What is AMH? AMH is short for anti-mullerian hormone. It is a substance made by small follicles called antral follicles in women’s ovaries. These follicles are in early stage of follicle development. Once the follicles grow bigger than 8 mm, they no longer produce AMH. The more small follicles are developing, the higher AMH levels are. Vice versa, the higher AMH means there are more small follicles in the ovaries. Since AMH is produced only in smaller follicles and its blood levels are constant, AMH has been used to measure the size of the pool of growing follicles in women. AMH blood levels reflect the size of the remaining egg supply.
If your AMH is low, there are less small follicles developing in the ovaries which means your egg supply is poor. With increasing women’s age, the size of their pool of remaining small follicles decreases. Low AMH reflects poor egg supply and less chance to get pregnant naturally. Low AMH value means poor response to ovarian stimulation and low IVF success rate. Some women may have problems of recruitment and development of follicles; in this case they have fewer follicles developed and their AMH tends to be low. Women with low AMH would have less chance to have good quality eggs. So they may have difficulty to conceive naturally. Women with low AMH level are likely to have poor response to ovarian stimulation for IVF and have fewer eggs retrieved. This reduces their chance to conceive via IVF.
Low AMH is caused by recruitment problem in follicles development. All eggs in women’s ovaries are at rest, they must be recruited for developing and maturing. If the follicles do not recruit enough there are less follicles developing. For example, in the case of premature ovary failure (POF) the ovary function is damaged and there are less follicles developing, AMH value is low in women with POF. What is important factor in follicle recruitment and development? Ovary microcirculation is the key factor in follicle recruitment and development. Good circulation helps bring nutrients to the follicles and take away the wastes produced in the follicles.
AMH is associated with menopause
Anti-mullerian hormone (AMH) is produced in small antral follicles. AMH concentration reflects ovarian aging. Can it be used to predict age at menopause (AMP)? If AMH falls below a critical threshold which corresponds to follicle depletion, will this leads to menopause? There was a large population study to investigate the relationship between AMH and AMP. In this study, there were 27563 women participated. AMH was measured in these women who attended fertility clinics. They found that the critical AMH threshold vary among women; AMH became undetectable about 5 years before the occurrence of menopause. This indicates that declining population average of AMH is associated with menopause.
Does low AMH means that you cannot have children? It is certainly not. Some women with immeasurable AMH still can get pregnant.
Do you need help if your AMH is low? Yes, though low AMH does not mean that you cannot conceive at all, you chance to conceive naturally and via IVF is indeed very low. Some women are trying for years without success.
Women with higher AMH values will tend to have better response to ovarian stimulation for IVF and have more eggs retrieved. Generally, having more eggs with IVF has a higher success rate via IVF.
Contraception pills decrease AMH levels
Women are trying not to get pregnant by different approaches. Contraception pills are one of the popular options. When taking the pills, does anyone ever think how the pills work? Are there any side effects of the pills? Recently Kallio S et al from Oulu University Finland studied the effect of combined contraception on antimulleria hormone (AMH) levels. There were 54 healthy women completed the study. They received combined contraception treatment for 9 weeks. The drugs were given by oral, transdermal and vaginal methods. Blood samples were taken before, at 5 weeks and 9 weeks of the treatments. They found that AMH, FSH, inhibin B, LH and E2 levels had decreased significantly in all study groups after 9 weeks of treatment. Significant reductions were already detected after 5 weeks use of combined contraceptives. This study suggests that the decrease of AMH during the use of all combined contraceptives indicates that follicle development is arrested independently of administration route of the contraceptives.
There was another study by Bentzen JG et al from Copenhagen University Hospital who compared ovarian reserve parameters between users and non-users of hormonal contraception. They compared the AMH value, the antral follicle count (AFC) and the ovarian volume in 228 users versus 504 non-users of hormonal contraception. Users of hormonal contraception had 29.8% lower AMH concentration, 30.4% lower AFC and 42.2% lower ovarian volume than non-users. AFC in all follicle size was lower in user than non-user of hormonal contraception. These findings were more pronounced with increasing duration of hormonal contraception. No dose-response relation was found.
Does acupuncture help follicles recruitment and development? During the follicle recruitment and development process, ovarian blood supply is the key. Good blood supply to follicles helps the process, because this helps provide enough nutrition to follicles and take away waste produced in the follicles. As we have already known that acupuncture improves ovarian blood flow to produce high quality of follicles and increased numbers of follicles and egg quality. This will improve the chance of conceivingnaturally or via IVF.
Case report: Low AMH, conceived naturally with the help of acupuncture
When you heard that your AMH is low and it is not possible to conceive with your own eggs. Is this really that bad? Actually a low AMH value does not necessarily mean that you cannot get pregnant naturally. You need to make more efforts than anyone else. Here is a story that a woman got pregnant naturally with low AMH. This is a simple story, but you can see the efforts that she made under the pressure of uncertainty and the lack of time.
There was a 39 year old woman who had been trying to conceive for a year without success. A fertility test found out that her AMH was very low (below 1) which was nearly immeasurable. She was determined to get pregnant naturally. She had paid attention to her diet and made sure her diet was healthy. She also had moderate exercise to keep healthy. By chance she found out that acupuncture could help and she kept going to acupuncture treatments on weekly basis. She made great effort and really believed herself. By the end of six months of acupuncture treatments, she got pregnant naturally.
Kallio S et al Fertil Steril (2013) 99:1305-10
Bentzen JG et al Reprod Biomed Online (2012) 25: 612-9
Dolleman M et al J Clin Endocrinol Metab (2013) 98:1946-53