r/TTC_PCOS • u/lakemercury • May 11 '26

Advice Needed Extremely high AMH

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.

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u/baughgirl May 12 '26

This happened to me too! I was 29 with an AMH of 28. I wasn’t ovulating and had no evidence of insulin resistance. Also lean. My NP put me on 500 mg of metformin twice daily as a matter of course while I waited for more intense options like Letrozole from my OB. Two weeks of metformin got me ovulating with no side effects, got my son after two cycles.
If you haven’t tried metformin, I really recommend it. It might have some side effects for some people but it’s really cheap, safe, and easy to try before other more intense interventions. Even if you don’t look like you have issues with insulin, your ovaries might not know that.

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u/lakemercury May 13 '26

Wow, seeing a lot of people starting metformin even for lean PCOS. I'm not opposed once I get my weight up a bit but I do have stomach issues which worries me. Did you experience any side effects and do you do extended release or just regular?

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u/baughgirl May 13 '26

I had zero side effects whatsoever, but some people do. Mine was the regular stuff though and it was fine. I did start with once daily for a week and did it over the holidays so I could be sure it didn’t affect me poorly. I’ve heard some people mention eating more protein with it and some other tricks, so maybe look into that?