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Low AMH

Female Infertility

Dr. Suman

Sep 30, 2021

You may not have heard about low AMH as you have heard about other hormones like testosterone, progesterone, estrogen, and insulin. Most people who have been pregnant must have heard about HCG i.e., Human Chorionic Gonadotropin. We haven’t heard about AMH as it is not widely discussed like the other popular hormones but that does not mean it is not a significant hormone. It certainly plays a very important role in pregnancy.

What is AMH?

AMH or Anti-Mullerian hormone is a hormone produced in the ovarian follicles by the granulosa cells. In fact, the rate of it directly reflects the ovarian reserve a woman is having. You can get this by thinking of your ovarian reserve like a basket of eggs that you are born with. These eggs get used as you keep living your life. Now, an AMH test can help you in knowing your egg count, which is also the reason why this hormone is said to be directly linked to fertility. So, if your AMH level is less it points to your ovarian reserve being lessened/reduced thereby, hinting at fewer chances of you getting pregnant. Although, there are a few points in which AMH test is lacking:

    • It is not that definite as we would like to believe.
    • It also can’t tell us about the quality of the eggs i.e., if the eggs are good or not.
  • AMH levels also are not able to tell if someone has any fibroids, tumors, uterine scarring, or any other condition creating a hindrance in the conceiving process.

What Causes Low AMH?

There can be many factors that can be held responsible for this. Some of those are given below:

Age: It is the factor that is the most influential in causing a change in the AMH levels. Each woman has the supply of immature eggs at the time of birth which is used in her lifetime. These eggs get used in the ovulation cycles as they keep growing after their puberty until menopause. This ovarian reserve keeps on decreasing as time passes, as the result the AMH levels also decrease as she gets older. Till the mid or late thirties, the number of eggs starts reducing significantly thereby, lessening the chances of conception/pregnancy. 

Diet: If someone is consuming a diet full of processed food and surplus fat then it can certainly bring changes in their AMH levels. Consuming unhealthy food leads to obesity which, in turn, causes other reproductive issues along with low levels. There have also been studies revealing that deficiency of vitamins especially, Vitamin D can impact the AMH levels and therefore, fertility. Hence, one should consume a balanced diet in order to have normal AMH values and be healthy holistically. Decreased AMH at 30 may sound normal to most people but there have been instances of those in the 20s also, for people having an unhealthy lifestyle.  

Prior Medical History: Medical history is also an important factor that can be responsible for lessening the AMH levels. Medical conditions can affect the levels of AMH no matter what the age of the individual is. Some women have experienced low levels of AMH even in their 20s and 30s also, which other women usually experience after 30 years of age. If someone has experienced medical conditions related to the reproductive system, for example, in the case of hormonal disorders then also the levels of AMH can be decreased. In cases of women with prior history of undergone ovarian surgery because of conditions like ovarian cysts, endometriosis, etc., also, there are huge chances of lower AMH levels.

Mental and Emotional Well-being: Stress is also a factor that can lead to reduced/low levels of AMH. If someone is trying to conceive then a healthy mind and emotional well-being always prove to be advantageous as it always seems to be harder to conceive for someone being under mental pressure/stress. Doing things like yoga which destress you can help you by correcting the AMH levels.

There are some other factors also that can cause lower AMH levels:

  • Genetic disorders (inherited from the parents) like Fragile X Syndrome
  • If someone is undergoing cancer treatment
  • In case of an autoimmune attack on the ovaries
  • Certain environmental causes like pollution

Symptoms of Low AMH

Most of the time, it is hard to notice low AMH symptoms. Yet, those having a diminished ovarian reserve may face the following symptoms:

  • Facing difficulty in getting pregnant
  • The menstrual periods being late or absent
  • Menstrual cycles being shorter than the regular ones, with 28 days being an average
  • Heavy and intense menstrual flow
  • Miscarriage

These symptoms are not always present so it becomes very important to talk with your doctor if you are incapable to conceive and if you notice something unusual going on in your body.

What can be considered as a normal AMH level?

Few problems can be witnessed when it comes to the interpretation of levels of AMH hormone. As this test has not been used routinely so the levels considered to be “normal” have not been clarified and decided by the experts.

There is a table given below having AMH interpretation guidelines gathered from the experience and also, by literature on fertility written till now. A little difference in the cutoff values can put a  woman in a “different box” in this table. This table is a continuum and hence it is not something that can categorize well.

