Low AMH – Causes And Treatment

 

AMH is Anti-Mullerian Hormone, it is a glycoprotein hormone secreted by preantral follicles and small antral follicles of the ovary, which helps in their growth and differentiation. When she reaches around 40 years of age there are less than 10000 eggs remaining. By the time she reaches menopause, there are no eggs in her body.

It defines the potential of a woman to get pregnant. It can be tested on any day of the menstrual cycle. The other tests of ovarian reserve like FSH have to be done on a specific day of the period i.e., Day 1 or day 2 of the menstrual cycle.

The normal AMH levels are between 1-3.5 ng/ml. Any AMH level above 2ng/ml is considered a good value, and a level <1ng/ml is low. Levels less than 0.3ng/ml are considered very low. Women with Polycystic ovaries have an AMH level > 3.5ng/ml.

Causes of Low AMH: -Age, endometriosis, genetic factor, auto-immune diseases, and cancer treatment contribute to low AMH levels. Women taking birth control pills and who have received lupron injections may show falsely low AMH levels.

Treatment of Low AMH: - Usually there is no specific treatment for low AMH, however with life lifestyle management, vitamins, and supplements pregnancy outcomes may be improved.

Lifestyle: The person must have a proper nutritious diet, low in calories and high in protein. Diet should contain fresh fruits and vegetables. There should be adequate exercise at least 40 min daily.   Smoking and alcohol must be completely avoided.

Vitamin-D, Co-enzyme Q10, folic acid, and fish oil supplementation has been associated with better outcomes in women with low AMH. DHEA (Dehydroepiandrosterone)and testosterone supplementation also are associated with a better response.

The decision regarding which treatment modality is best for these women should be extensively discussed. All options natural method, IUI (intra-uterine insemination), IVF treatment in Udaipur(In-Vitro fertilization), Donor Eggs, Surrogacy, and adoption must be discussed.

 The doctor evaluation will also include an ultrasound of the ovaries to count her follicles and co-relayed with the AMH values. A realistic chance of pregnancy is discussed.  

The various protocol to stimulate the ovaries in women with low AMH is agonist, antagonist, and duostim. Dustin is still experimental.  

Read Blog: IVF (Invitro fertilization or IVF) Dr. Alka (Best IVF Specialist in Udaipur, Rajasthan)

It is very important to know the fertility pyramid. This means that the total no. of embryos is not the same as the total no. of follicles.

We must no ignore the male partner. He also needs to have a good diet and exercise regularly. He must stop smoking and alcohol. Zinc and L-carnitine supplementation may be useful.

There are some experimental ways to treat women with low AMH. They are intraovarian platelet-rich plasma infusion, stem cell treatment, mitochondrial transfer, and ovarian transplantation.  

At Advanced Fertility and Gyne Centre we have had reasonable success with women with low AMH.   Older women with AMH fare much worse than younger women. Antagonists and long protocol work equally well. Embryo pooling is helpful.  

Finally, it is important to know when to stop treatment or go ahead with other options like egg donation or adoption.