What's causing low AMH levels in Indian women?

Mint

2 days ago

Doctors in fertility clinics across India—from buzzing metros to smaller tier-2 and tier-3 cities— are observing a startling pattern: a significant number of young women, even those in their late twenties and early thirties, are presenting with alarmingly low anti-Müllerian hormone (AMH) levels, a key marker of ovarian reserve. This phenomenon, once primarily associated with women in their 40s, now appears to be afflicting women a decade earlier, quietly reshaping the reproductive health landscape of the country.
Also read: What you should know about freezing your eggs
'We're seeing a clear downward trend in AMH levels even among women under 35," says Dr Rita Modi, senior IVF consultant at Motherhood Fertility & IVF, Kharghar, Navi Mumbai. 'And it's no longer restricted to urban India. The trend is equally concerning in smaller towns."
AMH, a hormone secreted by cells in developing ovarian follicles, is a critical indicator of a woman's egg supply. A drop in this value suggests a diminished ovarian reserve, reducing the chances of natural conception and often foreshadowing challenges with assisted reproductive techniques as well. Dr Angeli Misra, director of Lifeline Laboratory, Agilus Diagnostics in Delhi, confirms this trend with empirical data: 'The total number of AMH tests conducted pan-India in our centres annually is 4,700. There is definitely a noticeable rise in AMH tests being done in women under 35. This trend is mainly seen in metros and among young professionals who are starting their careers."
THE AGEING OVARY PARADOX
Paradoxically, this crisis comes at a time when India—still home to the world's largest population—is witnessing a declining total fertility rate (TFR). According to data from the National Family Health Survey, India's TFR dropped from 2.2 children per woman in 2015–16 to 2.0, slipping below the replacement level of 2.1. This reflects significant strides in maternal health and contraceptive awareness, but it also masks an emerging challenge: the premature biological ageing of Indian ovaries.
'Indian women typically hit menopause five years earlier than their Western counterparts," explains Dr Sonia Malik, chief clinical mentor at Nova IVF Fertility. 'It's not just social delay in motherhood—there's a deeper genetic and epigenetic acceleration in ovarian ageing that we're still trying to fully understand." Malik adds that environmental and lifestyle stressors—such as urban pollution, endocrine-disrupting chemicals in cosmetics and food packaging, and the rise of processed diets may be exacerbating the issue.
Also read: A practical guide to help you cut back on processed foods
According to Misra, the concern is far from anecdotal. 'The percentage of women showing lower AMH levels in our laboratory is as high as 38%, and those with very low ovarian reserve is about 26%. An increasing number of women under 35 are showing a low reserve, and these numbers are increasing every year. However, one must remember that we are mainly testing women who are being investigated for infertility, and not a normal cross-section."
EXTERNAL CAUSES
While age and genetics remain immutable drivers, external factors are proving equally detrimental. Air and water pollution, exposure to pesticides, and endocrine disruptors—present in plastics, cosmetics, and even produce—are widely believed to interfere with hormonal signalling and damage ovarian follicles.
In rural regions, infections such as genital tuberculosis, HIV, and other sexually transmitted infections are an added risk, often going undiagnosed and leading to pelvic inflammatory disease—a condition that can impair fertility by damaging the reproductive tract. 'Fertility health is increasingly under siege from both modern lifestyle choices and deep-rooted public health challenges," Modi notes.
Though often sidelined, psychological stress too is proving to be a silent saboteur. Chronic stress elevates cortisol—the body's stress hormone—which disrupts the delicate hormonal balance essential for ovulation. Malik points to the 'gut-brain-reproduction axis"—a triad that, when compromised by anxiety, poor sleep, and restrictive diets, can derail reproductive function. 'Many young women with intense work cultures or disordered eating habits end up with irregular cycles or unexplained infertility. These aren't just lifestyle issues they're medical ones," she emphasizes.
IS EARLY TESTING NECESSARY?
With fertility clinics becoming more mainstream and technologies like egg freezing gaining popularity, there's a growing call to integrate AMH assessments into preventive health check-ups much like regular screenings for thyroid, cholesterol, or diabetes. 'AMH testing can empower women to make proactive choices about their reproductive futures," says Modi. 'But it must be done with nuance and medical oversight. We don't want to create panic or rush women into interventions they may not need."
Dr Nidhi Rajotia, unit head – obstetrics and gynaecology at Artemis Hospitals, Gurgaon agrees. 'It's totally understandable for women to feel a surge of panic when they discover their AMH levels are low. It is important to keep in mind that this doesn't automatically rule out the possibility of pregnancy." AMH, Rajotia points out, is just one part of the bigger picture when it comes to assessing a woman's ovarian reserve. 'It tells us about the number of eggs, not the quality. Fertility is affected by a range of factors, such as age, egg quality, overall health, and even the health of your partner's sperm. So, having a low AMH level doesn't mean that natural conception is impossible," she explains.
Also read: Planning pregnancy after 35? Here's what you should know
There is also increasing curiosity around when to get tested. 'Understanding when to check your AMH levels can really help you make informed choices about your fertility," Rajotia adds. 'While there aren't any clear symptoms of low AMH, women who experience irregular periods, have a family history of early menopause, or struggle with conceiving should think about getting tested. It is also helpful for those who are planning to delay pregnancy or are considering egg freezing." Misra reinforces this sentiment by saying that there is a lot of increase in the awareness regarding the utility of AMH.
'Most women are getting it done on medical advice for investigation into infertility. However, there is an increasing number of young women who are now, as a part of their life planning—both personally and professionally—getting the test done to know their ovarian reserve and plan their future pregnancy or egg freezing," she adds.
Both experts agree that fertility awareness should be part of school and college curriculums, not just restricted to biology textbooks but as part of practical health literacy. Rajotia puts it plainly: 'Education about AMH is incredibly important, not just for women dealing with fertility challenges, but for all women out there. Understanding AMH is key to becoming more aware of your reproductive health, allowing you to plan for the future with confidence."
GET YOUR BASICS RIGHT
Dr Parul Prakash, head, reproductive medicine (Unit I), Artemis Hospitals, Gurgaon answers basic questions on the anti-Müllerian hormone (AMH).
What is AMH?
AMH is produced by small follicles in the ovaries. A blood test measures AMH levels to assess the number of eggs remaining. Because AMH remains stable throughout the menstrual cycle, it is considered a reliable fertility marker.
Is it normal for AMH to decline with age?
Yes. AMH peaks in the mid-20s and gradually declines. By 35, the average AMH is 1.5 ng/mL (nanograms per milliliter), and by 40, it dips to around 1.0 ng/mL. Levels below 1.0 suggest a diminished reserve but don't automatically imply infertility.
Why do Indian women's ovaries age faster?
Studies suggest Indian women experience menopause nearly six years earlier than their Western counterparts. Factors may include genetics, environmental stressors, and lifestyle habits.
Can lifestyle changes help?
While we can't reverse aging, lifestyle adjustments—balanced diet, exercise, stress management, and reducing toxin exposure—can support reproductive health.
Tanisha Saxena is a Delhi-based independent journalist. She writes stories that are on the intersection of art, culture and lifestyle.
Also read: Magnesium mania: Understanding the hype behind the wellness trend