Low AMH: What it Means for Fertility & Treatment Options

Low AMH: What it Means for Fertility

Low AMH indicates that you have fewer developing follicles in your ovaries compared to what's typically expected for your age. This condition suggests reduced ovarian reserve, meaning fewer eggs are available each month for potential fertilisation. However, it's essential to understand that low AMH primarily measures egg quantity rather than quality.

Low AMH can shorten your reproductive window and may affect how your ovaries respond to fertility medications during treatments like IVF. However, many women with low AMH levels successfully conceive both naturally and through assisted reproductive technologies.

Understanding Low AMH and Fertility

According to MedlinePlus, AMH levels naturally decline with age, reflecting the gradual decrease in your egg supply from birth to menopause. This hormone serves as a reliable indicator of how your ovaries might respond to fertility treatments, particularly during IVF procedures.

Fertility specialists use AMH testing alongside other assessments, including antral follicle count through ultrasound and follicle-stimulating hormone (FSH) levels, to create a comprehensive overview of your reproductive health. It's important to note that AMH doesn't directly measure your ability to conceive naturally or predict pregnancy outcomes. A woman with low AMH but regular periods may still ovulate normally and conceive without assistance.

Causes of Low AMH

• Natural ageing and ovarian ageing: AMH decreases steadily with age as your egg pool diminishes, eventually reaching undetectable levels at menopause.
• Genetic conditions: Some women inherit fewer eggs than average for their age due to genetic factors or primary ovarian insufficiency.
• Previous ovarian surgery: Procedures like cyst removal or endometrioma surgery can damage ovarian tissue and lower AMH.
• Cancer treatment: Chemotherapy and pelvic radiation can destroy ovarian follicles, significantly reducing AMH and fertility potential.
• Autoimmune diseases: Certain autoimmune conditions that target ovarian tissue may deplete follicles and lower AMH levels.
• Endometriosis: When it involves the ovaries, this condition can reduce ovarian reserve, particularly after repeated surgeries.
• Environmental factors: Smoking and exposure to certain toxins are associated with faster ovarian ageing.
• Turner syndrome: This genetic condition affects ovarian development and function.
• PCOS/PCOD: Although typically linked to high AMH, some women with these conditions may experience lower levels over time.

Signs and Symptoms of Low AMH

• Difficulty conceiving after trying for several months.
• Shortened menstrual cycles (lasting 21–24 days instead of the typical 28).
• Irregular or skipped periods in some cases.
• Hot flashes or night sweats if associated with early ovarian insufficiency.
• Poor response to fertility medications during previous treatment cycles.
• Vaginal dryness or other menopausal-like symptoms.

It's worth noting that many women with low AMH but regular periods experience no symptoms at all, making routine testing important for those planning pregnancy.

How Low AMH Affects Fertility

Low AMH levels primarily impact fertility by reducing the number of eggs available each menstrual cycle. With fewer developing follicles, your monthly chances of conception may decrease compared to women with normal AMH levels for their age.

In fertility treatments, particularly IVF, low AMH often correlates with fewer eggs retrieved during the collection process. This can mean fewer embryos available for transfer and potentially lower success rates per cycle. However, it's crucial to remember that pregnancy success depends on egg quality, not just quantity.

The relationship between low AMH and natural conception is complex. Some women with low AMH but regular periods continue to ovulate quality eggs and conceive without assistance. Your reproductive endocrinologist can help interpret your AMH levels alongside other fertility factors to provide personalised guidance.

How is AMH Tested?

The Anti-Müllerian Hormone (AMH) test involves a simple blood draw that can be performed on any day of your menstrual cycle, as AMH levels remain relatively stable throughout the month. A healthcare professional will take a blood sample from a vein in your arm using a small needle; after the needle is inserted, a small amount of blood is collected into a test tube or vial, and you may feel a brief sting.

The process usually takes less than five minutes, and a small bandage is placed over the area afterward. The blood sample is then analysed in a laboratory to measure AMH concentration, typically reported in nanograms per millilitre (ng/mL).

