- What do you do if you've been told you have a low AMH?
Can you conceive with a low AMH?
Welcome to Fertile Minds.
I'm Dr. Manny Mangat,
and I am a fertility specialist with IVF Australia.
Today I thought I will explain a little bit about AMH,
which I'm sure most of you have heard about.
AMH is a blood test that stands for Anti-Mullerian Hormone,
and it's often recommended
to check your baseline egg reserve or fertility
when it comes to planning what you're gonna do
with your future or prior to starting treatment.
Now, we are born, as women,
with all the eggs we're ever gonna have.
So we come out of our mothers with all our eggs,
and they live in primordial cells in our ovaries.
We are then genetically programmed
to recruit a certain number of those follicles each month.
And until puberty, there is no signal or communication
between our brain and the ovary
to tell those follicles what to do.
So each month they atrese or die,
and the following month, the recruitment starts again.
Now we are born with about a million eggs.
But by the time we go through puberty,
we only have about 350,000 eggs left.
So we've lost those eggs at an alarming rate,
even before we were ever ready to use them.
So what changes at puberty is that your pituitary,
or your brain, matures to communicate
with those primordial cells
that have been genetically brought out of resting.
They then become pre-antral cells.
And that is what releases the hormone AMH.
So it doesn't tell you the number of eggs you have left,
but it gives you an indication of a hormone level.
And therefore, it plots you on a graph based on your age
as to whether it is low, normal, or high.
Now, it's very important to remember
that the AMH level is a quantitation
and it does not reflect egg quality.
The primary determinant of egg quality is our female age.
Because those eggs have been in our ovaries our whole lives,
they are susceptible to reactive oxidative stress
and byproducts of our cellular metabolism,
and therefore, slowly age over time.
So it is important to note that the AMH level
is just an indication of quantity
and where you sit for your age.
So if you have been told you have a low AMH,
first of all, that does not mean you are infertile.
You definitely can still go ahead and fall pregnant.
Remember each month, your genetic programming bring up
a certain number of follicles.
Your AMH then communicates with your brain
to guide it as to how many follicles
to then choose for the month.
That group of follicles is what's called
your antral follicle count.
And that is what will be hormone sensitive.
And that is what your body can manipulate to ovulation,
or we can manipulate and rescue in an IVF cycle.
So naturally, one of these follicles will grow
and win the hormone race to dominance and then ovulate,
which gives you the chance of conception.
So as long as you have a group of follicles recruited
and still have eggs present,
and your hormones are working in the right order
to then cause an LH surge and ovulation,
you definitely still have a chance to catch that egg
and fall pregnant.
Therefore, the AMH level, I find, is more important
for patients of mine who come and see me
who may want to delay childbearing
or who may want to look at freezing their eggs.
Therefore, the AMH level gives me an idea of planning.
So I know if the level is low,
we should probably go ahead and do something now,
or we should progress to treatment sooner.
Or if we are doing treatment,
it gives me a guide on the dose of medication to use.
However, that AMH level itself,
as I would like to reiterate,
does not mean you cannot fall pregnant on your own
as long as you are ovulating
and having regular menstrual cycles.
Now, if you have been told, however,
that you have a low AMH,
obviously that can cause concern.
Therefore, please feel free to make an appointment
to speak to a fertility specialist
about your individual situation.
Now, if you haven't started trying
and you decided to check your AMH, it's come back low,
and now you think you might start planning a family
sooner rather than later,
I would still recommend that you track your ovulation,
know your cycle, time your intercourse at the right time.
And if things don't happen
after three or six timed attempts,
you should then see a fertility specialist
so that we can then guide you on the next steps,
depending on the levels,
on how to best achieve a positive outcome.
I hope that has shed some light on AMH and what it means.
The most important thing is to stay healthy
and keep those eggs in the best condition you can.
Please feel free to leave a comment
if you have any questions.
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Thank you.