What do Anti-Mullerian Hormone (AMH) Levels have to do with Fertility?

It may sound like a mouthful, but something called the anti-mullerian hormone (AMH) plays an important role in the development of a baby’s sex organs in the womb, as well as being a biomarker of ovarian reserve. If you’re trying to become pregnant, your levels of this hormone may provide some valuable information. Here are some of the most common questions and answers about this hormone.

What exactly is anti-mullerian hormone (AMH) and what does it do?

AMH is a hormone that’s made in testes and ovaries. Testing levels of this hormone in the blood can provide information about a number of reproductive health issues throughout the lifespan. In unborn babies, anti-mullerian hormone helps form reproductive organs. AMH and other hormones affect the early development of the reproductive organs and genitals.

Generally when ovaries have an abundant supply of eggs, AMH levels are higher. This is where testing for levels of AMH in the blood can provide helpful information regarding ovarian reserve and ovarian response to medications during IVF and other assisted reproductive techniques.

What is the anti-mullerian hormone test used for?

In most cases, an AMH test is done with other tests to give your health care provider information and as a way to make decisions about your care. The test measures the amount of AMH in your blood and may be done to:

• Measure ovarian reserve. As you get older, the number of eggs in your ovaries decreases; what’s left at a certain age is called ovarian reserve. An AMH test can give you an idea of the size of your ovarian reserve. As your eggs diminish your AMH levels will decrease. However, it doesn’t give you information about the health of those eggs, other conditions that may affect your fertility, or whether or not you will become pregnant.
• Provide information about how you’re responding to fertility medications. During IVF (in vitro fertilization), you will be prescribed medication that makes your ovaries prepare many eggs at the same time. Those eggs are collected and fertilized outside of your body to be put into your uterus or frozen for future use. Testing the anti-mullerian hormone levels in your blood during this process can give your doctor information on the medication dose necessary and how your body is responding.
• Find out if you have gone through menopause. As you age and approach menopause, your ovarian reserve and AMH levels decrease. Testing for AMH can determine if you’ve gone through premature menopause (prior to age 40) or early menopause (prior to age 45). At menopause, when no eggs are left in your ovaries, your AMH levels drop to zero.
• Help uncover health problems that might produce high AMH levels, such as PCOS (polycystic ovarian syndrome) or certain kinds of ovarian cancer.
• Provide information about babies with undescended testicles or those who are born with genitals that aren’t clearly male or female. This test provides information on whether the baby has any functional testicular tissue, and is usually done in combination with other tests.
• Help determine why you are not having menstrual periods. This test may be ordered for teens who haven’t begun to have periods by the age of 15 or for those who have stopped menstruating for several months in a row.

Are there other factors that could affect my AMH levels?

Yes, there are a number of things that can impact AMH. They include having PCOS or a family history of PCOS, previous ovarian surgery, having had chemotherapy, being on oral contraceptives, having certain genetic mutations that increase your risk for breast or ovarian cancer, being obese and being deficient in Vitamin D.

Are there other tests to measure ovarian reserve?

Yes, in addition to measuring your levels of anti-mullerian hormone, FSH screening and AFC screening are often used for this purpose. Don’t be confused by the alphabet soup; FSH screening measures follicle stimulating hormone (FSH) that stimulates your ovaries to release an egg each month. When egg count is diminished, the ovaries send a signal to the brain to ramp up and make more FSH. What this means is that elevated FSH levels is a likely indication of low ovarian reserve. An FSH screening is best done on Day 3 of your menstrual cycle.

Another test, called antral follicle count, or AFC screening measures the resting follicle in the ovaries. Follicles are tissue structures, like pouches, that hold the eggs. AFC is done through a transvaginal ultrasound, and can help determine how well you will respond to IVF or an egg freezing cycle. This test is best done in the follicular phase (first half) of your menstrual cycle.

While both FSH and AFC screenings are useful and reliable, testing your anti-mullerian hormone level is believed to be the most reliable indicator of ovarian reserve. Levels of this hormone stay steady throughout your menstrual cycle, so testing can be done at any time.

Do low AMH levels mean that I won’t ever be able to get pregnant?

No. AMH is measured to provide information that will be helpful for patients going through assisted reproductive procedures, such as IVF. What it can tell your fertility doctor is how you will or are responding to medications used to stimulate the release of eggs. This means that those who have higher levels of AMH will tend to need less medication and those with lower levels of this hormone may need medication at a higher dose. And if you’re trying to become pregnant naturally, many patients have become pregnant after having a low AMH test result—the test just provides information.

AMH is reported in pmol/L in Canada and ng/ml in the USA. While women’s health experts debate the exact numbers, an average reading for AMH is 1.1 to 3.0 ng/ml (nanograms per milliliter) or 8 to 21pmol/L (picomoles per litre). A low reading is considered when readings are under 1.1ng/ml or 8pmol/L.

Is there anything I can do to help raise my levels of AMH and my ovarian reserve?

Yes, many fertility clinic doctors refer their patients to acupuncturists for help in preparing their body for pregnancy, both naturally and through assisted techniques. Acupuncture treatments can help boost your fertility in several ways. Research studies have concluded that it can help regulate your menstrual cycles, promote ovulation, balance your reproductive hormones and provide increased circulation to your uterus and ovaries. Acupuncture can also help promote thickening of the endometrial lining, which helps prepare the uterus for implantation. And a great deal of research has also found that acupuncture is great for stress reduction—an added benefit during a very stressful time.

Your acupuncturist may also prescribe Chinese herbs as a way to refine and augment your treatments. Chinese herbal medicine is based on the fact that each herb has specific actions on the body. This simply means that you would be prescribed herbs that are based on your individual needs. For many patients, nutritional therapy goes hand in hand with acupuncture and herbal medicine. Your acupuncture provider is trained and experienced in providing dietary guidelines that can enhance your health and prepare your body to become pregnant.

In addition to acupuncture, herbal and nutritional medicine, cold laser therapy is a great tool for enhancing fertility. Cold laser involves the use of low-level lasers and LED light therapy to gently and painlessly penetrate deep into the tissues to stimulate positive changes within the cells. Some of the earliest research on cold laser therapy involved treating patients who were experiencing infertility. Cold laser works by increasing the formation of tiny vessels to enhance circulation in the treated area, decreasing inflammation, increased cellular activity and the generation of new cells.  This translates into the ability of cold laser to help increase the energetic activity in egg cells, especially in older patients when those cells are normally declining—producing more viable eggs. Cold laser therapy may improve the outcomes associated with assisted reproductive technology, both pre and post IVF.

So, when should you get started with acupuncture for fertility? The simplest answer is as soon as possible. That’s because acupuncture and Chinese medicine stimulate your body to heal itself, which can take time. It’s ideal to work with an acupuncturist for a few reproductive cycles to prepare your body to become pregnant, either naturally or through IVF. If you’d like more information about how I can help you with your fertility journey, please don’t hesitate to call me.

 

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