Low AMH- What It Means?

When you are not conceiving and go in for your initial assessment to a fertility management clinic, they will order a few tests among which, an important one is the AMH value or the level of the Anti-Mullerian Hormone.

Having low AMH levels means you have a low egg reserve, which is why you will need assistance to get pregnant.

While this does not mean that you cannot get pregnant naturally, you must understand that it may take a very long by which time, you may have completely depleted your egg reserve and will not be able to conceive even through an IVF cycle done with your own eggs. You may have to depend upon donor eggs – sourced from an unrelated, unknown woman.

Timely intervention by an expert is the key to boost up the chances of conception even with Low AMH.

We at YASH IVF have successfully offered the joy of motherhood for low AMH women. Let us understand how you can overcome a low AMH value. But before that let us find out what it means and signifies.

 The lifetime quota of a woman’s egg is gifted from her birth by mother nature. Throughout their lifespan, starting at the first menstrual cycle, the body directs a group of follicles (each with a small immature egg inside), that have the potential to grow and ovulate, to do so through the hormone response. 

 Usually, a woman will release & ovulate one egg per month. The other set of eggs that do not get selected to ovulate will dissolve and the process repeats itself if a woman is not pregnant that month. Initially, when she is young, generally below 35, the AMH value is well above 1. However, with every passing cycle the volume and quality of the eggs in the ovaries depletes. Menopause is when there are very few or no eggs left. The AMH value,  which indicates the quantity of egg reserve left in the woman’s ovarie, is almost zero.

So, let’s find out more about this marker of reproduction, the anti-Mullerian hormone.

What is the anti-Mullerian hormone?

Normally called AMH, it is a hormone made by the ovaries, and all the cells that surround the egg inside the ovaries. In that sense, AMH is a close connection to the eggs themselves. Fairly good numbers of eggs mean a good AMH score.  If you don’t have many eggs left, you have a low amount of AMH.

It is first made in primary follicles, which are microscopic and cannot be seen by ultrasound. AMH production is highest in preantral and small antral stages where the follicles are less than 4mm in diameter of development.

Production decreases and then stops as follicles grow over 8mm. This stage ensures a constant level of AMH & can be assessed on any day of the woman’s cycle.

How AMH is related to your fertility-

AMH and fertility are closely associated. Higher AMH values (greater than 1 ng/mL) usually dictate a status of normal ovarian reserve. Lower numbers (often less than 1 ng/mL) may point toward diminished ovarian reserve (DOR). AMH values also decline as women age. The important value of this test is that a woman with a low AMH can choose to do something about her fertility now if she desires a family in the future.

What is the normal range for AMH?

Typically, any score above one is considered “normal,” while anything less than one might be considered low, and suggests a somewhat depleted supply of eggs.

Importantly, this number can fluctuate as a woman’s fertility (and AMH level) does inevitably decline over decades, her AMH level can change month per se, due to weight loss, taking the birth control pill etc.

What if my AMH is less than one, will my dream of motherhood be a dream & not a reality?

Just as a score over one is not a guarantee that you will have a smooth journey to getting pregnant, neither is a score below one, a guarantee you won’t get pregnant.

Fertility is more of a continuous variable. “Most people just cannot be categorized simply as fertile or infertile as most people have good fertility earlier, and then not-as-good fertility over time.

Let’s Say, you’ve got a 35-year-old who’s told that over one is good and under one is bad, and she comes in at 1.1. Now, should she be nervous or reassured? Should she freeze the eggs on priority or should she wait for the time being.  If she waits will it be too late?

The real concern to this whole story is having real conversations, and understanding one’s reproductive future and goals with the help of a fertility expert.

Is AMH score a reliable indicator of fertility?

Not necessarily. One recent study found that AMH was not the only determining factor in IVF outcomes for women under 35. Women over 35 with higher AMH levels had much higher IVF live birth rates than women over 35 with lower AMH levels. The AMH test may be most valuable at the point at which one’s fertility is in sharp decline. Before that, age remains the most important determining factor in predicting a woman’s fertility. AMH remains one of the tests along with family history, genetic testing, ultrasounds and desired number of children (and timing of births). Guidance from the expert fertility specialist is a must for deciding the importance of AMH in pregnancy. It must be co-related with the values of the other tests, especially the follicular scans.

How closely are AMH & infertility related?

Only small ovarian follicles produce AMH, blood tests can predict the accurate results of AMH, which means, the size of growing follicles in women.

By studying the levels of an AMH blood test, a fertility doctor can determine ovarian reserve. As the age increases, the number of microscopic follicles too decrease along with those visible on ultrasound and there is a corresponding drop in the AMH value.

However, there are situations like PCOD (Polycystic ovaries), where women have many small follicles with corresponding high AMH values. Women may have few remaining follicles due to menopause & consequently may have low AMH levels.

There is a great correlation between AMH hormone values, fertility, and the status of ovarian responsiveness to hormone stimulation.

Diagnosed with Low AMH, what next?

Thanks to research and a lot of guidelines in place to help women with low AMH, in vitro fertilization (IVF) helps. Depending on your diagnosis, your doctor will either recommend an IVF with your eggs or  through the use of donor eggs fertilized by your husband’s sperms.