Low AMH levels – Causes, Symptoms & Treatment

Low AMH levels – Causes, Symptoms & Treatment

Low AMH Levels (Overview)

Anti-Müllerian Hormone (AMH) is a hormone produced by the developing follicles in the female ovaries. AMH decreases as the age of the women increases naturally. Women have commonly low AMH results over the age of 40. This implies that the ovarian reserve in women diminishes. Although many factors are considered to assess the accurate levels of AMH especially including age, the reference range for AMH value should be within 2.20 – 6.80 ng/mL. There are no definite ways to increase the AMH levels but various things can be tried.

Low AMH and pregnancy are often discussed simultaneously. This is because low AMH levels signify the decreased number of eggs or very low number of eggs in the ovarian reserve. And depleted eggs in ovarian reserve implies the meagre chances of getting pregnant.

However there are various differentiating factors such as different labs may give different results and now it is also recognized that AMH varies during the cycles also.

Causes of Low AMH Levels

There can be several causes for a low AMH level. Let us discuss some of them below:

  • Age: The most influential factor that causes the change in AMH levels. All the women possess the supply of immature eggs for their lifetime right at the time of birth. These eggs get mature and are used during the ovulation cycles throughout the lifespan of the women till the time of menopause. The ovarian reserve decreases with the time, so the AMH level starts decreasing as she gets older. Till the time women ages to the mid or late 30s, the number of eggs in the ovarian reserves starts reducing. That’s why fertility decreases as AMH starts depleting around the age of 35.
  • Poor Diet: A diet consisting of processed food and excess fat is never a good option for a healthy AMH level. The unhealthy intake of food results in obesity which causes various reproductive issues including low AMH levels. Also, some studies show that Vitamins deficiency especially Vitamin D directly impacts the AMH levels and fertility. So, it is advised to consume a balanced diet to have ideal levels of AMH.
  • Past Medical Record: Another factor causing low AMH levels apart from age is medical history. Medical circumstances can affect the AMH levels irrespective of the age. There are instances where some women face low levels of AMH even in their 20s and 30s while others continue to possess high AMH levels a few years after their 30s.
  • The experience of adverse medical conditions related to the reproductive system like hormonal disorders also impacts the AMH level causing its decrease. Also, the women with a previous history of ovarian surgery due to the conditions like ovarian cysts, endometriosis and ovarian torsion, etc., have a greater chance of having low levels of AMH.
  • Mental and emotional health: The next cause of a low AMH level is stress. A healthy mind and emotional well-being are always beneficial particularly for the women who are trying to conceive. Living with mental pressure or hyper stress continuously may result in failure to conceive. Moreover, de-stressing and maintaining a peaceful mind can correct the AMH levels.

Other factors that may cause low levels of AMH are:

  • Inherited genetic disorders
  • Cancer treatment
  • Autoimmune attack on ovaries
  • Other Environment causes

Symptoms of Low AMH Levels

Though, there are no specific or clear symptoms of low levels of AMH, getting done an AMH blood test when women notice a short cycle, irregular periods or premature menopause.

How low is too low AMH Level?

AMH levels tend to decrease with age of a woman. So, the answer to “how low is too low AMH level” varies from age to age. But a too low AMH score can be defined as a level which poses a health threat or indicates possible infertility in a woman where even an Assisted Reproduction Technology has a slim chance of success.

First, let us look at the list of ideal AMH levels according to the ages. 

Age Ideal AMH level
<24 months <4.7 ng/mL
24 months – 12 years <8.8 ng/mL
13 – 45 years 0.9 – 9.5 ng/mL
45 years <1.0 ng/mL

 

Interpretation AMH levels

Interpretation AMH levels
High levels (Testing for PCOS is advisable) >5.0 ng/ml
High levels (Ideal for IVF treatment) 3.5 – 5.0 ng/ml
Optimal levels 1.0 – 3.5 ng/ml
Low levels (Assisted reproduction is viable) 0.3 – 0.7 ng/ml
Very low levels <0.3 ng/ml

 

Note: The scale is general and intended for women only.It may vary according to race, ethnicity, environmental & genetic factors

As we can see in the above list that the levels from 0.3 to 0.7 ng/ml are considered low but Assisted reproduction like IVF treatment may be viable at these levels.

