AMH levels by age and how it relates to diminished ovarian reserve (DOR)

A large 2025 study charts how AMH levels decline with age in over 22,000 women, revealing when diminished ovarian reserve (DOR) becomes more common, regardless of infertility status.

Anti-Müllerian Hormone (AMH) is a hormone made by small growing follicles in the ovaries, specifically by the granulosa cells that surround each immature egg.

Biologically, AMH plays a key role in follicle recruitment and selection during the early stages of egg development. It helps regulate how many follicles get recruited each month.

AMH is a key marker of ovarian reserve that declines with age, reflecting the number of eggs remaining in the ovaries. When AMH falls below certain thresholds, usually around 1.2 ng/mL (8.6 pmol/L), it may be classified as diminished ovarian reserve (DOR).

DOR is more common in women over 40, but can also occur in younger women. DOR is often associated with a reduced response to ovarian stimulation, where only a few eggs may be retrieved.

A new study by Aslan et al. (2025) reports on how AMH levels decline with age and the prevalence of DOR, based on nearly 23,000 women aged 18-45 with different diagnoses.

This study analyzed serum AMH levels from 22,920 women aged 18 to 45, collected between 2015 and 2024 at a hospital in Turkey. About 24% of samples came from fertility-related departments (ART, REI, and Endometriosis), while the majority (61%) came from general hospital clinics like gynecology and internal medicine. All AMH levels were measured using the same assay.

For more background on egg quality and quantity, including AMH and DOR, check my Complete guide to egg quality.

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AMH levels by age (in ng/mL and pmol/L)

Looking for the average AMH at age 30? The chart below shows how median AMH levels decline with age, with the 25th and 75th percentiles illustrating the typical range for each age group. The median value is the middle point where half of people have higher levels, and half have lower. The 25th percentile means 25% of people have AMH levels below that value, while the 75th percentile means 25% are above.

And you can see the corresponding table below that shows how AMH levels typically change with age, including both ng/ml and pmol/L units (ng/mL is more common in the US, while pmol/L is more often used in Europe and Canada).

Age	Median AMH (ng/mL)	Median AMH (pmol/L)	25th Percentile (ng/mL)	75th Percentile (ng/mL)
18	3.8	27.13	1.90	7.0
19	4.0	28.56	2.30	6.8
20	4.2	29.99	2.50	6.7
21	4.2	29.99	2.60	6.8
22	4.1	29.26	2.20	6.4
23	3.9	27.84	2.10	6.3
24	3.6	25.70	2.00	6.1
25	3.3	23.56	1.90	5.7
26	3.4	24.28	1.90	6.0
27	3.1	22.14	1.70	5.3
28	2.8	19.99	1.50	4.9
29	2.6	18.56	1.30	4.6
30	2.5	17.85	1.20	4.3
31	2.3	16.43	1.10	3.9
32	2.0	14.28	0.90	3.8
33	1.8	12.85	0.80	3.3
34	1.7	12.14	0.70	3.3
35	1.4	10.00	0.50	2.9
36	1.1	7.85	0.40	2.3
37	1.0	7.14	0.30	2.3
38	0.7	4.99	0.20	1.7
39	0.7	4.99	0.20	1.6
40	0.5	3.57	0.20	1.3
41	0.4	2.86	0.10	0.9
42	0.3	2.14	0.10	0.8
43	0.2	1.43	0.10	0.6
44	0.2	1.43	0.10	0.5
45	0.1	0.71	0.05	0.3

For example, at age 30, the median AMH level was 2.5 ng/mL (17.85 pmol/L):

• This means that half of women at this age had AMH levels above 2.5 ng/ml and half had levels below it.
• The 25th percentile was 1.20 ng/ml, meaning that 25% of women had AMH levels below this value.
• The 75th percentile was 4.3 ng/ml, so 25% had levels above that.
• Together, this range (1.20–4.3 ng/ml) shows what’s typical for most women at age 30.

How common is diminished ovarian reserve (DOR) by age?

One way to estimate the prevalence of DOR is by looking at how many people fall below a specific AMH threshold. A commonly used cutoff is AMH <1.2 ng/ml.

The chart below shows the percentage of women with AMH <1.2 ng/ml by age. The risk increases steadily with age, rising sharply after age 35.

And you can see the corresponding table below that shows how DOR prevalence increases with age:

Age	DOR % (AMH <1.2 ng/ml)
18	15.9%
19	11.7%
20	8.5%
21	8.2%
22	10.5%
23	11.2%
24	12.2%
25	13.5%
26	14.6%
27	16.2%
28	18.6%
29	23.2%
30	24.3%
31	27.3%
32	33.2%
33	36.7%
34	39.3%
35	45.7%
36	52.9%
37	55.8%
38	64.0%
39	66.0%
40	73.0%
41	82.0%
42	85.0%
43	89.0%
44	91.0%
45	96.0%

For example, at age 30, about 24% of women had DOR (based on AMH levels below 1.2 ng/ml). By age 40, that number rises to 73%, and by 45 it reaches 96%. This doesn’t mean pregnancy isn’t possible, but it may mean fewer eggs retrieved during IVF.

Do these AMH levels apply to everyone or just IVF patients?

While AMH is commonly measured in fertility clinics, the data in this study included a wide range of patients and not just those undergoing fertility treatment.

