In the past, we had to depend upon FSH levels. A high FSH level suggests poor ovarian reserve, but FSH levels are not very reliable, because they vary according to which day of the cycle the test is done; and can also be artificially suppressed by a high estradiol level
AMH is a much better marker for ovarian reserve. It does not vary from cycle to cycle; and remains the same throughout the cycle. A low AMH suggests you have poor ovarian reserve - but even if your level is low, this does not mean you should panic !
Remember that it's just a test - and good doctors do not treat tests - we treat patients !
Step number one is to repeat it again - preferably from another lab.
Step number two is to run additional tests to check your ovarian reserve.
You have 2 options: an ultrasound test called the antral follicle count ?
and a blood test called a clomid challenge test.
Even if these are poor, this does not mean you cannot improve it ! While Western medicine does not have much to offer, there are alternative medicine options you can try to improve your ovarian reserve
These include the following:
1. Yoga
2. Acupuncture
3. DHEA, 25mg thrice a day.
4. Wheat germ daily
5. CoQ 10, 100 mg daily
6. Vit D3 ( Calcirol), 60000 IU, once a week for 10 weeks
Read the book, Inconceivable.
Re-test your AMH level after 12 weeks to see if it improves.
Even if it does not improve this does not mean you cannot get pregnant ! Patients with low AMH levels do also get pregnant on their own ( though their chances are reduced). After all, levels provide information about groups of women , and there can be a lot of individual variability !
If you have poor ovarian reserve, IVF is often your best option as it maximises the chances of a pregnancy. IVF allows you to make the best use of the few eggs which are left, by telescoping time.
Plan B would be to use donor eggs, if you are willing to consider this option. This has a much higher success rate
24 comments:
Since AMH is produced by the antral follicles, I've always thought of it as actually a surrogate measure for the antral follicle count, which is the true measure of your ovarian reserve. Is it that straightforward?
So then the question is, do DHEA, coenzyme Q10, wheat germ, accupuncture etc, increase the number of follicles recruited from the reserve?
Vitamin D of course is working by a different mechanism. Interestingly, I found that after increasing my vitamin D levels, my antral follicle count has actually dropped in half, going down from 30 to 15. Wonder whether that has something to do with Vitamin D- something else to study, IMO!
Unfortunately,nothing in medicine is ever simple !
For most women, this correlation is pretty good and both AMH levels and antral follicle counts go hand in hand, which is what one would logically expect !
However, there are always exceptions, and one can learn a lot by studying them ! There is a lot of inter-individual variability between test results and real life fertility - and patients need to appreciate the imprecision of all these tests, rather than starting to panic just because their numbers do not fall in the normal range !
Hi Dr.
I am 30 yrs old with 2 failed letrozole cycles (1 chem preg) and 1 failed gonadotropin cycle. My Amh was 1.6 and FSH was 10.6--my dr is saying IVF asap. I have a 2 year old that we conceived naturally (with the help of some monitoring). I am trying to destress as i know stress is playing a huge roll in this.
Any advice would be appreciated. Thank you.
Since this website mentions the work of Julia Indichova and her book Inconceivable, I would like to say that her approach is really unique and has helped many women with bad diagnoses. I also learned from Julia that talking about
stress and infertility creates a lot of confusion and often does more harm than good.
Several women with low AMH conceived with her tools, you can read the testimonials on her message board, www.fertileheart.com. She even has some special imagery on her latest CD
that are specifically created to support healthy ovulation. She works with diet and visualizations. you could also look at her video on fertility success stories on youtube. Hope this can help other women!
P.
Dear Dr,
If you could excuse me I would like to give my views on this post. AMH is a harmone secreted by growing follicles (pre-antral and antral) and hence its decline correlates with the decline in the number growing follicles. Thus it helps in determining ovarian reserve.
Does increasing AMH production by artificial means can increase pre-antral and antral follicle count (ovarian reserve)? Actually not. Research findings till date did not find a feed-forward loop. More AMH, more antral follicles but adding AMH to ovaries does not increase AFCs. Infact addition of AMH to neonatal ovaries in vtro inhibits primordial follicle recruitment and hence can decrease AFC. Thus it can also preserve ovarian reserve for a longer period. Slower recruitment of primordial folicles = longer reproductive period. Mice which do not produce AMH deplete their ovarian reserve faster and reach menopause quicker (they are fertile!). So if we artificially increase AMH or give AMH from outside recruitment of primordial follicle is prevented. This can explain Jay's observation that after taking Vit D (for increasing AMH levels) her AFC has decreased to half.
A very recent publication 'Vitamin D Regulates Anti-Mullerian Hormone Expression in Granulosa Cells of the Hen' has found an opposite effect of what Jay has experienced although it is not a study in humans.
