When you’re trying to conceive, there are a ton of different hormones to consider
You’ll likely have your oestrogen levels tested, as well as testosterone and progesterone. You’ll read about oxytocin and human chorionic gonadotropin (hCG), important hormones released during pregnancy and after giving birth. But what about anti-Mullerian hormone (AMH)?
While it may not get the same amount of attention, AMH is very important for any woman trying to get pregnant. Here’s a primer on everything you need to know about AMH, and if it can help or hinder you during IVF.
What is AMH?
You’re born with a massive reserve of eggs that deplete over the course of your lifetime. Simply put, AMH is a hormone that can help predict your ovarian reserve. Your ovarian follicles contact granulosa cells, which produce AMH – the more eggs, the more AMH. Therefore, the amount of AMH in your body reflects the number of eggs that remain in your ovarian reserve.
What do AMH tests reveal?
While AMH levels can help doctors and specialists gain a broader picture of your overall fertility, they cannot provide accurate and specific information. If you have not been trying – and failing – to conceive, your AMH levels are not much help.
As Dr Jessica Scotchie, an OB-GYN with Tennessee Reproductive Medicine, says, “in a non-infertile population, AMH levels don’t predict the time it will take to conceive, and they don’t predict infertility.”
That said, knowing your AMH levels are very helpful if and when you decide to go through IVF. They will be used to predict the number of eggs you may produce during each cycle, and can be of use to determine your medication dosages.
To determine the rate your ovaries of ageing, your AMH levels are only part of the formula. In addition to this test, your specialists will combine your AMH levels with your age and your antral follicle count (AFC). Your AFC is determined by counting the number of egg-producing follicles on each ovary.
Dr Mark P. Trolice, director of Fertility CARE: The IVF Center in Florida, stresses that your age is the best predictor of your egg health. “While both quantity and quality decline as you get older, age is the best indicator for your pregnancy chances.”
Why AMH test results do not provide the full picture
A low level of AMH usually represents a diminished ovarian reserve (DOR) (also known as egg count), but it is not definitive. It’s also important to note that a high level of AMH does not represent the quality of your eggs – AMH tells you nothing about egg quality, just quantity.
As a result, it should never be relied upon as a ‘fertility test.’ There are plenty of instances where AMH results have caused undue alarm in women under 35 and who are not experiencing infertility. For example, if 100 20-year-olds undergo AMH testing and 20 are revealed to have lower than average numbers, it could cause a tremendous amount of stress for them, when in reality only a few of them will have trouble conceiving.
He cautions against women under 35 not putting too much stock into AMH testing. “While it’s possible the results of AMH screening may prompt people to electively freeze their eggs, extensive counselling on the true meaning of AMH levels is essential.”
How are AMH levels tested?
Your AMH levels are tested with a simple blood test taken at any time during your cycle. The following conservative guidelines define the lower levels of AMH serum at each age:
25 years old: 3.0 ng/mL (nanograms per millilitre)
30 years old: 2.5 ng/mL
35 years old: 1.5 ng/ mL
40 years old: 1.0 ng/mL
45 years old: 0.5 ng/mL
If your AMH levels fall below 1.6 ng/mL, you will likely produce a lower number of eggs for IVF retrieval. Levels below 0.4 ng/mL are considered critically low. However, you need to take these results with a grain of salt and discuss with your doctor – remember, it’s natural and normal for your AMH and egg reserve to deplete as you get older.
Do AMH levels relate to IVF success?
This is a hard question to answer – it has many caveats. Simply put, if you produce more eggs during IVF stimulation and retrieval, you have a higher chance of good embryos developing during your transfer. However, these eggs may not be of the highest quality – as you have fewer eggs, you also end up with fewer quality eggs.
Lower AMH levels of less than 1.0 nanograms per millilitre are associated with issues that can hinder your IVF success.
Higher chances of abnormal fertilisation.
A higher chance your cycle will be cancelled due to no retrieved eggs.
Lower egg yield.
Dr Trolice says, “as a woman ages, the percentage of chromosomally abnormal eggs contributing to abnormal embryos increases. So, the lower the number of eggs retrieved, the less percentage of embryos.” Even if you have a high AMH level at an older age, you may have fewer quality eggs remaining.
Can you improve your AMH levels?
You cannot increase your AMH levels, but there are plenty of things you can do to improve the quality of the eggs you do have.
Maintain a healthy weight.
Limit or completely stop your consumption of alcohol.
Lower your stress levels.
Take prenatal supplements.
Treating any existing ovarian cysts or fallopian tube blockages.
Speak with your fertility specialist to find out more about what you can do to improve your egg quality.
AMH levels – Are they useful, or should your disregard?
Ultimately, AMH can be a useful test, but should never be used solely as a measure of fertility. As Dr Zev Rosenwaks, director of the Center for Reproductive Medicine in New York, says, “All it takes is one egg each cycle. AMH is not a marker of whether you can or cannot become pregnant.”
Have you been alarmed by your AMH levels? What are your concerns about this testing? We would love to hear from you at firstname.lastname@example.org