What do Low AMH levels mean?

What is AMH?

We are born with a large (1-2 million) but finite amount of eggs. By the time of our first period, this decreases to half a million eggs. So, if a woman has 12 periods a year for 40 years (before menopause), and roughly one egg is released in each period, that means approximately 480 eggs are released. So what happens to the rest of the millions of eggs? Well, in each cycle a group of these potential ‘egg’s (fluid-filled sacs known as follicles) are present, but only one manages to completely mature into an egg and release itself into the womb (for fertilisation). And therefore, the rest of these eggs dissolve, and a new set of eggs are used during the next cycle.

Anti-Mullerian Hormone (AMH), is released from these follicles as they are developing. It is found in the blood and can tell you whether you have the average number of eggs in your ovaries for your age (ovarian reserve). Age is the greatest determiner of ovarian reserve; as we get older we have fewer eggs, and the quality of these eggs are also lower due to the increased risk of genetic errors. Other factors include genetics, environmental factors, cancer treatment etc.

What are the benefits of AMH testing?

As we reach menopause, we have little or no eggs i.e. low ovarian reserve. AMH can tell us if our levels are in line with the expected level for our age, and whether we are likely to reach menopause at the average age. If tested regularly, a trend can be assessed to see if it is declining at an alarming rate. This is indicative of premature ovarian failure or premature menopause. 

Additionally, for those who are considering egg freezing, AMH level can inform on how many eggs can be frozen in one cycle (based on our ovarian reserve). If considering in-vitro fertilisation (IVF), AMH can be useful to predict your chances of success. Knowing your AMH level can help you have a realistic expectation of your chances of success (before spending time and money on treatment).

Can I still get pregnant with low AMH levels?

Low AMH levels do not cause infertility. You can have a reduced egg reserve and still ovulate every month regularly. Although the chances of fertilisation are reduced as you have fewer eggs (in quantity and quality), you may still be able to release an egg; it only takes one healthy egg to fall pregnant. If struggling to conceive naturally, some medications can help to stimulate the eggs to mature and be released.

What does the test not tell me?

As with all tests, there are some drawbacks. Firstly, the test gives information on the quantity of the eggs, but not the quality. The quality of the eggs is important as reduced quality can increase the risk of genetic problems to your baby, like Down’s Syndrome. The older you conceive, the higher the risk of genetic problems. 

The AMH test only gives the value as a snapshot in time. Many environmental factors like alcohol and diet can affect your AMH level, which is why we recommend repeating your level over time.

What can I do to boost my AMH?

Several studies have shown that women with lower Vitamin D uptake have lower AMH levels. (1) Vitamin D potentially increases the quality of the eggs. (2) Obtaining the daily Vitamin D requirements is often difficult through diet alone, therefore the most effective method is through sunlight, by being outdoors or taking an oral Vitamin D tablet. For further details: have a read of the advice provided by NHS Vitamin D – NHS.

Besides increasing nutritional intake, the body must be able to absorb it effectively. Some conditions, especially gastrointestinal conditions such as Crohn’s and Coeliac disease can decrease nutrient absorption and potentially decrease AMH. (3) Therefore if you have such conditions it may benefit to seek support to try to ensure it is under control. 

If you do have low AMH levels: 

• • • You may wish to consider repeating your test in 3-6 months to see the extent of the decline.
    • Plan for children earlier. 
    • Consider egg freezing if you don’t wish to conceive soon. 

If you would like more support, you can speak to our doctors at Zonas or visit your GP. 

References:

1. 1. Jukic AMZ, Steiner AZ, Baird DD. Association between serum 25-hydroxyvitamin D and ovarian reserve in premenopausal women. Menopause. 2015 Mar;22(3):312–6.
   2. ‌Dabrowski F, Grzechocinska B, Wielgos M. The Role of Vitamin D in Reproductive Health—A Trojan Horse or the Golden Fleece? Nutrients. 2015 May 29;7(6):4139–53.
   3. Senates E, Colak Y, Erdem ED, Yesil A, Coskunpinar E, Altunöz ME, et al. Sa1242 Serum Anti-MüLlerian Hormone Levels are Lower in Reproductive-Age Women With Crohn’s Disease Compared to Healthy Control Women. Gastroenterology. 2012 May;142(5):S-252.

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