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How do low AMH levels affect fertility?
Anti-Mullerian hormone (AMH) levels are not something that is commonly discussed, yet they play a significant role in a woman’s fertility assessment.
AMH is measured through a blood test, which indicates the number of eggs remaining in the ovaries and how well the woman may respond to fertility treatment. If your AMH levels are low, don’t worry, there are various fertility options available to assist you on your journey to parenthood.
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What is AMH?
AMH is a hormone produced by follicles, which are small fluid-filled sacs in the ovaries that contain immature eggs. It plays an essential role in the early stages of follicle growth.
When women are born, they already possess all the eggs they'll need for their lifetime, stored in ovarian follicles. The number of eggs naturally decreases with age, primarily due to the menstrual cycle until menopause, when the supply of eggs is depleted. So, the more eggs you have, the higher your AMH levels. These results allow fertility specialists to evaluate and optimise a suitable treatment plan. It is important to understand that AMH levels do not provide an analysis of egg quality, just quantity.
How are AMH levels tested?
For individuals considering fertility treatments, it is advisable to have AMH levels tested. This is done through a blood test, which reflects the number of follicles growing inside the ovaries and provides an evaluation of the number of eggs present. The results allow fertility specialists to create a personalised treatment plan to help increase the chances of conception.
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What impacts AMH levels?
Several factors can influence AMH levels, with age being a significant one. Lifestyle factors such as smoking, diet and obesity can also impact AMH levels. Additionally, medical conditions like polycystic ovary syndrome (PCOS), endometriosis, and autoimmune disorders can also play a role. Medical treatments, including chemotherapy and ovarian surgery, are known to impact fertility and decrease AMH levels. Some medications, like metformin, commonly used to treat PCOS and clomiphene citrate, used to stimulate ovulation, may also decrease AMH levels.
Although some medications may transiently affect AMH readings, the clinical significance is unclear. For example, metformin (used for PCOS) or ovarian stimulation drugs like clomiphene citrate may impact AMH expression but not necessarily ovarian reserve.
What does it mean if you have low AMH levels?
Low AMH levels may indicate a reduced number of remaining eggs and could make conception more challenging. However, it is still possible to become pregnant naturally. If you find you are having difficulty conceiving, several fertility treatments can enhance your chances of conception.
One of the most common treatments is in vitro fertilisation (IVF), which involves collecting eggs from the ovaries, fertilising them with sperm in a laboratory, and then transferring the resulting embryos into the womb.
While IVF can be performed with low AMH levels, the procedure relies on mature eggs. A low egg reserve may lead to less effective results from stimulation medication a lower response to ovarian stimulation, potentially reducing success rates. Alternatively, you might consider using donor eggs, which involves the same process as IVF, but with eggs from a donor, fertilised using either your partner’s or donor sperm to create embryos.
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Can I improve my AMH levels?
AMH levels naturally decline with age, so it is generally not possible to increase them. However, adopting lifestyle changes can help improve your overall fertility health, which may aid with conception.
A healthy and balanced diet including foods like berries, fish, leafy greens, and nuts can enhance egg quality and ovarian function, even if it doesn’t directly increase AMH levels.
Regular exercise, limiting alcohol and caffeine intake, and staying hydrated can also be beneficial. It’s important to contact your doctor before making any significant lifestyle changes.
Remember, AMH levels are just one aspect of your fertility journey. Other factors, such as age and medical conditions, also play important roles. Rest assured, we are here to discuss in detail your fertility options to ensure you have the best possible outcome.
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Reviewed by Dr Kausar Jabeen, Fertility Consultant at TFP Thames Valley Fertility.
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