According to a research in the Middle East Fertility Society Journal (Zaghloul, Y.I., Amin, Y.M., Mansour, R.T., 2020), AMH levels under 0.5ng/ml are considered to be less than desirable. However, even they have the potential for bearing off-springs with assisted reproduction – IVF. Yet, in the same age group, normal AMH levels resulted in higher pregnancy potential than low AMH levels. Moreover, women enjoyed successful outcomes from IVF treatments as their AMH levels increased. 1.0 ng/ml to 4.0 ng/ml.

So, the levels (around <0.3 ng/ml) at which the chances of conceiving are very slim even with the ARTs like IVF can be considered as too low.

 

Low AMH and Fertility issues

AMH levels are considered to be an indicator for a woman’s ovarian reserve. AMH levels don’t signify definite infertility. The base of the relationship between one’s AMH levels and fertility is that a woman’s fertility declines as she ages. This correlates with the decline in AMH levels too.

The reduced number of eggs or no eggs in the ovarian reserve of a woman reduce the chances of getting pregnant.

The quality of the eggs may also be affected in the age-related low AMH, as eggs accumulate mutations over time. Here, the probability of abnormal fertilisation and miscarriage rise. This especially holds true for older women who are over 35 or 40. That’s why the treatment is suggested for women with low AMH level. While there have been instances when younger women have not faced hurdles in conceiving despite low AMH level. 

In the blood test, AMH levels signal the potential number of follicles within the ovaries. Yet, AMH levels don’t portray the quality of eggs in a woman.

 

Options if you have low AMH levels? 

If you simple worried that your AMH test currently showed your AMH levels to be low then you may not worry because AMH levels change. AMH levels can be increased with certain lifestyle changes naturally. Some of those ways are mentioned in this article below.

And if you have been unsuccessful already in raising your AMH levels to optimum, then, treatments like IVF can come into your rescue if you want to conceive. More about IVF is mentioned in the article further.

 

What to expect from the doctor if you have low AMH Levels?

In the case of low AMH levels, doctors generally suggest considering the IVF treatments or other Assisted Reproductive Technology/Methods (ARTs) for the woman who is looking to conceive.

Along with the AMH test, the medical professional may evaluate the fertility by conducting some other tests like FSH (Follicle Stimulating Hormone) blood test and Antral Follicle Count (AFC) test as well.

Additionally, in some cases, doctors may ask to bring some changes and adopt new healthy habits which may help to improve the egg quantity in the ovaries and hence increase the AMH levels of the woman.

 

Treatment with low AMH Levels?

 

Natural Treatment

The AMH levels in a woman can be corrected naturally by adopting different ways. Practising Yoga regularly, getting acupuncture, consuming wheat germ daily, getting fertility massages at prescribed times are some fundamental courses of action which can correct your AMH levels naturally.

 

IVF with Low AMH levels 

A woman’s ovarian reserve portrays the possibility of a successful pregnancy. And if a woman has low ovarian reserve then IVF is a hope to get pregnant. IVF is an alternative that can help you conceive with a limited stock of eggs left in their ovaries, provided if the matured egg retrieved in a specific cycle of In Vitro Fertilization (IVF) should be of optimum quality. 

The unusually high spiked FSH levels along with the low AMH levels signal that the ovaries are not growing the optimal quantity and quality eggs. This would mean a poor fertility outcome. But, still with the proper treatment, if a woman her lifestyle healthy, takes DHEA supplement and with a specific (maybe customized) ovarian stimulation protocol, a woman may be able to conceive via IVF treatment successfully.

