Anti Mullerian Hormone (AMH)- The Ultimate Ovarian Reserve Test?

What you should know about AMH


When you seek medical advice for infertility issues, one of the hormone tests that you be advice to take is the Anti-Mullerian Hormone or AMH test. This test measures the AMH levels in your blood, which helps doctors determine your ovarian or egg reserve.


In this post, I’ll explain what egg reserves and AMH tests are, as well as what you can do if your AMH levels are low:


About egg reserves

Humans are born with a limited amount of eggs. To be precise, a girl is born with between one to two million immature eggs or follicles in her ovaries. But not all these follicles will survive into adulthood. In fact, throughout a woman’s life, the majority of her immature eggs will die in a natural process called atresia.


Did you know that by the time a girl has her first period, only about 400,000 follicles are left? And with each subsequent period, she loses about a thousand follicles, while just one matures into an ovum or egg. This means, throughout her reproductive life, a woman will develop only about 400 ovum. The number of developing follicles a woman has left, is called her “ovarian or egg reserve.”


Egg reserves and the quality of those eggs vary from one woman to another, due to factors such as age and infertility. Over time, both the quantity and quality of a woman’s eggs gradually decreases. Therefore, when seeking treatment for infertility, it is important for a woman to gain insight into the remaining quantity of her egg reserve and fertile years.

What is AMH?

When follicles develop in a woman’s egg reserve, her body release the Anti-Müllerian Hormone (AMH). AMH levels, therefore, can give us a good idea of the state of a woman’s ovarian reserve. Since AMH levels are determined by the number of developing follicles in a woman’s ovaries, low AMH levels are an indication that the ovarian reserve is depleted.


Fewer developing follicles mean slimmer chances for a mature and healthy egg to be released and fertilised. As such, when a woman knows the state of her egg reserve, she can determine how urgently she requires treatment.


AMH testing
While egg reserves generally decline in the mid to late 30s, leading to low AMH, age is not the only factor. Environmental factors can also cause low AMH, such as cancer treatment and inherited genetic causes. AMH levels can be easily assessed with a blood test, but like most diagnostic tests, it has its limitations. For example, it cannot indicate the quality of the eggs that are left, which requires a separate test. However, as AMH levels remain fairly constant in a woman’s cycle, she can have the test at any time.


What Can’t AMH tells you


As much as we would like to believe that AMH is ‘the ultimate test’ for ovarian reserves, however, it only tells us some aspect of your fertility performances but not all. AMH does not tell you the quality of your eggs. Therefore, some women who have plenty of eggs and high AMH level may not perform well in an IVF treatment cycle because of poor egg quality.


For women who take oral contraceptive pills, AMH level may not be a true reflection of their ovarian reserves. Those who were taking the pill had 19 percent lower levels of AMH and 16 percent fewer early-stage follicles.


Recently, there has been clinical studies which reported that there is a significant variation in serum AMH levels across the menstrual cycle regardless of ovulatory status. This variability, although statistically significant, is not large enough to warrant a change in current clinical practice to time AMH measurements to cycle day/phase.

What you can do

If you should take an AMH test and find that your level is low, do not lose heart! Your AMH level is just one piece in a complex jigsaw puzzle. Your best course of action is to discuss matters with your infertility specialist. Ask your doctor how you can protect your egg count and health, as well as discuss the best possible solution to your problem. For example, DHEA supplementation and well-managed IVF protocols have been shown to be effective in improving IVF pregnancy rates in women with low AMH. Maintain a positive outlook and don’t give up on your dreams of having a baby!


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A weighty issue


A weighty issue
How a woman’s weight impacts the risk of miscarriage

A miscarriage is a devastating experience for couples, perhaps even more so for those who have struggled with infertility and gone through the initial joy of a successful fertility treatment. Statistics have shown that in both natural and IVF conception, about one in six pregnancies will end in a miscarriage before the 20th week, with the rate being higher in older couples.

Understandably, couples are frightened of miscarriages and would rather not think or talk about it. However, it is important for couples to understand why miscarriages happen, as well as what they can do to reduce their risks.

Although the exact reason for a miscarriage is often unexplainable, it can occur due to a number of reasons. These include chromosomal abnormality, improper implantation of the egg and maternal health problems or trauma. The mother’s age also plays a significant role, as does her lifestyle, which includes exposure to stress, smoking, drug use, malnutrition, excessive caffeine, radiation and toxins.

Another well-studied factor than increases a woman’s risk for miscarriage, is her weight. As these studies indicate, if the mother is obese or underweight, this increases her risk of not only infertility, but miscarriage as well, regardless of the method of conception.


According to researchers at the Department of Obstetrics and Gynaecology, University of Adelaide, Australia, being overweight increase a woman’s risk of miscarriage by 29%, while being obese can increase the risk by 71% or more. However, for women undergoing assisted reproduction, researchers at the Assisted Fertilization Center, Brazil concluded that maternal obesity could increase the risk of miscarriage by up to 1330%.