The message is AMH is not an indcator of egg quality. But people with poor egg quality can have low AMH ( because aged people have poor egg quality and they also have less ovarian reserve). I beleive they are two different process not mutually exclusive. So a younger woman with low AMH doesnt necessarily have to have low egg quality. Woman with PCOD have higher level of circulating AMH (bcoz of more AFC) but not necessarily good quality eggs. The second message is increasing AMH artificially can decrease your AFC count and hence eggs available to be collected via IVF.Might be for a women with PCOD Vitamin D therapy can help if it decreases their extremely high AFC!
The entire thing is interesting because PCOD woman have more AFC and hence more AMH. Might be such high AMH levels prevent ovulation (by preventing selection of follicle hence no mature follicle) and also prevents primordial follicle recruitment. This means PCOD women can be fertile for a longer period of time than their normal reproductive counterparts interms of egg production. An older PCOD woman can produce more egs because her ovarian reserve is preserved but do they have good quality eggs is again a question here!
Just my few cents on this topic.
Dear Dr,
Want to make some changes to my previous comment :)
1) More AMH, more antral follicles but adding AMH to ovaries does not increase AFCs.
This sentance should be read as: More antral follicle count = more AMH but adding AMH to ovaries does not increase AFCs.
2)I beleive they are two different process not mutually exclusive.
This should be read as : I beleive they are two different process WHICH ARE mutually exclusive.
Actually you hypothesize somethng in science and scientific community already knows it :) Well something to support the last paragraph of my previous comment :
http://www.jeanhailes.org.au/resources/international-research/1290
Hope my comment is useful!!!
Hi Doctor,
'am a 35 years old with no kids. Have got a series of failed IUIs. Had 2 IVFs. first resulted in pregnancy only till 6 weeks and 2nd IVF failed.
My recent AMH is 9.98, FSH - 8.71, LH - 10.47, Estradiol - 39.89 and Progestrone - 0.38.
Pls suggest, is it difficult for me to conceive ?
Dear Dr. Malpani,
My doutor told me that my amh decrease from .58 to .30 in last 4 months while i was ranking dhea 3 times a das. He suggest to use eggs donated. What eles can i do to increase the amh until january 2013 to do Ivf .
Best regards
Vivino
Hi Doctor,
My wife is 40 years old, AMH is 0,2 and FSH is 6,1 and LH is 3,4, TSH 0,68, T4 16, our Doktor said there is no chans to my wife to get a good egg...
What can we do?
Mick
Dear Dr. Malpani,
I am a 40 year old lady who recently learnt that my AMH is 0.2 and my husbands sperm count is 5 million but motility 3%. Seeing this combination the Doctor here sees no hope in continuing it further. However since I was insistent she said that we could only once try (ICSI) Intracytoplasmic sperm injection. However before that we need to undergo a series of genetic test which we are currently doing. If they come normal we can go for ICSI.
My question is would be there some chance of having a normal child through this procedure or is it better to accept it as our fate and leave it for good.
I really need your answer as it would go a long way in clearing the dilemma.
Thanks...
A lady who wants to a mother....
Dear Dr.
I am 34 for years of age. I was diagnosed with grade 4 endometriosis in the year 2004 and operated on that very year. My recent amh and fsh test results show the levels at 0.03 and 14.78. I had done one cycle of ivf. Now doctors are suggesting ivf by donor egg.I am not being to come to terms with the concept. I ovulate normally and experience ovulation pain and light brown discharge during ovulation. Please help.
I am 36 yrs old and was diagnosed with an AMH of 4pmol/L - I.e. very low. I was devastated after having been given hope with my FSH & LH of 4.1 plus good estrogen and progesterone levels, plus I knew I was ovulating. We had been trying to conceive for around 18 months. Anyway, long story short, a few days after my low AMH came back and we were about to begin IVF, I discovered I was already pregnant - naturally. I'm now 15 weeks and confident things are progressing well. I hope my story gives people some hope. Number are sometimes simply numbers and miracles can and do happen.
Respected Dr. Malpani,My age is 31 i m married for last 4 years, but have not conceived yet, recently i got my amh done it was 1.7 ng/ml, what does this mean? can i conceive naturally? Plz answer my query
A low AMH does not necessarily mean you are infertile ! Women with low AMH levels can have babies too !
Do a complete workup before starting treatment haphazardly.
You need to do ALL the following simple medical tests:
semen analysis for your husband ( to check his sperm count and motility). Read more at www.drmalpani.com/sperm.htm
blood tests for you for the following reproductive hormones - FSH ( follicle-stimulating hormone),LH ( luteinising hormone),PRL ( prolactin) , AMH ( antiMullerian hormone) and TSH ( thyroid stimulating hormone) on Day 3 of your cycle, ( to check the quality of your eggs). Do this from a reliable lab such as SRL ( www.srl.in). Day 1 = Day the period starts.
HSG ( hysterosalpingogram, X-ray of the uterus and tubes, www.drmalpani.com/hsg.htm) on Day 8 of your cycle ( to confirm
your fallopian tubes are open);
The vaginal ultrasound scan on Day 10-11 should check for the following. a. ovarian volume b. antral follicle count c. uterus morphology d. endometrial thickness and texture
Please send me ALL the detailed test results and medical reports . You can scan them in as a single doc or pdf file and email them to me.
