understanding amh levels and its causes and treatments

What is an AMH level? Understanding Its Causes & Treatment Options

AMH or Anti Mullerian Hormone is produced by the granulosa cells in ovarian follicles. It determines the fertility potential of a woman as it represents the ovarian reserve (eggs in a woman’s ovaries) “. In this blog, we are going to talk about AMH levels, the causes & drawbacks of high or low AMH, and fertility treatment options.

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At birth, the normal female ovary contains about 1/2 million/oocytes (eggs). There is a gradual decline in the total number of eggs as women are not capable of making new eggs. Until a girl reaches puberty, the egg pool remains around 300,000. Over the next 30-40 years of a woman’s reproductive life, the egg supply gradually gets depleted. With advancing age, most women begin to experience a significant decrease in fertility. At the time of menopause, virtually no eggs remain.

What is a good AMH level for your age?

AMH varies according to the woman’s age and values mentioned below as per age are suggestive of concerns.

  • 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

An average AMH level for a fertile woman is 1.0 to 4.0 ng/ml. AMH values below 1.0 ng/ml are considered low and represent diminished ovarian reserve.

So, by and large AMH values between 1.0 to 4.0 ng/ml are considered as average.

AMH values below 1.0 ng/ml are considered low, and values below 0.4 ng/ml are considered significantly low.

AMH (Anti Mullerian Hormone) is produced by both male and female reproductive organs. Its role and normal ranges depend on one’s age and gender. It plays an essential role in determining the sex of the baby when it is in the mother’s womb. If a baby in the womb has XY (male) chromosomes, high levels of AMH along with other male hormones are produced. This prevents the development of female organs and male organs develop. If the baby has XX (female chromosome), small amounts of AMH are produced which do not suppress the development of female organs.

AMH helps provide information about fertility potential and egg reserve. It helps diagnose menstrual disorders and certain types of ovarian cancers.

Read more: Egg Freezing Process in India

Read more: Is Ovary Size Important To Get Pregnant?

Possible causes of low AMH:

The possible causes of low amh are mentioned below:

  • Age – As age advances ovarian function and AMH gradually decreases.
  • Endometriosis – the ovarian reserve (AMH) decreases in women with Endometriosis as compared to similarly healthy aged women.
  • Genetic factors – Research shows that low AMH has a genetic component. Fragile X and other X chromosome abnormalities are associated with low AMH.
  • Auto-immune diseases – Autoimmune diseases are conditions in which the body’s immune system attacks healthy cells. Autoimmune conditions such as Hashimoto’s thyroiditis, autoimmune oophoritis, subclinical hypothyroidism, SLE, and Crohn’s disease can contribute to low AMH.
  • Cancer treatment (chemotherapy/ radiotherapy) contributes to low AMH levels.
  • Excessive smoking has a dual action. It acts directly on the ovary, causing the depletion of eggs and indirectly by increasing the pituitary production of FSH.
  • Environmental causes like excessive use of Plastics, Cosmetics, and Non-Stick cookware which contain Endocrine disrupting chemicals (EDCs) like Bisphenol A (BPA), Phthalates.
  • Obesity – There is a significant association between obesity and AMH.
  • Women taking birth control pills may show falsely low AMH levels due to over suppression of the ovaries.

Why is the AMH Test done and why does AMH matter?

The reasons for undergoing an AMH test are as follows:

  1. To check if a woman can produce enough eggs to fertilise and become pregnant
  2. To confirm the diagnosis of premature ovarian failure (POF), in case the period has stopped in a woman.
  3. To determine the reason for early menopause.
  4. To help diagnose PCOS, a condition where anovulation can cause difficulty in getting pregnant.
  5. To help diagnose primary amenorrhea in girls above 15 years with no periods.
  6. To help decide the protocols in Controlled Ovarian Stimulation and titration of the dosage of the hormonal injections.
  7. To assess the prognosis of IVF treatment and to decide on egg donation.
  8. To help in decision-making for planning future pregnancy depending on the levels of AMH.
  9. Help in decision-making for oocyte freezing.
  10. Monitor women who have certain types of ovarian cancers.

