Anti-Mullerian Hormone (AMH)

When it comes to conception, all that you hear is hormones, hormones, and hormones. The levels of estrogen, progesterone, testosterone, and insulin are a few that your doctor will monitor to ensure you have a successful pregnancy. One less-talked yet super important hormone that plays a key role in your fertility journey is the Anti-Mullerian hormone. Produced by your ovaries, AMH detects your ovarian reserve and indicates your chances of conceiving naturally. 

If you are wondering what AMH levels are, how they can be effectively measured, when the test is needed, and why it’s essential, you are in the right place. We’ll be answering all your questions regarding Anti-Mullerian hormones and their role in your parenthood journey. Keep reading.

What is Anti-Mullerian Hormone (AMH)?

AMH is a hormone released by the ovarian follicles, the tiny sacs holding immature eggs, one of which is released monthly during ovulation. They are a viable indicator of your ovarian reserve, suggesting the number of eggs left in your ovaries. Fortunately, AMH levels do not fluctuate, so there’s never a bad time to take this test. 

A girl child is born with all the eggs that will be released from her ovaries until she reaches menopause. In other words, women have a fixed ovarian reserve. With age, her ovarian reserve diminishes. That’s why age is considered a prominent factor in assessing a woman’s fertility. An increased age can indicate a possibly low ovarian reserve, which means fewer eggs are available for fertilization. Not just the count, but your egg quality also declines over time. 

Why Does AMH Matter for Fertility?

As mentioned previously, the AMH test is primarily used for fertility testing. That said, the test shouldn’t be used as a sole factor for infertility diagnosis.

A combination of factors is used to confirm an infertility diagnosis in men and women. For instance, you can have a normal AMH but an underlying medication condition, like endometriosis or uterine fibroids, which might make it harder for you to conceive. 

The point is that AMH is only indicative of your ovarian reserve. It tells you how many eggs are still in your ovaries. Low AMH doesn’t necessarily mean you are infertile.

The Role of AMH in Fertility Treatments

Doctors usually test your AMH levels to determine the most effective IVF protocol. Here’s how it affects your IVF treatment:

Identifying the Best Medication Dosage: Testing the anti-mullerian hormone (AMH) in your blood gives your doctor a clear idea of what medicine dosage must be administered for the best results. Low AMH, for example, requires a high dose of gonadotropins and other ovarian-stimulating medication, while high AMH requires a lower dosage to minimize the risk of Ovarian Hyperstimulation Syndrome (OHSS).

IVF Success Forecast: Your AMH count also helps predict the success rate of your IVF treatment. The higher the count, the better the chances IVF and other fertility treatments will work in your favor.

Planning Egg Freezing: Women planning to freeze their eggs are also advised to take an AMH test to know the best time for egg freezing. Egg retrieval is scheduled around the time you are ovulating (after the hormone shots are injected). AMH gives an idea about the number of cycles needed to retrieve enough eggs for successful freezing. Some may require multiple cycles, while for others with high AMH, a single cycle is sufficient to retrieve multiple mature eggs.

AMH Test Results

Your AMH levels can be within the normal range, low or high, depending upon your age and how fast your ovaries are aging. Here’s what the results mean:

• Normal: Between 1.0 ng/mL and 3.0 ng/mL
• Low: Below 1.0 ng/mL
• Extremely Low: Below 0.4 ng/mL
• High: Above 4.0 ng/mL

These are considered general estimates, though. To know whether your AMH is within the normal range, it’s advisable to consult your fertility doctor.

Low AMH Levels: Challenges and Solutions

If your blood test shows an AMH level below 1.0 ng/mL, you might have a lower-than-normal ovarian reserve, especially if you are below 30. Several things contribute to a low AMH count, with age being the most common factor. Let’s explore why your AMH levels could be lower than required.

Age: Women between 35 and 40 experience a significant decline in fertility, and their AMH count can be lower. This is considered a natural age-related decline.

Premature Ovarian Insufficiency (POI): Lower AMH levels can also indicate POI in some cases. It happens when your ovaries stop functioning before 40.

