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 the size, the amount of AMH which is still being produced is almost non-existent. 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 ovary.
What is Low AMH?
If someone is having 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.
The levels of AMH will naturally become low when you will be 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 29,621 women who are in the 20-40 age group had Low AMH levels.
Causes of Low AMH
There can be various reasons for having a Low AMH level. So, let’s discuss some of the major reasons below:
One of the major reasons behind having a Low AMH level is age. All the 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 the 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 level.
It is a condition where tissues that are generally grown inside of a woman’s uterus, grow outside of the uterus. It is a very painful disorder in the reproductive system which causes inflammation in the ovaries and the fallopian tubes, which results in Low AMH level.
- PCOS (Polycystic Ovary Syndrome)
It is now one of the very 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 the 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.
Treatment Options For Infertility
Couples at a certain point in time have the desire to conceive. Many studies have found that almost 85% of the couples successfully conceive within one year of trying.
Infertility assessments include various examinations as well as tests to find out the underlying reasons behind infertility.
In Vitro Fertilization, or IVF is a kind of fertilization where the eggs combine with sperm for fertilization outside the body.
Follicular study or follicular monitoring is the process through which the doctor watches the growth of this follicle from the beginning of the menstrual cycle to the time it is ready to release an egg.
Ovulation induction is mainly a to-the-point treatment where hormonal pills are used for resuming ovulation.
Intracytoplasmic Sperm Injection, which is also commonly known as ICSI is one of the common and most successful treatments for male fertility.
Intracytoplasmic Sperm Injection is also known as IMSI is another procedure used during the time of IVF.
Stem Cell In IVF
In the whole world, around 8% to 12% of couples tend to get affected by the curse of infertility.
IUI, medically known as Intrauterine Insemination, is a simple form of fertility treatment.
Preimplantation Genetic Screening is a test that carefully examines the chromosomal material of an IVF or in-vitro fertilized egg before the process of implantation can begin.
Computer-Assisted Sperm Analysis or refers to a system where a complex electronic imaging system is used to visualize the sperm, while advanced software programs help measure the numerous individual parameters of said sperm.
Symptoms of Low AMH Levels
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.
Low AMH and Fertility issues
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 suggested to get the treatment properly.
But 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.
Options if you have low AMH levels?
There are lots of options are 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.
What to expect from a doctor if you have low AMH levels?
The women who are interested to get pregnant but have low AMH levels, doctors suggest them to go for IVF (In-Vitro fertilization) option. Other methods or treatments like ARTs (Assisted Reproductive Technology) is 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 their patients to lead a healthy lifestyle so that it improves the egg quantity in their ovaries and eventually increases the level of AMH.
Treatment with low AMH level
There is no such 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 treatment is there to increase the level of AMH such as:
- Yoga and Regular Exercise.
- Balanced Diet
- DHEA (Dehydroepiandrosterone) supplements. DHEA is mainly a hormone that has the ability to improve the quality and quantity of eggs.
If you are a young woman and you want to conceive then some treatments are available for you such as IVF with low AMH level and IVF with Donor Egg.
- IVF with low AMH level
A successful pregnancy mainly depends on the women’s ovarian reserve. For them, IVF is the best option that can make optimal use of those 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 ovaries. It means that she is not fertile enough. But, if a woman maintains healthy life and takes DHEA supplements, then she will be able to get pregnant through IVF treatment.
- IVF with Donor Eggs
This treatment is best for the woman who has very low AHM levels and has no eggs left. In case the IVF is not successful in retrieving good quality eggs, there comes this Donor egg in IVF. In this treatment, the good-quality egg of another individual is used to carry out the whole procedure.
1. Does the AMH tell me anything about my chances of getting pregnant right now?
– No, the AMH test does not provide any information on pregnancy. The AMH level can not predict anyone’s fertility. It depends on many other factors like the condition of fallopian tubes, the quality of your partner’s sperm, your time of ovulation, etc.
You can pregnant even if you have a low AMH level at a younger age. If you have regular cycles, then the chances of your pregnancy increase. Here, age is the major factor instead of the level of AMH. However. A low AHM level can indicate that you have a short span left to get pregnant.
2. Does the AMH tell me anything about my chances to conceive in the future?
As AMH can detect the ovarian reserve, that is why it is possible that the AMH test can give you an idea about your ovary condition. If you are in premature menopause, then you will get to know about it.
In premature menopause, you lose all of your eggs and will become unable to reproduce eggs anymore. So, it is recommended to all women that they need to do an AMH test so that they can take precautions before anything worse happens.
3. I have low AMH. Does it mean I am infertile?
No. this is absolutely not true. If you are having regular periods and ovulating one egg per month. Then you are fertile like others who have normal AHM levels. AHM level does decrease your ovarian reserve but that does not mean you won’t be able to conceive in the future.
On the other hand, you can increase your AHM level by maintaining a healthy lifestyle and a good diet. Moreover, if you want to get pregnant immediately and have gone through the treatment for low AHM then it is recommended to consult with a fertility expert now.
4. I was found to have high AMH levels. Does it mean I am super fertile?
No, it is not true at all. You will produce one egg per month like others. On the contrary, you can face problems with your period. You can have irregular periods due to high AMH levels.
PCOS (Polycystic Ovary Syndrome) can happen due to a high level of AMH and because of this, your chances of getting pregnant can be decreased. Apart from this, the good news is that you have a lower chance of having early menopause. It will improve the chances of getting success in your IVF treatment.
5. Why do fertility clinics check AMH levels?
An AMH test is usually done by fertility experts just to check women’s ability to produce eggs that will be fertilized for pregnancy. With fertility medication, a woman’s ovary ovulates multiple eggs and fertility experts take those eggs all at once to use this in IVF.
Here, the AHM test can predict how many of those eggs are likely to mature in one IVF cycle. Moreover, predicting the ovarian response through the AMH test is important in getting success in IVF.
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The average month length of menstrual cycle is 28 days. A menstrual cycle that is either less than 21 days or more than 35 days is considered irregular
Every time IVF is performed, the doctors re-examine all parameters. Even if no problems are identified after all these tests, the 2nd IVF success rate will be 35-40%
Dr. Jay Mehta
Fertility and IVF Specialist
Dr. Jay Mehta is the Scientific Director of Shree IVF Clinic. He is a well-known Azoospermia doctor in Mumbai and also among a few doctors in the country who specializes in Embryology and Andrology.