Interpretation

(Women with age under 35)

AMH level in Blood
High (seen in cases of PCOS) Above 4.0 ng/ml
Normal 1.5-4.0 ng/ml
Below Normal Range 1.0-1.5 ng/ml
Low 0.5-1.0 ng/ml
Very Low Below 0.5 ng/ml

More can be learned about AMH levels and their effects/relationship with fertility as we keep using this test to study its relationship with fertility, ovarian responsivity, chances for the success of IVF, etc.

Treatment for Low AMH values

You may be wondering how to get pregnant with low values. There can be more than one possible way to get pregnant even if you have low values. Let’s discuss them one by one.

  1. Natural Treatment: AMH levels can be corrected naturally if a woman adopts different ways or starts taking good care of her body and mind. Doing yoga regularly, having acupuncture and fertility massages, consuming healthy foods like wheat germ daily are some major points that can help in correcting your AMH levels naturally.
  2. IVF with Low AMH levels: If a woman has a low ovarian reserve then IVF is often playing the role of a savior in their lives. This is because IVF can help you in conceiving even if you have limited eggs left in your ovarian reserve. The only condition for IVF is that the matured egg which is extracted in the IVF cycle should be of an optimum quality i.e., the egg should be able to conceive.

The unusual high spike of FSH levels along with low levels of AMH levels indicate that the egg is not growing up to the optimum quality and quantity in the ovaries. This indicates below-optimum fertility. Still, with the proper diet and healthy lifestyle changes accompanied with DHEA supplement and with the specific or customized stimulation process, IVF treatment can help a woman in conceiving successfully.

  • IVF with Donor Egg: If there are no eggs left in a woman’s ovarian reserve or have a significantly low quality of eggs, and the retrieval process didn’t take place successfully, then the woman can opt for IVF with the help of donor eggs of superior quality and hence, can get pregnant.
Conclusion

It can be a piece of real heartbreaking news when you get to know that you have fewer AMH levels as it plays a major role in you getting pregnant. But, you need to know that you can still get pregnant. The pregnancy can be successful by using either your own eggs or eggs by a donor. All you need to do is to make sure you are getting competent medical help. We at FertilityZilla believe in,

“The best view comes after the hardest climb.”

Hence, don’t lose hope. We have helped many couples in getting pregnant even when they had low values. 

Patient Testimonial

I and my husband have undergone an IVF cycle at a local clinic in Agra but couldn’t succeed. We got devastated as we had really high expectations from the doctor that we consulted back then. The people at that IVF center told us that it was because of my decreased AMH values and that it would be impossible for me to get pregnant. A friend then told us about FertilityZilla and we contacted FertilityZilla the next day. The doctor at FertilityZilla formed a special stimulation protocol for me and she herself took care of the doses and injections. 4 eggs were retrieved and those too, of great quality. The IVF process was then carried further and now, thanks to the people at FertilityZilla, I am a mother of 3 months old baby boy. I highly recommend FertilityZilla to anyone with low values.

FAQs:

What does it mean to have low AMH but regular periods? What does it mean?

AMH reflects the number of eggs in your ovary. It doesn’t mean that you’ll stop ovulating the moment you are diagnosed with decreased AMH. As long as you can ovulate every month, you have the same pregnancy rate as that of a normal woman as AMH doesn’t tell about the quality.

What happens if AMH is low?/ How does AMH affect fertility?

Lower values does not mean infertility. It is just a signal that your egg reserve is decreased. But with decreasing number of eggs in the ovaries, the chances of a mature and healthy egg getting released from the ovary also decreases as the probability gets decreased.

Can AMH levels be increased?

The AMH level reflects the number of eggs present in your ovary and there is no way that this number can be increased as these eggs don’t get produced in the body after birth. They can only mature. Increasing your AMH levels even, won’t increase the number of eggs in the ovary.

Can AMH levels change month to month?

Yes. There have been instances where many women have been able to get pregnant with a lower level. AMH can vary from month to month. Even a low level doesn’t guarantee that you will not be able to get pregnant.

Why is AMH not accurate?

Because it can’t tell us about the quality of a woman’s eggs and the total egg count she is having. In fact, there have been studies revealing that even contraceptive pills can trigger a bogus low reading of AMH.

When should I do AMH test?

There is not a particular time for this. You can get your AMH measured at any point of your menstrual cycle except on day 3. Levels of AMH are increased until early adulthood and then start decreasing slowly with age until they become untraceable before menopause. 

References

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0081629

https://www.tandfonline.com/doi/abs/10.1080/09513590.2018.1505850

https://link.springer.com/content/pdf/10.1007/s00404-015-3901-0.pdf

https://www.jaims.in/index.php/jaims/article/view/1237

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