What is AMH? ( Low AMH and IVF )
AMH or Anti Mullerian Hormone is produced by the granulosa cells in the ovary. It is a marker of ovarian reserve. In this article, we will talk about IVF with Low AMH. To put it simply, AMH tells us about the egg count. A low AMH suggests a Diminished Ovarian Reserve (DOR). However, this being a hormonal test, the result is interpreted after a complete picture is obtained by supplementing with an ultrasound. There is a common misunderstanding that fertility or infertility is gauged by AMH Levels. It is important to understand that an AMH test is one of the many indicators of infertility and it is important to meet a fertility doctor to know more.
Little Angel IVF is a well-known infertility clinic in India. Dr Mona Dahiya of Little Angel IVF who is counted among the best IVF doctors in India, shares her views about often asked questions related to AMH.
What is a AMH Test?
AMH Test is a Blood test done to find out the egg reserve in a Woman. Women have a finite Egg reserve which reduces with Age and eventually at Menopause there are no eggs. Hence, the AMH test is done to find out the remaining quantity of eggs.
Do AMH levels indicate egg quality?
AMH levels do not indicate Egg Quality. AMH is an indicator of Egg Quantity or in other terms the Egg Reserve. High AMH levels indicate more Egg Reserve and Low AMHL levels indicate less Egg Quantity. However, there is an ideal range of AMH levels and High is not always good. Quality of eggs is determined by other fertility tests that an infertility specialist doctor will suggest.
Does low AMH mean infertility?
Low AMH does not mean infertility. AMH does not accurately predict natural fertility but is an indicator. Low AMH level only means that the Egg reserve is possible low and hence based on the data, a fertility doctor decides on the course of fertility treatment.
Can you still ovulate with low AMH?
Yes, you can ovulate with Low AMH. Low AMH level means that you have less eggs and does not mean that you have no eggs. Ovulation occurs in a normal manner with low AMH. Visit our blog page to read Low AMH Natural Pregnancy Success Stories shared by our customers.
Why is a AMH Test Done?
AMH test is done by a Fertility Doctor with the following 5 key objectives.
- Determine the number of Eggs to determine fertility treatment procedure
- Ageing rate of ovaries vis-à-vis the natural rate.
- Planning the dosage of injections required during IVF.
- A clearer estimation of the number of eggs that would be retrieved during IVF.
- A criterion to suggest the planning of pregnancy time or Egg Freezing.
What is the normal AMH Test Result?
- Normal AMH Test Result is over 1.0 ng/ml (Known as the AMH Blood Level). A range of (0.7 to 1.0) ng/ml can at times be considered to Normal of a Low range.
- An AMH Level in the range of (0.3-0.6) ng/ml is considered as Low.
- An AMH Level of less than 0.3 ng/ml is considered as Very Low.
- An AMH level over 3.o ng/ml is considered High. Very High levels are indicator of PCOS.
When should AMH levels be checked?
AMH levels should be checked for Menopause, PCOS, Menstruation or Age-related factors.
- Menstruation: To find out the reason of absence or delay in periods/menstrual cycle.
- Menopause: To check for a relation to early menopause.
- PCOS: To detect polycystic ovary syndrome which affects infertility.
- Ovarian Cancer: To check the ovarian levels for women suffering from ovarian cancer.
Does stress affect AMH levels?
Yes, Stress affect AMH levels. Most documented medical research have shown that chronic stress is one of the reasons for decreasing AMH Levels as well as infertility. Chronic Stress affects and activate the following two known to damage ovarian follicles leading to decreased AMH levels.
- HPA: Hypothalamus Pituitary Adrenal
- SPA: Sympathetic Adrenomedullary Pathway
Known to damage ovarian follicles leading to decreased AMH levels.
Do AMH levels fluctuate month to month?
Since the AMH value almost remains same throughout the menstrual cycle, the test can be done on any day of the menstrual cycle. Also, AMH levels do not vary or fluctuate from cycle to cycle but remain more or less constant.
What is a good AMH level for IVF?
A good AMH level for IVF is 1.5 ng/ML and an AMH level below 0.5 is considered LOW.As a general guideline, the following levels (in nanograms per millilitre) represent the lower limit of AMH by age in women.
- 45 years old: 0.5 ng/mL
- 40 years old: 1 ng/mL
- 35 years old: 1.5 ng/ mL
- 30 years old: 2.5 ng/mL
- 25 years old: 3.0 ng/mL
How quickly does AMH decline?
Every lady has a biological clock and according to the natural process of ageing the AMH begins to decline after 30 years. After the age of 35 years there is a steep decline in AMH levels which falls rapidly.
Why should AMH Levels be low?
AMH declines with age in accordance with the natural ageing process. As the number of eggs in the ovaries of a lady declines, the AMH Levels also decline. There is a sharp decline after the age of 35 years as both the number and quantity of eggs decline in a woman. Low AMH may also be seen in young women who have
- Surgery for endometriosis or chocolate cysts
- Surgery for ovarian cysts
- Autoimmune diseases like SLE which cause oophoritis and lead to pre mature ovarian failure.
