important consideration before cancer treatment whenever feasible.Lifestyle and environmental factors may also influence reproductive health. Smoking has consistently been linked to reduced ovarian reserve, while obesity, chronic stress, inadequate sleep, nutritional deficiencies, and exposure to environmental toxins are areas of ongoing research. Although these factors may affect fertility, they are rarely the sole cause of low AMH in young women.
One of the challenges is that low AMH often has no symptoms. Most women continue to have regular menstrual cycles, and the condition is frequently detected only during fertility evaluation or routine reproductive health screening. Women under 35 who have not conceived after one year of regular, unprotected intercourse—or after six months if they have irregular cycles or known risk factors—should seek medical evaluation.Importantly, a low AMH level does not automatically mean that IVF is required. Many young women with low AMH conceive naturally. However, since ovarian reserve may decline further over time, early evaluation allows couples to make informed decisions regarding family planning. Depending on individual circumstances, options such as egg freezing or assisted reproductive treatments may be discussed.
Maintaining a healthy weight, avoiding smoking, eating a balanced diet, exercising regularly, managing stress, and getting adequate sleep all contribute to overall reproductive health. However, there is currently no scientifically proven treatment or supplement that can significantly increase AMH levels. Women should therefore be cautious of products that claim to “boost AMH.”The increasing detection of low AMH in women under 30 highlights the importance of fertility awareness rather than creating fear. Early consultation with a fertility specialist, especially for women with risk factors or a family history of early menopause, can help preserve reproductive choices and enable timely, evidence-based care.
Low AMH is not a diagnosis of infertility. In younger women, egg quality is often preserved despite a lower ovarian reserve. The focus should be on timely evaluation, individualized counselling, and proactive family planning rather than panic.