Does AMH really matter for fertility?
Does AMH really matter?
Yes and no.
First off, what is AMH? Anti-Mullerian Hormone (AMH) is produced by the ovary and is a useful marker of ovarian reserve. AMH is looked at through the lens of age. A general guideline for optimal AMH levels by age is:
· Under 33 years old: 2.1ng/ml
· 33-37 years old: 1.7 ng/ml
· 38-40 years old: 1.1 ng/ml
· 41: 0.5 ng/ml
An AMH of 0.3-0.6 ng/ml generally indicates diminished ovarian reserve and less than 0.3 ng/ml may indicate premature ovarian failure.
As we age our quantity off eggs diminishes. This is a natural process as we lose eggs with each menstrual cycle. Your AMH should decline with age. But, what if you are in your early to mid 30s with an AMH of a 41 year old?
When I have a patient come in with an AMH level that is low for their age my first question is “why”? In this instance AMH matters because it is pointing out that something is going on that should be addressed.
What can cause low-for-age AMH?
· Endometriosis can cause low AMH when endometrial lesions impact the ovaries or there is an endometrioma.
· Premature ovarian failure, which can be caused by genetics, smoking, autoimmune disease, chemotherapy, radiation, chromosomal abnormalities.
Of course, I am not just looking at AMH. Additional labs that can round out the picture include Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH) estrogen, antral follicle count and others.
But, and this is the most important thing, AMH is only a measure of quantity. It is not a measure of quality. Egg quality is much more important than quantity. It only takes one quality egg and one quality sperm to create a healthy embryo. Neither Chinese Medicine or Western Medicine can increase egg quantity but acupuncture, herbal medicine, supplements and lifestyle adjustments can improve egg quality!
One of my patients had very low AMH for her age, likely due to endometriosis. She was told she would probably need to use donor eggs. She got on the waiting list for donor eggs and in the meantime started working with me. We spent about 3 months doing weekly acupuncture, herbal medicine and she made some important lifestyle changes. She decided to try an egg retrieval. Over the course of 3 egg retrievals she ended up with 7 euploid (genetically normal) embryos! She is now almost through her first trimester with a healthy pregnancy.
If you have very low AMH you may still need to utilize IVF but why not optimize your outcomes by taking a few months to focus on egg quality first? As an added bonus acupuncture may also help your body respond better to the stimulation medications and help with the stress of the IVF process.
As a side note, very high AMH can be an indication of PCOS. So AMH can be a useful diagnostic tool but it’s not the whole story.
Have questions about AMH or want to chat about ways to improve egg quality? Book a free consultation with me, I’d love to help.