Of the over 22,000 women included in the hospital-based study:

• Only ~24% had their AMH tested through infertility-specific clinics at the hospital, including an ART (IVF) center, REI (Reproductive Endocrinology and Infertility) unit, or Endometriosis center.
• The majority (61%) of samples came from general clinics, including gynecology, internal medicine, dermatology, and endocrinology departments.

To make sure the results weren’t biased toward people with infertility, the researchers ran an extra analysis excluding infertility specific clinics at the hospital.

They found that AMH levels by age were nearly identical in this general population compared to the infertility population. This means the AMH values shown in the chart and table above can be used more broadly, whether or not someone is being treated for infertility.

Women from the Endometriosis Unit had significantly lower AMH levels (median 1.6 ng/mL) compared to other departments (median 2.03 ng/mL), however the sample size was smaller for this group (n= 834) and the endometriosis patients were slightly older (31.9 vs. 29.8–31.6 years).

AMH levels can vary

While AMH is commonly used to estimate ovarian reserve, its levels can shift more than most people realize, especially between cycles!

• Cycle differences: AMH can vary by up to 44% between cycles, leading to reclassification of 20% of women from “normal” to “poor responder” or vice versa in one study (Şükür et al. 2024). The authors recommend measuring AMH in the early follicular phase of the same cycle when ovarian stimulation begins, rather than relying on a prior cycle’s result. Other studies have also documented AMH fluctuations both between and within cycles, prompting some experts to caution against basing clinical decisions on a single AMH test (Overbeek et al. 2012, Hadlow et al. 2013, Bungum et al. 2018)
• Birth control : Long-term hormonal contraception (9 weeks) can temporarily lower AMH by up to 50% (Kallio et al. 2013).
• Ethnicity: Black and Hispanic women may have lower AMH levels than white women of similar age, even with regular cycles (La Marca et al. 2013)
• Lifestyle: BMI, smoking, and even vitamin D levels can affect readings (La Marca et al. 2013, Hadlow et al. 2016).
• Lab differences: Different labs and test kits may yield different AMH results, adding another layer of variability (Bungum et al. 2018).

Conclusions

This large study provides one of the most comprehensive age-based charts of AMH levels to date, covering over 22,000 women aged 18 to 45. It shows that AMH levels decline steadily with age, dropping sharply after the mid-30s, and that the percentage of women with diminished ovarian reserve (AMH <1.2 ng/mL) rises from under 10% in early adulthood to over 90% by age 44.

AMH levels by age were similar in both the general and infertility populations, though women from the Endometriosis Unit had lower AMH levels. The authors note that this may be due to inflammation or mechanical damage caused by endometriosis, which may accelerate ovarian reserve depletion, however the sample size was smaller here and the patients were slightly older.

While AMH is not a direct measure of fertility, it is a widely used marker of ovarian reserve and can help guide decisions about fertility preservation, IVF stimulation, and egg freezing.

Want to read more about AMH, DOR and IVF outcomes?

• Comparing IVF outcomes from cycles with low AMH.
  Researchers in a 2022 study compared IVF outcomes in women with low AMH (<1.2 ng/ml) and while there were differences in cancellation rates and number of eggs retrieved, there were no differences in clinical pregnancy or live birth rates.
• IVF and pregnancy outcomes in women with low AMH (≤0.3 ng/ml), by age.
  Researchers in a 2022 study compared IVF and pregnancy outcomes for women with low AMH (≤0.3 ng/ml) and found a decrease in live birth rates with increasing age compared to national SART rates, but these rates were comparable when low AMH women had up to 3 IVF cycles.
• Meta-analysis combines 38 studies on treatments for diminished ovarian reserve.
  A 2024 meta-analysis combined the results of 38 studies investigating treatments for diminished ovarian reserve patients. DHEA, testosterone, high-dose gonadotropins and delayed start protocols all improved the number of eggs retrieved.
• Study compares IVF cumulative live birth rates based on age, eggs retrieved, diagnosis.
  A 2024 study compared cumulative live birth rates for patients based on their age, the number of eggs retrieved and diagnosis. For women with DOR, they found that cumulative live birth rates were 46.7%-79.2% with five or more FETs.

Related studies

These additional studies were referenced by the authors of the paper and haven’t been covered on Remembryo. They may be helpful if you’re exploring this topic further. This section is available for paid subscribers.

Reference

Aslan K, Kasapoglu I, Kosan B, Tunali A, Tellioglu I, Uncu G. Age-stratified anti-Müllerian hormone (AMH) nomogram: a comprehensive cohort study including 22.920 women. Front Endocrinol (Lausanne). 2025 Jun 20;16:1612194. doi: 10.3389/fendo.2025.1612194. PMID: 40620793; PMCID: PMC12226283.

 

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About Embryoman

Embryoman (Sean Lauber) is a former embryologist and the founder of Remembryo, an IVF research and fertility education website. After working in an IVF lab in the US, he returned to Canada and now focuses on making fertility research more accessible. He holds a Master’s in Immunology and launched Remembryo in 2018 to help patients and professionals make sense of IVF research. Sean shares weekly study updates on Facebook, Instagram, and Reddit regularly. He also answers questions on Reddit or in his private Facebook group.

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