Anti-Müllerian hormone (AMH) has become one of the most commonly discussed blood tests in fertility care. It is widely used to assess ovarian reserve and to predict response to ovarian stimulation. When women are told that their AMH is low, the immediate question is: Can AMH be improved?
From both scientific evidence and long clinical experience, the answer is nuanced. There is no proven way to permanently increase ovarian reserve, but there are situations in which AMH levels may appear to rise, and there are strategies that may improve ovarian function and fertility outcomes even if AMH itself does not change significantly.
What AMH really represents
AMH is produced by granulosa cells of small, growing follicles in the ovary. It reflects the number of recruitable follicles at a given time and generally declines with age. AMH is extremely useful for counselling and treatment planning, but it is not a direct measure of egg quality, natural fertility, or the ability to conceive. Many women with low AMH — particularly younger women — still achieve pregnancy.
Hormonal suppression and AMH
Several commonly used hormonal medications can suppress ovarian activity and lower measured AMH levels. These include combined oral contraceptive pills, progestins, and GnRH analogues such as leuprolide. Importantly, this reduction in AMH is usually functional and reversible.
After stopping hormonal suppression, AMH often rises again over weeks to months, sometimes returning close to baseline. Therefore, AMH values should be interpreted cautiously in women who are currently on, or have recently stopped, hormonal medications.
AMH after ovarian surgery
Ovarian surgery, particularly cystectomy for endometriomas, is well known to cause a decline in AMH. This fall is usually most pronounced in the early postoperative period. However, multiple studies show that AMH often partially recovers over time, typically over 3–12 months.
The degree of recovery depends on surgical technique, extent of ovarian tissue removal, laterality, and baseline ovarian reserve. Early postoperative AMH values may therefore underestimate long-term ovarian potential, and timing of AMH testing after surgery is clinically important.
Supplements: DHEA and Coenzyme Q10
DHEA has been studied mainly in women with diminished ovarian reserve or poor ovarian response. Some studies have shown modest increases in AMH and improved response to ovarian stimulation after several months of supplementation, particularly in younger women. However, results are inconsistent, and not all patients benefit.
Coenzyme Q10 (CoQ10), a mitochondrial antioxidant, has shown promise in improving ovarian response, oocyte competence, and IVF outcomes in selected patients. While its direct effect on AMH may be limited, it appears to support overall ovarian function.
Both supplements should be used judiciously and under medical supervision. They are adjuvant therapies, not treatments that reverse ovarian ageing.
Lifestyle factors
Lifestyle optimisation — including smoking cessation, healthy body weight, exercise, good sleep, and correction of nutritional deficiencies — is important for reproductive health and treatment outcomes. However, strong evidence that lifestyle changes alone significantly increase AMH is lacking.
Age matters more than AMH
One of the most important clinical observations is that younger women with low AMH generally do far better than older women with the same AMH level. Age remains the strongest determinant of egg quality and reproductive potential. AMH should never be used in isolation to deny treatment or predict failure.
Insights from our multicentre Indian study
An important contribution to this discussion comes from our multicentre observational study conducted across several fertility clinics in Northern India, examining reproductive and lifestyle factors influencing AMH levels in Indian women.
This study demonstrated that:
- Increasing age, short menstrual cycles, amenorrhea, and a family history of premature menopause were associated with lower AMH levels.
- Higher AMH values were commonly seen in women with polycystic ovary syndrome (PCOS).
- Interestingly, women whose partners had severe male factor infertility (including azoospermia and severe oligoasthenoteratozoospermia) also showed higher AMH levels.
- No significant association was found between AMH and lifestyle factors such as BMI, diet, sleep, smoking, or use of electronic devices.
These findings reinforce the concept that biological and reproductive factors, rather than lifestyle alone, are the dominant determinants of AMH in our population.
The bottom line
- There is no proven method to permanently increase ovarian reserve.
- AMH may rise after stopping hormonal suppression.
- AMH often partially recovers after ovarian surgery, given adequate time.
- DHEA and CoQ10 may benefit selected patients, particularly younger women.
- Lifestyle changes support fertility health but rarely raise AMH substantially.
- Age remains the most important prognostic factor.
In summary, your clinical intuition is correct: AMH cannot truly be “boosted” in a biological sense. What matters most is correct interpretation, appropriate timing of testing, and individualized fertility planning. AMH is a guide — not a verdict.
References
- Banerjee K, Thind A, Bhatnagar N, et al. Effect of reproductive and lifestyle factors on anti-Müllerian hormone levels in women of Indian origin. Journal of Human Reproductive Sciences. 2022;15(3):259–271. PMID: 36341011.
- Bentzen JG, Forman JL, Pinborg A, et al. Ovarian reserve assessment: a comparison of anti-Müllerian hormone versus antral follicle count. Human Reproduction Update.
- Tal R, Seifer DB. Ovarian reserve testing: a user’s guide. American Journal of Obstetrics and Gynecology.
- Raffi F, Shaw RW, Amer SA. The effect of ovarian cystectomy on ovarian reserve: a systematic review and meta-analysis. Fertility and Sterility.
- Somigliana E, Ragni G, Benedetti F, et al. Does laparoscopic excision of endometriomas significantly affect ovarian reserve? Human Reproduction.
- Barad DH, Gleicher N. Effect of dehydroepiandrosterone on ovarian reserve and IVF outcome. Reproductive Biology and Endocrinology.
- Yeung TWY, Chai J, Li RHW, et al. A randomized controlled trial on the effect of DHEA on ovarian reserve markers. Human Reproduction.
- Xu Y, Nisenblat V, Lu C, et al. Pretreatment with coenzyme Q10 improves ovarian response in women with diminished ovarian reserve. Reproductive Biology and Endocrinology.
- Bentov Y, Casper RF. The aging oocyte—can mitochondrial function be improved? Fertility and Sterility.
Bentzen JG, Jensen TK, et al. Influence of oral contraceptive use on AMH levels. Fertility and Sterility.
