How To Improve Egg Quality with Low AMH

What is AMH?

The Anti-Müllerian Hormone, or AMH, is a hormone that is secreted by the small follicles in the ovaries. The glycoprotein hormone serves as an indirect yet reliable measure of the remaining pool of the primordial follicles, also known as the ovarian reserve. In simple words, high AMH levels indicate a good ovarian reserve, while low levels hint at fewer eggs.

AMH levels are measured in nanograms per millilitre (ng/mL) or picomoles per litre (pmol/L). A test to determine AMH levels is done with the help of a blood sample, usually taken during the menstrual cycle. This makes sure that the levels are stable.

For more accurate results, AMH tests are done with an antral follicle count, a test that determines the number of follicles in the two ovaries. It is important to note that factors like age can affect the numbers.

Generally,

The value for low AMH levels is typically 0.5-1.0 ng/ml or lower. On the other hand, high AMH levels show a value of 4.0 ng/ml and may be an indication of PCOS.

Link Between Egg Quality and Low AMH Levels

AMH levels indicate how active your ovaries are. Low AMH levels indicate that fewer follicles are available for stimulation during a natural or medicated cycle. This is important for predicting response to ovarian stimulation in assisted reproductive methods, like IVF.

Now, the question is, does low AMH mean low egg quality? No. Low AMH levels do not affect or impair egg quality, nor do they regulate menstrual cycles. In fact, changes in other hormones, such as FSH, LH, and oestradiol, are more likely to affect egg quality and cycles. Similarly, low AMH does not negatively affect ovulation.

On the contrary, your egg quality can be affected when AMH levels are high, as seen in PCOS.

What Causes Low AMH Levels?

There are a number of factors that can decrease AMH in the female body, including but not limited to:

• Diet: It shouldn’t be surprising that a diet that mainly focuses on processed food and unhealthy fats isn’t good for anyone. This can lead to obesity, which causes multiple reproductive issues, such as low AMH levels.
• Age: Age is the biggest culprit when it comes to a change in AMH levels since women have all the supply of immature eggs right when they are born. As they grow older, eggs mature, and the ovarian reserve decreases.
• Medical history: Medical issues, such as ovarian surgery, cancer therapy, and endometriosis, can decrease AMH levels even at a young age.
• Genetics: Apart from medical history, genetics also play a role in a woman having low AMH levels. Some can be born with a medical condition that affects the ovarian reserve at a quicker rate.
• Autoimmune disorders: Disorders like lupus, rheumatoid arthritis, and thyroid illnesses can cause inflammation, which in turn harms the ovarian function.
• Others: Other issues like PCOS and hormonal imbalance, chronic stress, mental health, Turner syndrome, and more, can also result in low AMH levels. At times, there may not be an underlying cause at all. This is known as idiopathic diminished ovarian reserve.

Signs of Low Egg Quality

While low egg quality does not usually produce clear physical symptoms, women should still be on the lookout for the following warning signs.

• Difficulty conceiving despite regular ovulation.
• Recurrent miscarriages.
• Failed or poor IVF outcomes.
• Irregular or absent menstrual cycles.
• Abnormal hormone levels.

Can Egg Quality Be Improved?

Strictly speaking, eggs cannot be replenished once they are lost. So, when we say “improving egg quality,” what we mean scientifically is enhancing the environment for follicular growth over the three to four months leading up to ovulation.

It takes around 90 to 120 days for an egg to reach maturity inside its follicle before being released. In this time frame, it is susceptible and responsive to fluctuations in oxidative stress, mitochondrial efficiency, hormonal communication, ovarian blood flow, nutrition, and inflammation. The ability to positively influence these factors over the 3-month period has led to significant improvements in fertilisation rates and live birth rates.

That is why most reproductive endocrinologists advise initiating a program aimed at enhancing egg quality no less than 3 months prior to an assisted reproductive procedure such as IVF, egg cryopreservation, or natural conception.

Supplements That Can Help Improve Egg Quality with Low AMH

Supplements can help improve egg quality in case of low AMH levels. These include coenzyme Q10 (CoQ10), DHEA (Dehydroepiandrosterone), Vitamin D, Vitamin C, Myo-Inositol, Melatonin, Omega-3 Fatty Acids (EPA and DHA), among others.

How Does Diet and Lifestyle Affect Egg Quality?

A healthy, balanced diet will always work in your favour for your well-being, regardless of the conditions affecting your body. For egg quality, a good diet helps modulate inflammation, hormone levels, and oxidative stress.

