Dr George Lee returns to discuss the latest medical news. Expect deep insights delivered with generous humour. Menopause is part and parcel of ageing for women, but the symptoms can be severe and the changes difficult to accept. But IVF specialists in Britain have proposed a new procedure that they say can delay menopause for up to 20 years. We’ll be speaking to Dr Helena Lim, consultant obstetrician and gynaecologist, to unpack this and whether delaying menopause is a possibility.
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!
Fertility on ice
What you should know about egg freezing
We often hear of the expression “ticking biological clock,” but what does this actually mean for a woman? Well, here are the facts and figures. As a woman, you were born with about one to two million immature eggs or follicles, and these begin to die off as soon as you leave your mother’s womb.
By the time you’ve reached puberty, you’ll only have about 400,000 follicles left, and with each menstrual cycle, you’ll lose thousands more. Due to the loss of follicles throughout your reproductive life, when you’ve reached your mid 30s, your fertility would have sharply declined. And in your late 40s, any follicles that remain are unlikely to mature due to the hormonal changes brought on by menopause.
Now that you understand a little more about eggs, let’s find out why some women choose to freeze theirs and what it entails.
What is it?
Just as the name suggests, in egg freezing, a woman’s unfertilised eggs are frozen through a process called vitrification. This is done so that the eggs can be stored for many years. When a woman is ready, the eggs can be thawed and fertilised with sperm. Once the egg has developed into a healthy embryo, it can be transferred to the woman’s uterus for a chance of pregnancy.
Why?
Some women choose to freeze their eggs because they are currently not in the position to become pregnant and they want to preserve their healthiest eggs. One of the leading reasons for egg freezing is serious illness. For example, a woman who is undergoing cancer therapy may worry about the impact of the treatment on her fertility. As such, she may have her healthy eggs removed and frozen for future use before she undergoes treatment.
Other women, on the other hand, may be concerned about age-related infertility. Though a woman may be at her most fertile between her 20s and early 30s, for some women, childbearing is unavoidably delayed due to education, career or personal goals. Through egg freezing, a woman can store her healthy eggs for use in the future, enabling her to start a family when she is ready. A woman’s age when her eggs are frozen also affects her chances of conceiving later in life. For example, if she opts to freeze her eggs during her late 30s, her chances of pregnancy are significantly lower.
How?
Much like the early stages of IVF, the egg freezing cycle takes about 10-12 days. The woman will give herself daily shots of hormone injections, which stimulate her ovaries and ripen her eggs. When her eggs have matured, they are removed using a special needle that is inserted through her vagina. An ultrasound is used to help guide the needle and the woman is sedated, so she will not feel any pain. Once retrieved, the eggs are immediately flash frozen.
Is it safe?
In a word – yes! To date, more than 300,000 children have been born worldwide from frozen embryos and studies conducted in recent years have shown that the use of frozen eggs does not increase pregnancy complications or birth defects.
If you’d like to learn more about egg freezing and the costs involved, don’t hesitate to speak to a fertility specialist.
Dr Helena Lim 