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.
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!
Dr George Lee returns to discuss the latest medical news. Expect deep insights delivered with generous humour. Dr Helena Lim joins him this week to discuss period-tracking apps and whether it makes her work as a Consultant Obstetrician and Gynaecologist easier, or more difficult.
Dr George Lee is a renowned Urologist who dealt with male issues, whereas Dr Helena Lim is a Fertility Specialist
Find out more about what they have to say:
Getting it just right
Exercise and how it affects pregnancy rates
We all know that staying physically active is beneficial to our overall health and wellbeing. But did you know that the right amount of exercise can also improve your chances of conceiving? Here’s why.
Firstly, regular exercise is known to help optimise the reproductive system. It does this by stimulating the endocrine glands, which releases hormones that help your eggs to grow. Secondly, exercise can enhance your metabolism and circulation, which in turn optimises your egg production.
Thirdly, exercise can help you manage or achieve an ideal body weight. Since being overweight or obese can impair fertility in both men and women, weight management is widely known and used to prevent and treat infertility. And lastly, regular workouts also help to relieve stress, which in itself can inhibit fertility.
While regular moderate exercise can have positive effects on fertility and conception, the opposite is true for vigorous exercise. According to a 2009 study in Human Reproduction, and a Harvard study of elite athletes, vigorous exercise is linked to reduced fertility and pregnancy rates. Therefore, when it comes to exercise and fertility, it is possible to have too much of a good thing.
While there are no guidelines for women to follow when it comes to workout intensity for fertility, there is a way to strike a balance. Studies have shown that women who exercised moderately for at least 30 minutes a day can reduce their risk of infertility due to ovulation disorders. Evidence also suggests that moderate regular exercise can positively influence assisted reproductive technology (ART) outcomes. But what is the right amount of exercise?
If you’re already at your ideal weight, it is safe to stick to your regular routine, but keep it to half an hour maximum per day. Studies had shown that vigorous aerobic exercise of more than 4 hours per week reduces the chance of pregnancy in women going through IVF. If your cycle is still irregular and you haven’t conceived after a few months, you might want to cut back on the intensity of your workouts. However, if you’re underweight, focus on gaining weight and increasing your body fat to the recommended amount of over 12%. If you exercise regularly, cut back on the frequency and opt for a less vigorous routine.
Meanwhile, if you’re overweight, work on cutting down on your calories with healthy eating. You can also increase your exercise routine gradually to achieve your ideal weight. Lastly, if you’re undergoing fertility treatments, it is best to avoid high-impact exercises, as they can be detrimental to your ovaries, which have been enlarged by fertility drugs.
Still have doubts on where to begin? Before you step up your exercise routine, start by speaking to your doctor. If you’ve been having trouble conceiving, your doctor will need to assess your condition first. This includes your age, cycles, ovulatory status, the condition of your uterus and tubes, as well as your partner’s sperm. Once certain conditions have been identified or ruled out, your doctor will be able to advise you on whether the underlying cause may be too little or too much exercise.
A timely decision
How age affects your chances of IVF success
Have you been seriously considering In vitro fertilisation or IVF treatment? If you have, it’s best that you understand how your age can affect your chances of success. This is so that you can make an informed decision on when to begin. But before we get into that, let’s take a brief look at IVF and what it entails.
For some couples facing fertility problems, IVF is a viable method that can help them to conceive. During IVF, a woman’s ovaries are stimulated and an egg is removed to be fertilised with sperm in a laboratory. Once fertilised, the egg becomes an embryo, and it is returned to the woman’s womb to develop.
Studies have shown that the success of IVF treatments can be affected by a woman’s age. This is because it’s an inescapable fact that a woman’s fertility declines as she grows older. So if you were to undergo IVF using your own eggs, your chances of conceiving would be higher if you were younger.
According to the Human Fertilisation and Embryology Authority (UK), in the most recent study conducted in 2010, on average, the percentages of live births resulting from women having IVF using their own fresh eggs are: 32.2% for women aged under 35, 27.7% for women aged between 35–37, 20.8% for women aged between 38–39, 13.6% for women aged between 40–42, 5.0% for women aged between 43–44 and 1.9% for women aged 45 and over.
As you can see from the statistics above, a woman’s fertility begins to decline at around age 30 and this exacerbates at about age 38. By the time she is 44, her chances of having babies via IVF with her own eggs is nearly nonexistent at less than 2%. This is why women above the age of 42 are generally discouraged from undergoing IVF, as the success rate is considered far too low.
Most IVF clinics also have an age limit for IVF treatments that use a woman’s own eggs. This is because the age of the eggs is crucial, not the age of the uterus. But, why is egg age so important? Two words – quality and quantity.
But what is egg quality? In fertility, an egg’s quality refers to its chromosomal status. As a woman’s age increases, the risk of chromosomal abnormalities in her eggs also rises. During IVF, we hope to obtain multiple healthy embryos, whereby the best ones will be selected for transfer into the mother’s uterus. But before embryos are transferred, we need to check their chromosomal status. Therefore, the embryos undergo Preimplantation Genetic Screening or PGS, which checks for chromosomal normalcy. On average, healthy embryos with normal chromosomes have a much higher potential for implantation and live birth.
Meanwhile, egg ‘quantity’ refers to how many eggs are left in a woman’s ovaries. As such, her egg quantity is often called her “ovarian reserve”. Although egg quantity doesn’t greatly impact the chances of a natural conception, in IVF, egg quantity may influence a woman’s response to ovarian- stimulating medications.
So if you’re considering IVF, don’t hesitate to ask questions and seek the advice of a fertility consultant. The information you receive can help you make a decision on when best to start your treatment.