Try to focus on a diet that is rich in antioxidants. Suggested food items can include those rich in vitamin C (citrus, bell peppers), vitamin E (almonds, sunflower seeds), selenium (brazil nuts, eggs), and zinc (pumpkin seeds, legumes).

Apart from that, incorporate healthy fats in your diet, which can be obtained from fatty fish, olive oil, and avocados. Focus on protein quality, refrain from drinking alcohol, and cut down on highly processed and sugar-containing products.

In addition to eating well, your overall lifestyle plays an important role in improving egg quality, especially when AMH is low. Exercise regularly, participate in stress-management activities, stay hydrated, and make sure to get enough sleep.

You should also ensure that you stay away from toxins commonly found in the environment, such as BPA, phthalates, dioxins, and pesticides. These toxins can interfere with your hormone receptors and the mitochondrial function in oocytes.

The Effect of Stress on Egg Quality

Chronic psychological stress activates the hypothalamic-pituitary-adrenal (HPA) axis, which in turn increases cortisol levels in the body. Elevated cortisol levels adversely affect egg quality through oxidative stress. It is similar to biological rusting, which degrades the genetic material in eggs and ages cells.

Elevated cortisol reduces GnRH pulsatility in the hypothalamus, thereby muting hormonal messages (FSH and LH) required for egg maturation and ovulation. Tools like yoga or meditation can be extremely beneficial in managing the harmful stress levels, thus improving egg quality.

Does Impaired Egg Quality Affect Fertility?

In every menstrual cycle, the female body typically releases one mature egg during ovulation. The egg’s quality can be important in determining whether the fertilisation will be successful or not. It can also affect the chances of embryo development and pregnancy as a whole.

When egg quality is poor, women may experience lower fertility, failed IVF cycles, chromosomal abnormalities in embryos, and even miscarriages.

What Medical Treatments Are Available for Low AMH?

Although AMH levels may not be able to rise permanently, there are multiple methods through which women's fertility can be improved.

Treatment options for low AMH levels include:

• ICSI (Intracytoplasmic Sperm Injection): This is the ideal method that is employed to ensure that there is an increased probability of successful fertilisation. In ICSI, a single sperm is injected into a single egg.
• In Vitro Fertilisation (IVF) Treatment and Ovarian Stimulation: For patients with low AMH levels, IVF treatment and customised ovarian stimulation would be the most effective medical treatment.
• Freezing Your Eggs: Young women with decreasing AMH levels can benefit from egg freezing.
• Adjuvant DHEA & Growth Hormone: Adjuvant DHEA and Growth Hormone are used to improve poor ovarian response as well as egg quality in women with low AMH.
• Lifestyle: As noted earlier, maintaining a healthy lifestyle, such as proper eating, exercise, and avoiding smoking and excessive consumption of tobacco products is necessary.

On the other hand, to improve your egg quality, you should concentrate on controlling stress, nutrition, toxins, and weight issues. Some supplements and therapies can also assist in improving the quality of eggs. Such therapies consist of platelet-rich plasma therapy, ICSI with IVF, and egg donation.

Avoid This When Trying to Improve Egg Quality

Sometimes, the best treatment is prevention. Some things you should avoid while trying to improve egg quality include,

• Regular smoking as it contains tobacco,
• Excessive alcohol consumption, which can be associated with decreased fertility,
• BPA and plastics, as endocrine disruptors, can interfere with oocyte development,
• extreme caloric restriction, which impairs GnRH pulsatility and reduces follicular blood flow,
• And the intake of self-prescribed hormones or supplements, especially in high doses.

Conclusion

A diagnosis of low AMH levels may not be a definitive indicator of infertility. Similarly, while it signals a reduced ovarian reserve, it does not say much about the quality of the remaining eggs. While the total number of remaining eggs cannot be increased, the biological environment around them can be enhanced. By focusing on a nutrient-dense diet rich in antioxidants and low in unhealthy fats, managing chronic stress, making lifestyle changes, and avoiding environmental toxins, women can improve egg quality, even if AMH levels are not ideal. Supplements such as CoQ10, vitamin D, vitamin E, and others are also beneficial, as are medical interventions.

At the end of the day, improving egg quality mostly depends on proactive lifestyle management and targeted medical support. This ensures that the remaining eggs have high chances of healthy fertilisation and successful pregnancies.