What AMH test can’t tell us?

The AMH test cannot state the genetic condition of eggs nor can it tell us the rate of depletion of eggs. It cannot also tell us the outcome of pregnancy. ·

How to interpret AMH results?

AMH results can be interpreted using the help of the table below. However, the result varies from lab to lab.

How to interpret AMH results

What is a good AMH level to get pregnant?

It is difficult to predict a good AMH level to get pregnant as women with very low AMH can have a natural conception whereas women with good AMH may struggle to get pregnant. However the levels of concern as per age are as below:

  • 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

Fertility treatment and AMH

AMH plays a major role in the prediction of the outcome of IVF treatment. AFC (Antral follicle count) also contributes to the prediction of the outcome of IVF treatment. Associated factors such as tubal factors, male factors, uterine status and medical conditions contribute to predicting the results of the fertility treatment. Poseidon and Bologna are the two classification systems which are based on AMH and help predict the fertility treatment outcome.

Can AMH levels fluctuate?

AMH is not associated with the menstrual cycle and hence remains the same when done in any phase of the cycle. AMH can be affected by the use of drugs. Oral contraceptive pills, Metformin and Clomiphene Citrate lead to decreased AMH level whereas DHEA and Vitamin D can help to maintain AMH levels. A GnRH-agonist injection leads to dynamic variation in AMH levels.

What does a low AMH level mean for IVF?

A Low AMH level is a predictor of poor IVF outcome.

It suggests that higher doses of hormonal stimulation injections may be required for getting optimal results. In case of very low AMH it can also help women decide about donor eggs or adoption.

Can you increase AMH levels?

Ideally, AMH levels cannot be increased. However, there are several supplements which can help improve the quality of the eggs.

  • Supplements containing Co-Enzyme Q 10, antioxidants, DHEAs, grape seed extract (Resveratrol) are promising.
  • Lifestyle changes, adequate sleep, avoidance of stress, eating healthy food and regular exercise are very helpful in improving the quality of the eggs.
  • Mediterranean diet, low sugar intake, increased intake of oils containing omega 3, olive oil and a high protein diet are some of the healthy eating habits that can be adopted to improve egg quality.

Also Read:

FAQs: AMH levels

Is it possible to have low AMH with regular periods?

Yes, It is possible to have low AMH with regular periods.

Do you ovulate every month with low AMH?

Ans: Yes, you can ovulate every month with low AMH. However the periods can starrt getting irregular with very low AMH levels.

Does the AMH tell me anything about my chances of getting pregnant right now?

Ans: Yes, It is an indicator of ovarian reserve. However, women with low AMH can also conceive spontaneously.

I have low AMH. Does it mean I am infertile?

Ans: It does not suggest absolute infertility but it is a warning sign for you to take action.

I was found to have high AMH levels. Does it mean I am super-fertile?

Ans: No, High AMH levels do not mean you are super-fertile.High AMH is associated with PCOS and ovarian tumours such as granulosa cell tumours. Women with high AMH have hyperstimulate during ovarian stimulation and adequate precautions need to be taken for this.

I was found to have high AMH levels, and my cycles are irregular. Is this concerning?

Ans: This can suggest that you have PCOS. The right decision for you would be to consult  a fertility specialist who can advise better procedures to improve your chances of conceiving.

Why do fertility clinics check AMH levels?

Ans: AMH is used as a predictor of fertility treatment outcome. It also helps in deciding the dosage of hormonal injections for ovarian stimulation.

How often should AMH level be tested?

Ans: AMH does not need regular testing. However, testing AMH levels every six months may help decide if the ovarian reserve is declining quickly.

What does a low AMH level mean for IVF?

Ans. A low AMH level indicates that women need to hasten fertility treatment because of depleting eggs. It also indicates that higher doses of stimulation injections may be required. Low AMH levels are associated with less number of eggs. This can bring down the chances of pregnancy.

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