What Happens If AMH Is Low?

What Is Anti-Müllerian Hormone (AMH) And What Is Its Importance?

AMH indicates ovarian reserve and can help determine the number of eggs in the ovaries. AMH levels remain fairly stable through the menstrual cycle, unlike other hormones, which will fluctuate. AMH is an effective marker for assessing fertility. Higher AMH levels can indicate a good ovarian reserve and a larger number of remaining eggs, while lower AMH levels indicate a smaller number of eggs. This is why AMH testing is widely used as part of evaluating fertility and before procedures such as IVF.

What Happens If AMH Is Low?

Low AMH indicates a reduced number of remaining eggs in your ovaries. The chances of natural conception may decrease as your age increases. Low AMH can also have an impact on the way your ovaries respond to fertility treatments. Women who have low AMH may produce fewer eggs during ovarian stimulation and therefore have lower chances of success with procedures like IVF. However, low AMH does not directly indicate egg quality; it only indicates that there are fewer eggs. Low AMH may mean that you may have:

• Decrease in the number of eggs available for fertilisation
• Shorter window of time in which you can reproduce
• Potentially harder to conceive naturally
• Lower response to fertility medications

What Are the Causes of Low AMH Levels?

A few things can lead to low AMH levels. Ageing is the main contributor, as the number of stored eggs naturally decreases over time, but that's not the only factor. Other factors causing low AMH levels include:

• AMH levels decline gradually with age and may decline more rapidly after 35.
• Some women may have fewer eggs due to genetic defects.
• Chemotherapy and radiation can impact ovarian reserves.
• Partial or complete removal of an ovary may result in a decreased ability to conceive.
• Autoimmune diseases can affect the ovaries' capacity to function normally.

Knowing what causes low AMH can help to get appropriate treatment and plan a family.

What Are the Symptoms of Low AMH?

Since AMH indicates the number of eggs in the ovaries, low AMH levels typically do not show clear or direct symptoms. Most women find out that they have low AMH during routine hormonal evaluations or fertility testing.

• Women with low AMH may experience irregular and unpredictable menstrual cycles.
• Women with low AMH may have a shorter time between menstrual cycles. Instead of being exactly 28 days apart, their menstrual cycles may occur within 21–24-day intervals.
• Women will occasionally have a 'lighter' period or a much heavier than normal flow, commonly due to hormonal fluctuations associated with ovarian reserve.
• Women with low AMH levels will often experience menopause type symptoms such as hot flashes, sweating at night, dryness, and mood changes.

In many instances, no recognisable symptoms are present; thus, low AMH has been termed a “silent” predictor of decreased fertility. Many women with low AMH levels may have regular cycles and feel just fine; therefore, many do not show any signs of low AMH.

As there are no identifiable signs of low AMH, bloodwork is the best way to assess AMH levels along with other hormones. If fertility is a concern due to age or irregular cycles, then AMH testing, along with other hormonal testing, can be ordered to get a complete assessment of the ovarian reserve or reproductive health.

Diagnosis of Low AMH

AMH, or Anti-Müllerian hormone, is a key marker of ovarian reserve. A simple blood test confirms the level of AMH in a woman’s body to determine whether the ovarian reserve is normal, low, or extremely low. Because the AMH level is relatively stable throughout the menstrual cycle, this test can be performed at any point during the cycle. Lower AMH levels generally indicate fewer eggs remaining in the ovaries of a woman.

An ultrasound will often accompany the AMH test to complete an antral follicle count (AFC). This test counts the small follicles in the ovaries at the beginning of the menstrual cycle. The AFC will typically be used to assess ovarian reserve in women. If the AFC is low, this usually indicates a low AMH value, which can help the physician determine how to proceed with treatment options.

Doctors will also check the level of follicle-stimulating hormone (FSH) on day 2 or 3 of the menstrual cycle to evaluate ovarian function. If FSH is elevated, then it is likely that the ovaries are not responding to the body’s signals, which is to be expected in a woman with low AMH. The FSH test result can also help the physician determine how to manage treatment for a woman with a low AMH value.

In addition to FSH, estradiol is tested, as abnormal values of either hormone can affect FSH levels and lead to inaccurate results. Thus, testing for both FSH and E2 will provide a comprehensive assessment of the patient's hormonal balance and overall ovarian reproductive function.

A physician may request a comprehensive fertility evaluation, including the woman’s and the man’s medical histories, menstrual history, ultrasound studies, and the male partner’s fertility status. This aims to get a proper understanding of different aspects of a woman’s reproductive functions and evaluate other reasons that can affect fertility or conception.

What Are the Treatment Options for Low AMH Levels?

Low AMH cannot be cured or directly increased; however, the goal of treatment is to improve your chances of conception as much as possible, with what ovarian reserve you have at this time. Each case is different, and what works for one woman may not work for another. The factors affecting the available treatment options include age, overall health, and the degree of reduced ovarian reserves.

Doctors may prescribe fertility medications to stimulate the ovaries to produce eggs. The use of fertility medications facilitates the growth of multiple follicles within one cycle, increasing the chances of ovulation and fertilisation. However, it is important to note that women with diminished ovarian reserve may have a reduced response rate to the medications prescribed.

IVF is the most effective treatment option available for women with low AMH levels. The ovaries are stimulated to produce eggs, and these eggs will then be retrieved, fertilised in the laboratory, and placed into the uterus. While only a limited number of eggs are retrieved, you may still have a good chance of success if your eggs are of good quality.

Women diagnosed with low Anti-Müllerian Hormone (AMH) at a young age may benefit from egg freezing to preserve their remaining eggs for future use if they do not wish to use them right away.

If a woman's ovarian reserve is extremely low and she does not have success with other treatments, she may be advised to use donor eggs for the chance of pregnancy. The reason for this is that donor eggs are typically from young and healthy women, so there is a high success rate of using donor eggs.

Lifestyle modifications may not substantially increase AMH; however, they can support a woman's overall reproductive health. Lifestyle changes can help the body respond better to fertility treatments and can include: consuming a healthy diet, reducing stress, avoiding smoking, and managing body weight.

Receiving an early diagnosis and starting treatment as soon as possible is very important in managing low AMH. If a woman sees her fertility specialist early, she can better plan for future fertility treatment and will likely have a higher chance of conceiving successfully.

Does A Low AMH Level Indicate Infertility?

Most couples believe that low AMH indicates infertility. It is a false misconception. Low AMH levels only indicate the remaining ovarian reserve (egg supply), but they do not mean that you cannot get pregnant. There have been many successful pregnancies with low AMH levels. The chances of a woman getting pregnant depend on multiple factors, such as the quality of her eggs, the condition of her partner's sperm, and her overall reproductive health. Low AMH levels are an indicator of reduced ovarian reserve and may suggest a narrower fertility window.

When Should You Visit a Fertility Specialist?

It is recommended to visit a fertility specialist if:

• You are trying to conceive for over 6-12 months
• If you are above the age of 35
• You are having irregular periods
• You have low AMH levels

Early consultation with a fertility specialist can help in proper planning and timely treatment of infertility.

Conclusion

Low AMH levels indicate a woman's reduced ovarian reserve. A reduced reserve can directly impact a woman's fertility by decreasing the number of eggs available for fertilisation. Just because a woman has low AMH does not indicate that pregnancy is impossible. Many women with low AMH levels have achieved successful pregnancies with the assistance of medical intervention, and many women have successfully conceived naturally, with minimal intervention. Every woman with a low level of AMH should look for treatment options, and if needed, see a fertility doctor.