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Low AMH-the villain. But how bad indeed?

Updated: Mar 7

A rather recent discovery (1990's) the Anti-Mullerian hormone has become the bad guy of fertility assessments. Lots of medical articles about it on the web, but in normal non medical language, what is the AMH, where does it come from, why is it low (if it is low), can we make it grow, and most importantly: how big a role does it play in our fertility?


We, females, are born with a certain ovarian reserve, i.e a certain number of eggs.

We are born with them and we grow old with them, ovulating more ore less one egg every month, ever since we start having our period and until we get menopaused, unless we are pregnant, on birth control or having anovulatory cycles.

This means our eggs age as we age, which is not fair, but there is not much we can do about it. 

It has been discovered that the shell of our eggs produce this AMH, it circulates in the blood, where it can be tested any day of the month. We know AMH can fluctuate, but not by much, and that different labs can produce very different results, which is why it is essential to have this test done in the same lab, if you need to have it tested several times.


AMH being the reflection of our ovarian reserve, it is natural it decreases with age, as our ovarian reserve is depleted. Therefore, women over 40 are expected to have lower AMH levels. Fertility wise, a low AMH is considered to be under 1 ng/ml. This being said, pregnancies are known to occur even when AMH is undetectable. We all know someone who knows someone who, in their early or mid-forties thought to have reached menopause, only to discover the menopause was in fact a baby.

So basically, every woman in her late 30's and early to mid 40' who is getting pregnant, gets pregnant despite low(er) AMH levels. We might safely assume this is the case for the vast majority of older women.


And we get to the burning question: is low amh linked to infertility? Does having low AMH mean we cannot get pregnant? The answer is no, rather than yes. 

More and more reputable reproductive endocrinologists worldwide admit lately that AMH is actually too new to be able to give an accurate image all by itself. That while it can give us an idea of how a woman might respond to fertility treatments (in case she ends up needing them) AMH doesn't mean much when taken alone. Instead, a better assessment of the female fertility can be obtained by corroborating the AMH with the Day 3 Tests and the Antral Follicle Count.


One thing most experts agree on is that AMH has to do mainly with egg quantity, not quality. Therefore, while you may produce less eggs for IVF in case IVF is what you need to get pregnant, they can still be of decent quality, depending on your age. Or, better yet, if you do not have any reason to do IVF, and so you are not interested in the number of eggs, you can relax, low AMH doesn't mean your eggs are not good anymore. Again, depending on your age.


When we find out our AMH is on the low end, the first question that comes to mind is "can I make it go up"? Well, no you can't, not really. Since AMH is a reflection of the quantity of eggs we have left, it is just logical that not being able to increase the egg reserve, it is impossible to "increase" the reflection of it in your blood stream.


But there might be a catch here. It has been discovered that Vitamin D, one of the vitamins with crucial role in conception (and not only) might influence our AMH levels. If your Vitamin D level is low, this may artificially lower your AMH levels.



Once you get proper supplementation of Vitamin D and your vitamin D levels get back into the normal range, you may have the surprise to discover your AMH level is higher. Which again, doesn't actually mean your AMH has "increased" but just that it has been brought back to its place.

Studies show that humans do lack Vitamin D as a general rule, and more than that, there is also a matter of proper absorption when it comes to vitamin D. So when in doubt, maybe get your Vitamin D levels tested.


As far as I am concerned, when I first had my AMH tested at age 40, it came back a crushing 0.2 ng/ml. Sure enough, my Vitamin D level was at 19 which is very low! I started supplementing and kept on doing so for almost 6 months. I managed to double my Vitamin D level and got it up to 39 (which still isn't stellar, cause according to the Endocrine Society, 60 ng/ml is the ideal level for both adults and children). I had my AMH levels checked again and bam: 0.96 ng/ml. Sure, 0.96 will still be considered low by fertility clinics, but let's not forget I was already 40, and my AMH levels still went up 5 times.

I considered this to be my little victory.


Last but not least: when you are told your AMH is "low", what exactly does "low" mean? We should keep in mind that AMH has different values for different ages, and what is low for a 25 year old, might be just normal for a 38 year old.

The bottom line I guess, is that AMH is not quite the be all and end all of fertility, that you cannot care less about it if you are trying to conceive naturally, and that ultimately, the egg quality is given by age. But even here there is a catch, because studies show supplements and lifestyle changes have a great role to play in improving egg quality. 


All of the above only to tell you, ladies, that there is life after a low level AMH test!


Sources:

https://www.ncbi.nlm.nih.gov/pubmed/22508713

http://www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893

https://www.healthline.com/nutrition/vitamin-d-dosage


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