Can low AMH cause early Menopause?
Low AMH predicts early menopause. Low AMH implies a decrease in ovarian reserve. That said menstrual cycles may occur over the next 10 years even with low AMH. Very low AMH predicts the time to menopause and indicates approaching final period over next one to two years.
Is AMH more important than FSH?
Yes, AMH is more important than FSH. AMH is a better indicator of the Ovarian reserve than FSH because AMH tests are constant and can be done any day of the menstrual cycle while FSH fluctuates throughout the Menstrual cycle and is usually done on Day 3.
Are FSH and AMH related?
Yes, FSH and AMH are related as these are both screening tests done to check the same outcome i.e., Ovarian reserve in a woman. That being said, AMH is a better ovarian reserve test than FSH since it detects a change in the ovarian reserve earlier on and also because there are less fluctuations in its value.
What are the AMH and FSH correlation?
AMH and FSH are inversely correlated. When the ovarian reserve declines, the AMH also declines but the FSH rises. The FSH hormone stimulates the ovaries to release an egg hence a high FSH means that the ovarian reserve is Less. ivf success with low amh
Low AMH and Pregnancy chances after IVF? Has anyone got pregnant with low AMH?
During IVF, when an optimal number of eggs is retrieved (10-15), the chances of pregnancy are good. If the number of eggs retrieved is less, then the chances of pregnancy also decline, since not every egg is fertilized and progresses to form a good quality embryo. That said, the quality of eggs is also a major determinant of the success rate. At Little Angel IVF, with individualized treatment protocols, patients with as few as 1-3 eggs have also had successful pregnancies. Couples with Low AMH can be subdivided into two groups.
- Those who are young and have low AMH have less quantity but good quality of eggs. Their chances of pregnancy are better.
- Those who are old and have low AMH they have both poor quantity and quality of eggs. Their chances of pregnancy are less.
- With minimal stimulation IVF protocols or mini-IVF, many couples with low AMH have had successful pregnancies.
Has anyone got pregnant with low AMH?
Countless women have got pregnant with low AMH. At Little Angel IVF, after a thorough assessment and formulation of a tailor-made protocol, couples with AMH low as AMH 0.2 ng/ml have also conceived successfully.
Read More:- Low AMH IVF Success Stories
What are the challenges in IVF with Low AMH?
The challenges in low AMH IVF in couples are the following 3…
- Cycle cancellation: In 10-15% of couples, the response to stimulation with injections may not be appropriate and IVF cycle may have to be cancelled.
- Low AMH how many eggs retrieved (Lowe number of eggs retrieved).
- No good-quality embryo formed.
Is there any treatment for low AMH?
Yes, there is treatment for low AMH. However, it is important to note that as one ages, one has fewer eggs. The AMH levels decrease as one ages and it is Natural process. Low AMH means less eggs and not no eggs. Low AMH levels does not mean that one can not get pregnant as the truth is that only 1 Egg is required for fertilization.
Can low AMH levels be improved?
Yes, low AMH levels can be improved. There are drugs that may help improve AMH levels. Certain trials have shown some positive results with DHEA supplement. However, it has not been well documented and has its limitations especially in patients with very low AMH. Vitamin D and Coenzyme Q10 supplements also, to a certain extent, aid in improving fertility outcomes. But one can work on the egg quality by adopting a healthy diet and lifestyle, avoiding smoking and maintaining a healthy weight. Even if the eggs are few in number but if they are of good quality, it maximizes the chances of pregnancy.
How can I improve my AMH levels at home?
You can improve AMH levels at home by adopting a healthy lifestyle and eating habits. Avoiding smoking, alcohol and maintaining a healthy weight help in improving AMH levels and especially the quality of Eggs. Even if the eggs are few in number but if they are of good quality, it maximizes the chances of pregnancy. One should eat food that is rich in Vitamin D.
Does vitamin D improve AMH?
Yes, Vitamin D improves AMH as a deficiency of Vitamin D is associated with reduced fertility in women. Studies have shown that positive effects of Vitamin D in improving AMH Levels. However, it is to be noted the improvement of AMH levels is minimal and not very substantial. Foods that are rich in Vitamin D or Vitamin D supplements are known to arrest the decline in AMH Levels.
Can AMH be falsely low?
Some researches have shown AMH to be falsely low when a contraceptive pill is taken. One must visit a trusted pathology lab to get the AMH test done so that the results shown are accurate.
To Conclude, One does need to be anxious just because the AMH level is low. Fertility is strongly related to Egg Quality and not the number of Eggs. One may have Fewer eggs but Egg quality is the key determinant. We hope the above FAQ related to AMH will give insight to patients seeking clarity.
Dr Mona Dahiya, Director of Little Angel IVF