Low AMH: Should It Really Insight Fear? Understanding Its Relevance to Fertility
What Is AMH?
Anti-Müllerian Hormone (AMH) is a protein produced by antral follicles in the ovaries. These are the follicles that are visible during an ultrasound scan. While AMH is commonly referred to as a marker of "ovarian reserve," it doesn’t directly measure the total number of eggs left in the primordial pool. Instead, it reflects the activity of follicles and only tells us (with your antral follicle count), how many eggs are likely to be retrieved in an IVF egg collection.
Why Does Low AMH Cause So Much Anxiety?
Low AMH levels are often misunderstood. While it’s true that AMH naturally declines with age and is associated with menopause, it is not an accurate predictor of when menopause will occur. Research shows that AMH levels only become a meaningful indicator of imminent menopause when they drop to very low levels, such as 0.02 ng/mL or less. Many women will have a low AMH their whole lives and not know it, but feel incredibly anxious when they get a low AMH result!
Importantly:
Low AMH doesn’t mean menopause is around the corner. Many women with low AMH continue to ovulate and menstruate for years.
It doesn’t predict egg quality or natural fertility. Women with low AMH can still conceive naturally.
The Role of AMH in IVF
The fear surrounding low AMH is often amplified by NHS or private fertility clinic treatment thresholds. If your AMH falls below a certain level, you may not qualify for IVF that is NHS-funded, or even at some private clinics. This has led many women to believe that low AMH equates to low fertility.
Here’s the truth:
AMH levels can affect the number of eggs retrieved during an IVF cycle, as lower levels often correlate with fewer antral follicles.
However, egg quality—a crucial factor for embryo development and implantation—is not determined by AMH. Women with low AMH who manage to retrieve eggs have the same chances of success per embryo transfer as those with higher AMH.
The primary challenge with low AMH in IVF is the reduced likelihood of collecting multiple eggs, which could limit the number of embryos available for transfer.
Can You Improve AMH Levels?
Yes, AMH levels can be influenced by various factors, including:
Inflammation:
Chronic inflammation from conditions like insulin resistance, poor liver function, or digestive issues can suppress AMH.
For example, women with Crohn’s disease often show lower AMH levels during active flare-ups, but these levels improve when the condition is in remission.
Infections:
Systemic infections, as well as vaginal or uterine microbiome imbalances, can impact AMH levels.
Nutrient Deficiencies:
Low levels of vitamin D, ferritin (iron stores), and melatonin (often linked to poor sleep) are known to affect ovarian health.
Circulation Issues:
Scar tissue or adhesions from previous abdominal surgeries, such as appendectomies, can restrict blood flow and lymph drainage to the ovaries and therefore AMH.
Techniques like womb massage and castor oil packs may help improve circulation in e.g. those with Endometriosis.
Recent Hormonal Changes:
AMH levels can drop temporarily after pregnancy, miscarriage, or even being on the contraceptive pill. It can take months for AMH to stabilise after these events.
Acute Illness or Stress:
Even short-term health events, such as a bout of COVID-19, can temporarily lower AMH.
What Low AMH Doesn’t Mean
Low AMH does not mean you’re infertile.
In fact, month-to-month natural fertility—your ability to conceive naturally—remains the same regardless of AMH levels.
Don’t Forget the Male Factor
Low AMH in women often overshadows male fertility considerations. However, male factor infertility contributes to nearly 50% of all infertility cases. A comprehensive male fertility workup should include:
Testicular ultrasound
Full semen analysis
Seminal microbiome testing
DNA fragmentation analysis
Trusted providers like Fertility Solutions or Andrology Solutions offer these tests.
The Bottom Line on AMH
AMH is a snapshot of your ovarian activity and reflects your body’s recent health. It’s not a fixed or stable number, as levels can fluctuate even within a single menstrual cycle. Instead of fixating on AMH, focus on optimising your overall health, addressing inflammation, improving nutrient levels, and enhancing circulation.
If you’re navigating fertility challenges or have concerns about your AMH levels, I can help you develop a tailored plan to support your reproductive health. Whether through acupuncture, nutrition, or personalised fertility coaching, we’ll work to enhance your chances of conceiving naturally or preparing for IVF.
Contact me today to learn more about your options.
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