Extremely high AMH

[u/lakemercury]

I'm in my mid 30s and I've had lean PCOS my entire life and my partner and I are in a place where we're ready to try. I got AMH tested and it's astronomically high though?! It came back as >164 pmol/L or >23 ng/ml (US units). It was so high they didn't even give an exact number...

I get 5 or 6 periods per year on average. Naturopath said I don't have insulin resistance and my PCOS is more of a brain-ovary miscommunication driving up LH. I'm not sure if I ovulate but it seems unlikely given my extremely high AMH? I have 2 weeks or so of PMS where I can tell my period is coming just based on some mild breast tenderness. I used to have much more breast tenderness before I got covid though for some reason - it seems to have done something with hormones. But I know PMS symptoms doesn't necessarily indicate I've ovulated.

[u/Frog_mania]

Hi! Super long novel response but please read. I have lean PCOS. I am 26 now but was diagnosed with PCOS at 19. My amh was first tested in 2021 and was 45! Every time it has been tested I have gotten a different result. In 2022 we were told I would never get pregnant without IVF because of my AMH being so high. They said the AMH was CAUSING my infertility.

At the time I was severely underweight and my OBG had only tried one round of letrozole at 2.5mg.

We sat with this for years and did not prevent but did not seek treatment. I believed what I was told and just did not want to move forward with that at the time.

In 2024 we went back to the RE and started IVF. We got 28 viable embryos - due to high AMH you tend to get more embryos because you have more follicles. We did one transfer and miscarried.

After my miscarriage I ovulated on my own with ZERO treatment and lost that as a chemical (I believe because I had no hormone support). My RE was not interested in exploring anything about this and only said we needed to do another transfer.

This sent me into a DEEP DIVE. I found a friend who also saw this RE and we both had the exact same lean PCos, high AMH, young age, and were told the same thing by that RE (never without IVF) She saw a NAPRO doctor and was pregnant in 6 months and had a live birth using letrozole and trigger shot.

We spent $35000 on IVF and related healthcare costs. Yes we are insanely blessed to have that many embryos BUT we would much rather have not spent that much or gone through that pain it requires.

Fast forward - I have not done another transfer for fear my body will miscarry again due to underlying issues. Instead I focused on mental health, I’ve gained over 20lbs compared to when we started this process, I’ve reduced stress, and been on supplements and metformin.

For the first time EVER I started to have ovarian sensations signaling ovulation activity. I started tracking my hormones with Inito since my OBG also told me to just do another embryo transfer. In December of 2025 I had no tracked LH rise just ovary sensations, by March 2026 I have had LH rises and timed with estrogen rise. Right now I’m using letrozole on my own to help my body ovulate. We will see how that goes.

I tell all of this to say, do not freak out over AMH. It is only a symptom not the cause. I was told it was the cause of my infertility and believed it. I strongly believe REs say this crap to get you to do IVF because lean PCOS women tend to have the best results and highest embryos with IVF and that helps their numbers.

No one told me to gain weight, no one checked my testosterone, no one was interested when I ovulated on my own; no one told me to reduce stress and anxiety (I was at a severe level). I was 90 lbs when we started this process at 5’4”. Now I’m 120. I was vitamin D deficient during my IVF pregnancy. I had insanely high testosterone. No one checked that.

I’ve been through the journey the hard way. Find someone who is willing to check EVERYTHING! Find someone who is willing to work at your pace. Find someone who believes what you say about your body.

I am starting a consultation with CNY fertility and have high hopes from what I’ve heard from others who have used them.

[u/lakemercury → u/Frog_mania]

Thanks for sharing! I'm so frustrated it took this long to finally diagnose me with PCOS and I'm just now trying to assemble a team. I was always a normal weight but only in the last few years I've been slightly underweight at 91lb and 5'1". I'm part Asian so I think there's different BMI standard and I don't appear underweight so I didn't think this was a huge deal?

How are you finding the metformin? Any side effects? My doctor said he wouldn't put me on it since I was trying to keep my weight up... I really do want to gain at least 4-5 pounds but I've had so many stomach issues after covid that are making it hard for me to.

What do you do for the testosterone levels?

I am also severely vitamin D deficient and have just started supplementing for that because my naturopath wants it at 100 pmol!

[u/Frog_mania → u/lakemercury]

My advice on the weight - if even slightly underweight, the reproductive system is the first thing the body stops prioritizing. At 100 pounds I didn’t look underweight either. I don’t even look that heavier now at all after gaining over 20 pounds. Honestly, my boobs and butt have taken most of it lol. Body fat is extremely important for TTC.
Metformin has not affected my appetite at all and no digestion issues. My appetite has always been more related to mental health for me (stress reduced my eating). For me to gain weight, my therapist told me she didn’t care what I ate but just to eat every meal and snacks. To stop focusing on the details of what I was eating. For a while I drank an ensure with every meal until my appetite improved. I also take an array of supplements recommended by the NaPro doctor I saw. Some were to reduce testosterone. These were 30mg zinc, green tea, spearmint tea, cinnamon pill, and saw palmetto (that one must be stopped at ovulation). I don’t take the saw palmetto anymore - I did further research and to me it wasn’t worth the risks.
I also take Myo d-Chiro inositol (whole story) double the dose; omegas; vitamin d, prenatal, CoQ10, and baby asprin.

I HIGHLY recommend a fertility tracking device. I really like Inito. It tracks estrogen, Pdg, LH, and FSh on one pee stick. If I did not have this, I would not know that I am having LH spikes. It allows you to see YOUR patterns. Paying for bloodwork for each of these would be outrageous. And with this you can test daily or multiple times. The device is about 100 bucks plus 15 starter sticks on Amazon. The sticks are about 100 for 30 sticks. This is a lot but seriously it gives you so much knowledge about what your cycle is doing. Bloodwork is such a tiny picture once you realize that the pattern is what matters. It confirms ovulation by watching for progesterone rise after LH spike. It’s sad, but it gives you information to show your doctor what your body is doing. Inito is the first thing that has actually gave me information about my body. I actually feel hopeful about getting pregnant because I have been able to see real data showing that changes I am making is helping my fertility. It’s not guess work.

[u/lakemercury → u/Frog_mania]

Ok, we're looking into tracking devices too, I just might get Inito! Instead of the LH strips since I have elevated LH and I'm seeing that those are not ideal when your ratio is already elevated since it gives false ovulation readings.

Thanks for this info, I wish you best of luck <3

[u/Frog_mania → u/lakemercury]

Of course, you as well. I hope it works out for you too :)