Low AMH Treatment at Shree IVF Clinic, Mumbai

Introduction

Anti-Mullerian Hormone is the full form of AMH. It is a protein hormone that is mainly produced in small follicles (which are that tiny pouches that contain eggs in the ovary) by the granulosa cells.

Granulosa cell is something that helps the eggs to develop in the woman’s ovaries. The maximum amount of AMH is mainly given by these cells when the follicles are in the preantral and small antral stages of their development.

As the follicles grow larger, the amount of AMH produced begins to decrease. When a follicle reaches approximately 8 mm in size, the amount of AMH that is still being produced is almost nonexistent.

As preantral and small antral follicles are always present in the ovaries, this means that AMH levels are constant from day to day. That is why an AMH test can be done on any day of a woman’s cycle to know the number of eggs that are left in her ovaries.

The common confusion amongst the patients is that this test is required to be done on a specific day of the menstrual cycle., The report is usually available within 3 to 4 hours of doing the test; it costs approximately ₹2500 in India.

If someone has a low AMH level, it indicates that her ovaries are producing fewer preantral follicles. So, the AMH level mainly provides information about the number of eggs that are present in the ovary. If you have a high AMH level, that means you have more eggs, and a low AMH level means you have fewer eggs left in your ovary.

Both high and low AMH are not good for the overall reproductive health of a female; women with very high levels of AMH may suffer from something called severe PCOS, in which the production of the egg is severely hampered, and the majority of them are required to do ovulation induction in order to make sure that they eat correctly so that they can go ahead and have a natural pregnancy.

The levels of AMH will naturally become low when you are in your advanced stage. Still, if you face low AMH levels in your younger stage, then the chances of premature ovarian failure will increase. Besides, it also decreases the chance of getting pregnant naturally. In India, a survey says that almost half of the 29,621 women who are in the 20-40 age group had low AMH levels.

Based on the standard directive, an AMH value of less than 1.2 ng/mL is considered to be a low AMH value. As a patient, you should simply understand that this indicates the capacity of your ovary to respond to stimulation, just because you have a low AMH. It does not mean that you will not be able to become pregnant naturally, or you may have to end up doing IVF only to make sure that a conception occurs.

There can be various reasons for having a low AMH level. So, let’s discuss some of the major reasons below:

• Age

One of the major reasons behind having a low AMH level is age. All women are born with all the eggs that they are going to have in their lifetime. Then, after that, these eggs are naturally used during the ovulation cycle throughout life until the time of menopause. Therefore, ovarian reserves will decrease over time along with the level of AMH as she gets older.

When women are in their mid-30s, the number of eggs starts decreasing. That is why the chances of the fertility of a woman also start to decrease as AMH starts depleting by then.

• Very Poor Diet

Processed food and fat are not a good option for healthy AMH levels. Unhealthy foods will affect your body, which results in obesity, and that can be the reason for various health issues, such as low AMH levels.

• Endometriosis

It is a condition where tissues that are generally grown inside a woman’s uterus grow outside of the uterus. Endometriosis is a very painful disorder in the reproductive system that causes inflammation in the ovaries and the fallopian tubes, which results in a low AMH level.

• PCOS (Polycystic Ovary Syndrome)

It is now one of the most common female reproductive disorders in which your ovary produces an abnormal amount of male sex hormones. So, the small cyst in your ovary can affect the AMH level.

• The genetic factor

The inherited genetic disorder can be one of the reasons behind the low AMH level. If you have anyone in your family with a low AMH level, then genetically, it can affect your AMH level as well.

• Autoimmune diseases

In this case, your immune system mainly attacks your healthy cells along with your healthy eggs, which can lower your AMH level.

• Cancer treatment or Chemotherapy

If anyone is undergoing cancer treatment, then it damages the healthy follicles of their ovary, which causes a low AMH level.

• Mental Health

Stress can be a cause of having a low AMH level. If someone is living with mental health issues, then it automatically lowers the chances of getting pregnant. It is necessary to be healthy and have a healthy mind if someone is trying to conceive. Also, de-stressing can correct the level of AMH.

• Change in lifestyle

The changes in your lifestyle can also affect the level of AMH, such as excessive smoking, obesity, pollution, Vitamin D deficiency, etc.

Generally Low AMH does not have any specific symptoms, but if you see any general symptoms like irregular periods, short cycles, or premature menopause, then you should consult with a doctor.

