Low AMH? Don't Freak Out
You’ve had your AMH levels checked and they came back low - before you panic, take a deep breath and read on.
What is AMH and Why Is It important?
Anti-Mullerian hormone tests can give you a rough idea of how many eggs are available each month. It tests the number of eggs - not the quality of those eggs. AMH testing (sometimes marketed as the ‘egg timer test’ or biological clock test) measures anti-mullerian hormone (AMH) which is secreted by growing follicles (egg sacs) inside your ovaries. There’s a wide range of AMH readings that are considered normal which makes things a little tricky as most people tend to assume that higher AMH levels is the goal. At home testing although empowering and more affordable can also create confusion.
In general higher AMH = more eggs available and lower AMH levels = less eggs available.
However research suggests that healthy women with low AMH or normal AMH have equal chances of becoming pregnant.
Whether you’re planning to freeze your eggs or are going through the baseline tests at your clinic it’s important to understand how AMH levels can be influenced by many different factors. Even if you’re doing at home testing one test alone may not give you a truly accurate picture. Experts are concerned that women with no history of infertility are making the huge decision about when to start TTCing based on at home tests. But the test cannot predict whether a woman with no history of infertility can get pregnant naturally.
Factors that can affect your AMH levels include:
Timing of the AMH test (there can be month to month variations so check more than once to see if there’s any patterns that may need more investigation).
Lifestyle factors - stress is associated with lower AMH. A 12 week program found yoga was significantly better than physical exercise in reducing AMH, LH, testosterone, and it improved menstrual frequency. A new animal study published suggests AMH levels are affected in as little as 3 weeks when rats were exposed to stressful stimulus.
Clinic testing protocol - a few years ago it was discovered that a popular AMH test used by clinics was reporting inaccurate rates (underestimating fertility by about 68%) but some clinics continued with the outdated inaccurate test protocol.
Oral contraception - for a more accurate result, test when you’ve been off the pill for a minimum of 3 months.
Age - yep the older we get the less quality eggs we produce.
PCOS is associated with higher than normal AMH levels.
Endometriosis is associated with lower than normal levels.
Previous cancer therapy.
Supplements of CQ10 & Vitamin D may be helpful but the evidence is limited.
Emerging therapies - PRP Injections (Platelet Rich Plasma). PRP is a relatively recent development in the fertility world. Several studies have reported that the use of PRP can reduce the features of inflammation, postoperative blood loss and infection. Basically a sample of blood is taken, spun in a special machine to access the platelets that are full of growth factors and that blood is then re-injected into the ovaries. Some clinics also use it a few hours ahead of an IVF by infusing it directly into the uterus as a wash to prepare the uterine lining for IVF. But although there is lots of excitement around these new therapies the research is limited and it’s an added expense.
Your reproductive health is unique to you so this test needs to be considered alongside the bigger picture of your future family building plans and clinical history.
How long have you been trying to conceive?
Are you planning to have more than one child?
Is egg freezing something you’re considering?
Do you have a partner?
Is there a family history of early menopause?
Based on these considerations, your age and overall clinical picture you may discover that putting off starting a family may not be the best approach.
Interestingly ACOG (USA) recommends not testing AMH routinely unless you are experiencing infertility. I’m a big believer that the more information consumers have about their health the better. It puts you in the drivers seat. You can’t make meaningful changes if you don’t know what needs changing.
Have you checked your AMH levels? How did you feel about the results?
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