Anti-Mullerian hormone (AMH) is a hormone that is produced predominantly by granulosa cells of the growing follicles within the ovary.
These follicles are the smallest, earliest stages of growth and development of the follicle or egg.
Your AMH level is therefore a reflection of your growing or actively maturing follicles which can be correlated with your follicle count or ovarian reserve.
In healthy women, their AMH level increases until early adulthood, peaks at 25 years of age, and then slowly declines until after menopause (at which time there are no more growing follicles).
If you have low AMH, your ‘ovarian reserve’ is low – in other words, you have fewer growing follicles. But it is important to know that this has nothing to do with your egg quality. Your AMH is all about egg quantity, not egg quality.
According to research, AMH levels are ‘not a good predictor of female fertility’. ‘AMH measurement is only useful as an indirect marker of the remaining female fertile years in those women who have premature ovarian failure.’
Among women aged 30-44, without a history of infertility who had been trying to conceive for 3 months or less…..findings do not support the use of AMH levels to assess natural fertility with these characteristics’.
So, even though your AMH levels naturally start to decrease with age, you should still be able to conceive. The issue is that there are fewer follicles to recruit, so it might become more difficult the older you get.
Fertility specialists are interested in measuring AMH levels as it helps them decide which assisted reproductive technique, ovarian stimulation protocol and medication dosage they will use for the IVF cycle.
It has nothing whatsoever to do with predicting the quality of your eggs during egg retrieval
In other words, if you are undergoing IVF, your specialist would need to work out if you have enough eggs for a successful outcome, and also how well your ovaries will respond to being stimulated with medication.
In these cases, women with low AMH levels might need their stimulation medication adjusted accordingly. And women with high AMH levels, as in PCOS, would need to be very carefully monitored.
Yes! Your AMH levels can change during various times during your cycle, and under certain conditions.
As you’ve seen in the above examples, genetic and epigenetic (lifestyle) factors can influence your AMH levels.
There are many avenues I use in my practice to help women improve their health status and hence their AMH levels.
Even though there are no medical options available for improving AMH status, Naturopathically there are many.
As a Naturopathic Fertility Practitioner, I consider AMH levels as just one part of a much bigger picture when making my overall assessment of each patient.
I need to consider many factors when giving advice and making my treatment decisions.
I hope I have given you a better understanding of AMH and how I approach it from a Naturopathic perspective.
And I also hope I’ve given you more confidence in your fertility prospects regardless of what your levels are.
Joanne Lipinski – Fertility Naturopath Melbourne