AMH level mainly indicates the woman’s ovarian reserve. It does not define infertility. There is no such relationship between the level of AHM and infertility. The main thing is that women’s fertility decreases as they age, and this is associated with the decrease in AMH levels.

Fertility depends on the number of eggs women have. So, if someone has fewer eggs or no eggs, then the chances of conceiving decrease. Furthermore, the quality of the eggs can be affected by the level of AMH, which increases the chances of miscarriage or abnormal fertilization. This is why older women with low AMH levels are being advised to get the treatment properly.

However, it is seen that younger women have fewer chances of not getting pregnant even if their AMH level is low. Besides that, a survey said that over 38% of women ages 26-30 were reported to have extremely low AMH levels. So, if you do the blood test, the AHM levels only show you the potential number of follicles in your ovary.

There are lots of options available if you have low AMH levels. But it is very difficult to know which will be the best for you. You can surely consult with your doctor about it. If you do a blood test and it shows that you have a low AMH level, you do not have to worry about it, as you can increase the level naturally with certain lifestyle changes.

If you’re worried about your AMH levels, consult with Dr. Jay Mehta, a fertility specialist in Mumbai, for more guidance on fertility options.

For women who are interested in getting pregnant but have low AMH levels, doctors suggest they go for the IVF (in vitro fertilization) option. Other methods or treatments like ARTs (Assisted Reproductive Technology) are available as well.

There are so many tests as well to evaluate fertility, along with the AMH blood tests, such as the FSH blood test (Follicle Stimulating Hormone) and AFC blood test (Antral Follicle Count). Sometimes, medical experts recommend that their patients lead a healthy lifestyle so that it improves the egg quantity in their ovaries and eventually increases the level of AMH.

There is no complete cure for low AMH. But there are ways available through which a woman can improve her AMH level before going for ART as an option. Along with different treatments, natural treatments are there to increase the level of AMH, such as

• Yoga and Regular Exercise.
• Balanced Diet
• Acupuncture
• DHEA (Dehydroepiandrosterone) supplements. DHEA is mainly a hormone that has the ability to improve the quality and quantity of eggs. However, such types of drugs are to be consumed with a very strong amount of caution because the majority of the time, patients believe that it is this drug that is going to solve the AMH values and increase their AMH value.

Also, please make sure that if you have a low AMH value, it does not indicate that you need to do IVF, and moreover, especially in a country like India, you should make sure that you are not going to be pushed to do treatment with donor eggs.

No matter what, you are going to be promised that the eggs sourced are going to come from ART banks, and the majority of the clinics in India will give you a fancy offering, and you have to be utterly careful of such types of situations.

It should be noted that the majority of the women, despite having a very low AMH, will end up conceiving using their own eggs, and as a result of this, if you are a patient, kindly go to a healthcare practitioner who understands the science properly and treats you accordingly, rather than simply going to a clinic that is located close to your home and falling prey to fancy marketing practices.

• IVF with low AMH level

A successful pregnancy mainly depends on the woman’s ovarian reserve. For them, IVF is the best option that can make optimal use of the limited eggs that are left in their ovaries.

If any woman has abnormally raised FSH levels along with low AMH levels, then it is an indication that the right quantity and good quality eggs are not being produced by the ovaries. It means that she is not fertile enough.

Certain specialised protocols are available for ovarian stimulation in women who have a low AMH value
1. Random start stimulation is an excellent technique to stimulate women who have low AMH.
2. In the vast majority of patients, I also prefer to use something called a luteal phase stimulation.

If you’re doing IVF with low AMH, remember one thing: you will end up getting approximately 3 to 5 good-quality eggs. Then it comes down to the clinic that you have chosen and how good the doctor and the Embryologist in the facility are to make sure that with limited number of eggs, these eggs are optimally utilised, what the laboratory protocol is, and how many blastocyst embryos you actually get out of this

Many religions in India do not allow for the treatment with donor eggs, and we have to respect their religious and social choices because, at the end of the day, even with extremely low AMH, women end up having a child using their eggs

As a specialized referral unit for patients with AMH across the country, we end up delivering more than 50 patients every year who have conceived with our treatment, with an AMH of less than 0.1. This is an indicator of how beautifully the correctly done treatment works on a well-selected patient in order to make sure that they end up having a conception.