Please send me all the results together, rather than piecemeal, so I can interpret them intelligently
With these test results, we can determine what medical problems are causing your
infertility.
If there is a problem, then we can treat it !
Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !
You can talk to some of our patients by email at http://www.drmalpani.com/success-stories.htm
We look forward to helping you to have a baby !
Regards,
Dr Aniruddha Malpani, MD
Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
Bombay 400 005. India
Tel: 91-22-22151065, 22151066, 2218 3270
FAX ( India) 91-22-22150223.
Helping couples build families !
PS Read our book, How to Have a Baby - A Guide for the Infertile Couple,
online at www.DrMalpani.com !
Hi Dr. I wondered if you would give me your thoughts on my case?
I am 25, I had my AMH test done twice over a 10 day period, first it was in the reduced response category at 2.25 and then came back even lower 0.95. I had my FSH, LH and Oestradiol which came back normal, and my follicle count was 15 over the two ovaries. My womb looked fine on the scan. I know that AMH is a predictor of IVF success, which considering my score doesn't look good for me, I know that most stats will tell you that an average of 30-35% success for those under 35. But I wondered if you had any further thoughts on my chances specifically. I have been referred as a high priority case on the NHS for IVF. I am hoping that because I am young my chances are higher than a normal person because the majority of people going through IVF are older??
also, i am healthy, sporty - go to the gym, i dont smoke i very rarely drink although my BMI is 28/29
any thoughts would be appreciated.
Thank you
Dear Sacha,
The fact that you are young and you have a good antral follicle count means you have a good prognosis, so please don't panic.
Let me know how your cycle progresses !
Best of luck !
Dr Malpani
where and in what form can I find Wheat germ? how should I take it?
Thank you for giving some of us hope :)
Hello Doc,
I have irregular menstrual cycle problem due to which my doctor advised me to test my AMH level.
Following are my details.
Age: 28 yrs
TSH:2.77
AMH: 0.5 ng/mL
My doc has told me that I have low AMH level which could cause problem in conceiving.I have not planned pregnancy yet for 6 months atleast.
Can you please tell me , whether I will be able to conceive naturally ?
Hi Dr
Could you send me the items you listed above? or tell me where i can get them?
Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at www.drmalpani.com/afc.htm
You can try the following to improve your ovarian reserve.
1. Yoga
2. Acupuncture
3. DHEA, 25mg thrice a day. This is an anti-aging hormone
4. Wheat germ oil, 1 capsule daily. This is a nutritional supplement
5. Coenzyme Q10 , 100 mg daily .This is an antioxidant
Continue these until you get pregnant
6. Cholecalciferol ( Vit D) , 60000 IU, once a week for 4 weeks
Read the book, Inconceivable, at http://www.amazon.com/Inconceivable-Winning-Fertility-Julia-Indichova/dp/0966007859/ref=sr_1_2?ie=UTF8&qid=1330844751&sr=8-2
Hello doc im a 40 year old i've had my tubs burned and i want to have a baby i have 3 kids already but i want one more i had my amh levels tested and they came back 0.1 iknow i have to go thur ivf to have a baby because of my tubs but should i tke dhea to raise my amh levels i want to use my eggs if i can.please help
Your low AMH level ( www.drmalpani.com/amh.htm)
Suggests you have poor ovarian reserve .
You can read more about this at www.drmalpani.com/oopause.htm.
You can try the following to improve your ovarian reserve.
1.Yoga
2. Acupuncture
3. DHEA, 25mg thrice a day.
4. Take wheat germ daily
5. Coenzyme Q10 , 100 mg daily
6. Cholecalciferol, 60000 IU, once a week for 4 weeks
Read the book, Inconceivable, at http://www.amazon.com/Inconceivable-Winning-Fertility-Julia-Indichova/dp/0966007859/ref=sr_1_2?ie=UTF8&qid=1330844751&sr=8-2
IVF with aggressive superovulation would be your best option as it would maximize your chances of getting pregnant quickly and help you make the most of the eggs you have left
Treatment takes about 20 days. Should I send you the treatment plan ?
Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !
Treatment can be expensive, but a baby is priceless.
Plan B would to consider natural cycle IVF. Read more at www.drmalpani.com/naturalcycleivf.htm
Plan C would be to use donor eggs, if you are willing to consider this option
This has a much higher success rate
You can talk to some of our patients by email at http://www.drmalpani.com/success-stories.htm
We look forward to helping you to have a baby !
Dr Aniruddha Malpani, MD
Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
Bombay 400 005. India
Tel: 91-22-22151065, 22151066, 2218 3270
FAX ( India) 91-22-22150223. Our US FAX is 1-775-249-6041
Helping couples build families !
PS Read our book, How to Have a Baby - A Guide for the Infertile Couple, online at www.DrMalpani.com !
Read my blog about improving the doctor-patient
relationship at http://doctorandpatient.blogspot.com/
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