Chemotherapy: Cancer treatment, like chemotherapy, can also adversely affect your ovarian function and may result in a diminished egg count. 

Genetic Factors and Other Medical Conditions: Certain genetic factors and existing medical issues can cease your ovarian function, resulting in a significant drop in the AMH.

Challenges For Women With Low AMH

Rapidly declining AMH can put women at an increased risk of infertility, as there are fewer eggs in their reserve to facilitate fertilization. These women are comparatively less likely to respond to assisted reproductive technology compared to those with a normal AMH count. They also tend to enter menopause sooner.

Solutions for Low AMH

Egg count can’t magically increase, although dietary modifications, a good quality lifestyle, and certain medications can slow the rapid egg decline. It’s more important to focus on planning a natural pregnancy as soon as you suspect a decreasing AMH. If not, your best bet is egg freezing.

Fertility Preservation: Many couples who are not ready for pregnancy due to career goals and other commitments can opt for egg freezing. It’s done when your egg count is enough for the fertility specialists to retrieve and store them for future use. This ensures that you can plan pregnancy even with a low AMH count in the future.

Personalized IVF: IVF may still work for women with low ovarian reserve. You need to see a fertility specialist who can tailor your treatment approach to your individual requirements. They might follow a more aggressive ovarian stimulation protocol to retrieve good-quality, mature eggs in a single cycle.

Lifestyle Changes: Some basic lifestyle changes, like weight management, quitting smoking, avoiding alcohol, practicing exercises, and following stress-relief techniques, can improve your ovarian health. Supplements, like Coenzyme Q10 and Vitamin D, can also help. These tips can only help by improving your egg quality so they can be used for IVF fertilization.

How to Increase Your AMH Levels Naturally?

As discussed before, you can’t raise the AMH levels by diet or medication, but a few tips can help improve your reproductive health, making pregnancy likelier for you. Here’s what can help:

• Eat a balanced diet rich in omega-3 fatty acids, vitamin D, and antioxidants.
• Maintain a healthy weight
• Practice moderate exercises
• Try yoga, meditation, and counseling for stress relief
• Get good quality sleep
• Quit work or a lifestyle that exposes you to industrial toxins
• Avoid smoking and alcohol
• Try acupuncture and herbal treatments (after consulting with your fertility doctor)

Your fertility doctor may provide better guidance on how lifestyle changes combined with fertility-boosting medication can help improve your ovarian function.

High AMH Levels and PCOS

While some women struggle with low AMH, others are diagnosed with high AMH count. AMH above the normal range can be due to Polycystic Ovarian Syndrome (PCOS) a hormonal disorder that produces multiple follicles in your ovaries and an increased level of androgen. The high number of follicles can result in an increased production of AMH. 

Ideally, AMH assesses your fertility, but it isn’t considered a fertility indicator in this case. The follicles in your ovaries can be immature and not ovulate at all. These women might experience irregular ovulation or completely absent ovulation, which can be a possible obstacle to conception.

Fertility treatments for high AMH need to be tailored to the woman’s ovarian and overall health. On one side, high AMH means a greater chance of pregnancy, as more eggs can be retrieved in a single IVF cycle. On the other hand, your doctor may not want to put you at risk of OHSS a condition in which your ovaries do not respond well to the ovarian stimulation medication. They can swell and lead to complications.

AMH Test Cost 

The average AMH test cost in Pakistan is between PKR 4,000 and PKR 8,000, but this may differ from lab to lab and depend on additional tests or treatments. Australian Concept Infertility Medical Center (ACIMC) provides low-cost fertility testing and treatment packages for couples facing issues with conception. Contact our fertility specialists to learn more about our treatment protocol and testing requirements.

Conclusion

The AMH test is a crucial factor in checking your existing egg count. Fertility specialists may want to know whether or not a lower ovarian reserve is an underlying cause of your infertility. If you are concerned about your egg count and quality, meet fertility specialists at Australian Concept and get a simple blood test to assess your ovarian reserve.