Obesity also compounds miscarriage rates in women with PCOS. The Department of Obstetrics and Gynecology, Faculty of Medicine, Erciyes University, Turkey found that the miscarriage rate in obese women with PCOS is about nine times higher than average.

And while miscarriage is often the result of an unhealthy fetus, researchers from the Department of Obstetrics and Gynecology, Stanford Hospital and Clinics, CA, USA found that the risk of miscarriage of a healthy fetus is significantly higher in obese women (with BMIs of 25 or more).

While obesity has been identified as a risk factor for spontaneous miscarriage, the mechanism for it remains unclear. But a study by The Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield and Sheffield Teaching Hospitals, Sheffield, UK points to the endocrinological changes in obesity as possibily causing complex adverse effects including circulating adipokines, sex steroids and insulin resistance.

Women who are underweight, with a BMI of under 20, also face an increased miscarriage risk. A study by researchers at the German Cancer Research Centre found that pregnant women who were underweight faced a 70 % higher risk of having a miscarriage.

Therefore, it can be concluded that among intrauterine environmental factors, nutrition appears to play the most critical role in influencing placental and fetal growth. Since maternal undernutrition or overnutrition during pregnancy can impair fetal growth, women must adopt healthier diets and incorporate exercise to lower their risk of miscarriage.

If you have any concerns regarding miscarriage, especially after IVF, please do not hesitate to consult with your fertility consultant for advice.


The dairy seesaw


The dairy seesaw

How dairy may lower or increase your risk for infertility and miscarriage

Dairy is a good source of calcium, protein, vitamin D and phosphorus, which is why pregnant women are often advised to include dairy in their diet. After all, these nutrients are essential for a baby’s developing bones, teeth, muscles, heart and nerves. However, some studies have shown that some dairy products can be good for you, while others can be bad. So before you reach for that glass of milk or bowl of ice cream, let’s weigh the pros and cons of dairy.

The Pros

According to an eight-year Harvard study involving around 18,000 women, the moderate consumption of high-fat dairy products like ice cream, whole milk, yogurt and cheese is considered fertility and pregnancy friendly. This is because whole milk contains a complete protein that is important for egg quality. Their findings showed that dairy could reduce the risk of anovulatory infertility by more than 50%. and lower the risk of miscarriage by 33%.

Meanwhile, another study by the Laboratory of Experimental Endocrinology, University of Crete, School of Medicine, Heraklion, Greece, has found that dairy may reduce the body’s unwanted immune response, which secretes antibodies that affect the fetus and can cause recurrent miscarriages.

The Cons

While the moderate intake of dairy is beneficial, the high consumption of milk has been linked to a decrease in fertility. This is because excess protein intake (more than 120 grams a day) can cause embryo implantation problems. In addition, women with dairy intolerance and allergies are more likely to miscarry.
However, many people are unaware that they are lactose intolerant. According to the Physicians Committee of Responsible Medicine, 75% of the world’s population is lactose intolerant. A study published by the European Journal of Obstetrics, Gynecology, and Reproductive Biology (2001) also found that eating butter and oil can double a woman’s risk for miscarriage.


What about low fat dairy?

It is known that full-fat dairy foods contain the female hormones estrogen and progesterone. But when fat is skimmed from the milk, the process removes these hormones and leaves behind male hormones or androgens, which impairs ovulation. The same Harvard study mentioned above found that low fat dairy can increase the risk of ovulatory infertility by 85%.

Milk and hormones

While we’re on the subject of hormones, it is important to note that because animal milk contains hormones, high intake of dairy may disrupt your own hormonal balance. Some of the fertility issues that can be associated with hormone imbalance are PCOS, Endometriosis and male infertility.

A study conducted by researchers from the Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia has found that women who eat high amounts of dairy can have 15% higher estrogen levels, which may influence circulating concentrations of estradiol. Estradiol is a form of estrogen that while is necessary for many processes in the body can also cause harm to pregnancy and unborn babies.


Milk and inflammation

In traditional Chinese medicine, dairy is believed to be ‘damp’ and cause inflammation, which hampers fertility and causes problems in getting pregnant. However, in Western medicine, several studies have been found that dairy can help reduce inflammation.

For example, researchers from the Department of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Iran discovered that probiotic yogurt can lower one marker of inflammation by 29%.

A similar study by the Department of Nutrition Science-Dietetics, Harokopio University, Athens, Greece also identified an inverse association between dairy products consumption and levels of various inflammatory markers among healthy adults. They found that dairy lowers inflammatory markers by as much as 16%.

These findings are supported by another study by the Department of Nutrition, University of Tennessee, Knoxville, USA, which found that calcium and dairy consumption can reduce tissue oxidative and inflammatory stress.

From the findings above, we can conclude that the moderate consumption of whole dairy products is beneficial to fertility and pregnancy. However, if you’re feeling uncertain, don’t take the drastic step of cutting dairy out of your diet completely. Instead, speak to your fertility consultant about how much dairy you should be consuming.