Does a Low AMH Level Indicate Infertility?

Getting Pregnant with Low AMH: The Fertile HeartTM Ovum Approach

by Julia Indichova 

AMH, another acronym that has been showing up as a troublesome marker linked to infertility, stands for anti-mullerian hormone, a substance produced by granulosa cells at the earliest (primordial) stage of ovarian follicle development.  Since the number of these primordial cells is linked to the number of follicles that ultimately grow into viable, fertilizable eggs, AMH levels are used to assess a woman's remaining egg supply.  

For inspiration on how to best protect yourself from a current confusion among fertility experts and fertility patients struggling to navigate the landmines of an increasingly more bewildering and competitive industry, my blog post Low AMH, High FSH and Anything in Between, might be a useful read.

To illustrate just how misleading the low AMH levels diagnosis can be for both patient and fertility specialists, consider a case history of M. a 28 year old young woman with AMH levels of 0.6ng/ml, who has given birth only six months earlier, and began trying to have a second child.  Since her first child was conceived with Clomid, she tried that route again but this time was a "poor responder" to ovulation induction by Clomid. As a result she was advised to more on to IUI, and consider donor egg as her most reliable option of getting pregnant.  Luckily M. began to do her own thinking and  research and found a better way.

What this young woman ultimately needed was time to rest and nourish her body after an eventful pregnancy and birth; to engage with the "inner Orphans" that showed up with her first experience of motherhood and to trust that, although her first conception was  induced with Clomid, in didn't need to happen  the same way the second time around.

The current, most common measurement of AMH levels is as follows:

High                  Over 3.0ng/ml

Normal               Over 1.0ng/ml

Low Normal       0.7-0.9ng/ml

Very low              0.3-0.6ng/ml

Very low              Less than 0.3ng/ml

The above values are then used to predict chances of conception with higher numbers indicating a larger ovarian reserve and as such a more promising odds of pregnancy and lower levels mirroring poor reserve and poor chances of conception.

Opinions among reproductive endocrinologists range from fertility doctors who claim that AMH level is the the gold standard test (Dr. Angeline Beltsos, a guest teacher at the Fertile Heart Guest Teacher Series is one of those specialits)  for measuring ovarian reserve, to fertility experts who feel that AMH testing is mostly useful in assessing a woman's response to ovarian stimulation for IVF, where retrieving more eggs is thought to increase chances of pregnancy.

Based on the last 20 years of counseling, research, and a review of several studies on the subject, I once again suspect that the conventional interpretation of AMH levels as they relate to conception rates is highly misleading.   It is, as with high FSH levels, drawing conclusions that are sending countless women into a tailspin over their rapidly decreasing odds of getting pregnant and pressuring them into treatments that may not only harm their remaining ovarian reserve but rob them of the opportunity to assess the root cause of their "infertility."

The two studies cited below report interesting findings which to me, validate my own thoughts and experience with AMH levels. The first study reports the case of two women with very low AMH levels who became pregnant spontaneously, the second study compared AMH leves of two groups of healthy women: obese and non-obese.  The obese women, whose overall level of health and organ function may have been compromised, had lower AMH levels.    

The current scope of information about AMH is simply inadequate in predicting conception.  AMH levels though they may reflect a diminishing size of the remaining ovarian pool, are also a reflection of ovarian function related to a woman's overall level of health. Since AMH levels  do not reflect egg quality, when the overall level of the woman's health, be it physical, emotional or spiritual  (the "holy human loaf")  increases,  chances of pregnancy increase.

Timothée Fraisse, Victoria Ibecheole, Isabelle Streuli, Paul Bischof, Dominique de Ziegler: Undetectable serum anti-Müllerian hormone levels and occurrence of ongoing pregnancy. Fertility and Sterility, Volume 89, Issue 3, March 2008, Pages 723.e9-723.e11

Ellen W. Freeman Ph.D. Clarisa R. Gracia M.D. Mary D. Sammerl Sc.D. Hui lin M.S, . Lony Chong-Leong Lim Ph.D., Jerome F. Strauss III M.D. Ph.D. 

Association of anti-mullerian hormone levels with obesity in late reproductive-age women. Ferti and Sterility Vol. 87, Issue 1, January 2007, Pages 101-106

The Possibility of a  Holistic Approach to ART, Audio Recording of Guest Teacher Conference with Dr. Angeline N. Beltsos, M.D is the Medical Director of FCI's River North Center in Chicago, IL

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