I HAVE LOW AMH – WHAT DOES IT MEAN IF I’M UNDER 40?

The reason I am writing about AMH under 40, is that there is such as strong correlation with AMH and menopause – and yes, we expect AMH to be significantly lower over the age of 40. But there’s more to it than that for younger women.

I have a lot of patients who are in their mid thirties, coming to me following an initial fertility assessment, having been told they have low AMH and they either need IVF – or sometimes IVF with donor eggs, if it is very low. 

Should you be worried? The answer is, not about AMH by itself – in fact it could indicate you have better fertility prospects if other reproductive tests are all good.

The AMH test is a fertility clinic test which is useful for those undergoing IVF. It tells fertility clinics about the quantity of eggs they are likely to collect, which provides them with useful data, and can help them establish treatment protocols.

AMH TEST ALONE IS NOT A CLEAR MARKER OF YOUR FERTILITY 

Other testing such as menstrual hormones, Androgens, SHGB, sperm analysis, full thyroid profile, vitamin D, B12, iron and ferritin can flag up any other fertility factors that are more likely to be the reason it’s taking a long time to conceive, than AMH itself. If you have known infertility factors and low AMH, then this is more reason to be looking at AMH. If you have a healthy menstrual cycle and good sperm quality, then AMH is not likely to be a problem, in fact studies show this is the case.

WHY?

Simply because AMH is a marker of egg quantity not quality. Just because you have fewer developing eggs – it could likely mean that those fewer eggs are riper, juicier and more full of vitality than someone who is producing a higher volume but maybe not so juicy! Remember, only one egg is picked in a natural menstrual cycle, so the emphasis must be on quality and not quantity. 

WHAT EXACTLY IS AMH?

AMH (anti-Mullerian Hormone) is a protein produced by granulosa cells in ovarian follicles. It’s production begins in the early stages of follicle development and continues until the follicles reach a more mature stage.

AMH shields Follicles from the stimulating effect of FSH – because the follicles need a nice amount of time to grow (approximately 3 months), so it sort of acts as a gatekeeper ensuring only a limited number are selected for further growth and maturation.

So AMH helps control which follicles reach the Antral stage, this is your AFC that gets found on a scan (these are the candidates for ovulation)!

So, in a nutshell, AMH regulates the how fast the follicles mature by controlling the number of follicles stimulated by FSH, ensuring a steady, long term supply of mature eggs and preventing the ovaries from being overstimulated.

CAN ACUPUNCTURE HELP WITH AMH LEVELS?

The answer is, not directly. But it can help with some of the causes that are linked to low AMH levels such as:

• Long term high levels of stress

• Hypothalamic amenorrhea

• Endometriosis 

• Autoimmune disease 

• Premature ovarian failure 

• Chronic microbiome issues

Remember, AMH can be genetically linked and can be low throughout a woman’s entire life, she will still ovulate and conceive perfectly well if she is in good health.

CAN I STILL CONCIEVE NATURALLY WITH LOW AMH?

Yes. For people with normal menstrual cycles between 24-35 days, low AMH is not correlated with reduced fertility.

CAN LOW AMH AFFECT MY IVF CHANCES?

It depends. Purely because the lower the AMH, generally the less eggs are collected, statistically it can mean less chance of a high number of successful embryos. But again, we are looking at quality not quantity, so you may have less embryos - they may be fewer but have a better chance of making it to implantation. This is where sperm quality is so important too.

CAN AMH LEVELS FLUCTUATE?

Yes. There is some evidence that levels can fluctuate slightly throughout the menstrual cycle and are typically higher during the follicular phase. Some of my patients have experienced changes in AMH throughout acupuncture treatment but there is no way of knowing if it’s all down to the effect of acupuncture, and there isn’t any quantifiable research, so I cannot make any claims to this.

WHAT IS MY BEST COURSE OF ACTION FOR LOW AMH AND MY FERTILITY?

Many factors influence AMH levels, so it’s important to get help with a comprehensive plan to improve fertility which include supplementation, diet and lifestyle changes, exercise, and stress management. If you come to me for acupuncture, I look at all these key areas with you in my integrated approach to treating you.