 

IVF with Donor egg 

If a woman has left with no eggs in the ovarian reserve or have a substantially low quality of eggs and if the stimulants have failed to retrieve good quality of eggs, then she can go for the IVF with a donor egg. In this case, the good quality eggs of a stranger(donor) are used to carry the process of IVF and get you pregnant eventually.

 

Low AMH: Does it affect pregnancy? 

A low level of AMH signifies that you may have a low chance of getting pregnant. The decreasing ovarian reserve shows that you should not delay your motherhood for long because your ability to get pregnant may reduce soon. Although, a woman can become pregnant naturally with low AMH. But the possibilities reduce as the AMH scores drop below the “low” level. Moreover, AMH levels may change from time to time.

Low levels of AMH may also mean that you are heading towards menopause. Low levels of AMH are common in women after menopause and young females. The AMH level test can also tell whether the treatment is working or not in a woman who is being treated for ovarian cancer. As we know that the fertility in women declines with the increasing ages, so, correspondingly the AMH levels also start decreasing as women age. 

FAQ’s

Can I conceive with low AMH?

As we know, the AMH levels can change and do not represent a comprehensive scenario of the fertility of a woman, it is still possible to conceive if one has low AMH levels currently.

A lot of studies report that the scope of getting pregnant for women remain unaffected by the AMH (Anti-Mullerian hormone) levels. However, a study (Steiner AZ, Pritchard D, Stanczyk FZ, 2017) published in the Journal of the American Medical Association (JAMA) with 981 volunteers contradicts and proved otherwise. It showed a trivial correlation to diminishing ovarian reserves and fertility potential.

In short, women having low AMH levels too can get pregnant. There are possible ways which might correct the AMH levels in a woman. And even with the low AMH levels treatments like IVF may make it possible for a woman to conceive. (
Both of these solutions are already discussed above.)

What happens if AMH is low?

Low levels of AMH may signify the starting of menopause. Also, women after menopause and young females commonly have low levels of AMH. If a woman has low AMH levels then it may indicate fewer chances of conceiving. It is always better to have the ideal levels of AMH for higher chances of getting pregnant. Natural and IVF treatments may assist a woman to correct the AMH levels and even get pregnant with low levels. 

Moreover, Natural IVF and Modified Natural IVF can prove more appropriate treatment for the women with a lower count of eggs in their ovarian reserve. This is because, in the conventional IVF, a woman is expected to respond poorly to the drug doses when she has very low levels of AMH.

How to increase low AMH levels?

Though, there does not exist any sure shot ways to increase AMH levels. 

Here are a few measures which can help enhance the quality and quantity of eggs and subsequently correct the AMH levels naturally.

Practising regular exercise and Yoga
Taking Dehydroepiandrosterone (DHEA) supplements
Acupuncture
Keeping away from smoking
Having fertility massages
Consuming Vitamin D rich food or supplements
Consuming Wheat germ extracts
Taking L-arginine supplements
Avoiding Bisphenol – A (BPA) exposure

In addition to this, intaking a customized nutritional diet can have a profound bearing on a woman’s ovarian reserve and AMH levels. A diet including food rich in iron, fibre, proteins, high-fat dairy is recommended to women to boost fertility levels. While red meat, processed food, fast food and any kind of eating stuff with processed sugar pose an adverse impact on women’s fertility levels.

A list of food items that can help increase AMH levels and enhance the health of the ovaries eventually.

Dry fruits and nuts
Green leafy vegetables
Fruits
Oily foods like fish, vegetable oils
Whole grains — oats, brown rice
Avocados
Zinc-rich food — legumes, cheese
Spices — turmeric, ginger

Also, Water being water is a non-negotiable part of a woman’s diet, especially who is trying to work on her AMH levels. Maintaining the ideal water intake can improve the AMH levels and also the overall health in general.

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