Treatment Options for Low AMH

• Timed intercourse: If you're young with normal menstrual cycles, your doctor may recommend optimising natural conception timing.
• Ovulation induction: Medications can stimulate egg development and improve the chances of conception each cycle.
• Intrauterine insemination (IUI): Combined with ovulation drugs, this can increase pregnancy likelihood.
• In vitro fertilisation (IVF): Customised stimulation protocols can maximise egg retrieval from reduced reserves.
• Egg freezing: Preserving current eggs for future use before further decline occurs.
• Donor eggs: When ovarian reserve is severely diminished, using younger donor eggs can significantly improve success rates.
• Fertility preservation: Storing eggs or embryos before cancer treatment or other interventions.
• Lifestyle optimisation: Supporting overall reproductive health through diet, exercise, and stress management.

The choice of low AMH treatment depends on your age, your partner's fertility status, how low your AMH levels are, and your personal preferences regarding treatment intensity and timeline.

How Lifestyle Changes Can Improve AMH Levels

• Stop smoking immediately: Tobacco accelerates ovarian ageing and further reduces AMH levels.
• Maintain a healthy weight: Balanced nutrition and regular exercise support hormonal balance.
• Manage chronic conditions: Proper treatment of endometriosis, thyroid disorders, and autoimmune diseases.
• Limit exposure to toxins: Avoid pesticides, heavy metals, and industrial chemicals when possible.
• Prioritise sleep quality: Adequate rest supports hormone production and overall health.
• Manage stress effectively: Chronic stress can impact reproductive hormones.

IVF and Egg Freezing for Low AMH

• Customised stimulation protocols help maximise egg retrieval in cases of reduced ovarian reserve.
• Higher medication doses may be necessary to achieve an adequate ovarian response.
• Multiple retrieval cycles may be recommended to collect an adequate number of eggs for treatment.
• Realistic expectations about egg numbers and potential cycle cancellations.
• Focus on egg quality rather than quantity, particularly in younger women.
• Preimplantation genetic testing (PGT) may be considered to identify chromosomally healthy embryos.

Should I Consider Donor Eggs for Low AMH?

Donor eggs may be recommended when AMH levels are extremely low, previous IVF cycles have yielded poor results, or age-related factors compound ovarian reserve concerns. Using eggs from younger donors typically offers significantly higher pregnancy and live birth rates compared to using your own eggs with severely diminished reserves.

This decision involves careful consideration of emotional, financial, and ethical factors. Counselling with fertility specialists and mental health professionals can help you navigate these complex choices and determine the best path forward for your family-building goals.

Can Low AMH Levels Be Reversed?

Currently, no proven medical treatments can restore ovarian reserve or significantly increase AMH levels once follicles are lost. Rather than focusing on reversing low AMH, current medical approaches emphasise accurate assessment, timely intervention, and optimised treatment strategies. Working with experienced fertility specialists ensures you receive evidence-based care tailored to your specific situation and reproductive goals.

Low AMH and Pregnancy: What You Should Know

Having low AMH doesn't mean pregnancy is impossible, but it may require more strategic planning and potentially medical assistance. Many women with low AMH conceive naturally, especially if they're younger and have no other fertility issues. The key is avoiding delays in trying to conceive and seeking medical advice if pregnancy doesn’t occur within six months.

Research indicates that pregnancy outcomes in women with low AMH who do conceive are generally similar to those with normal AMH levels. The main challenge is achieving pregnancy rather than maintaining it once established.

Age and Low AMH: A Critical Factor

Age significantly influences how strongly low AMH levels impact your fertility prospects. A 25-year-old with low AMH may have better chances of conception than a 35-year-old with normal AMH levels because egg quality remains more important than quantity for successful pregnancy outcomes.

Women under 35 with low AMH often have more time to try various treatments, while those over 35 may need to consider more aggressive interventions sooner. This is why age-specific counselling about fertility options is crucial for making informed decisions about your reproductive timeline.

How Low AMH Affects IVF Success Rates

Low AMH treatment through IVF typically involves individualized stimulation protocols to maximize egg retrieval from a diminished ovarian reserve. Success rates depend heavily on age, with younger women maintaining better pregnancy chances despite low AMH. Studies show that while egg numbers may be reduced, embryo quality and implantation rates can remain reasonable, particularly under age 35.

Low AMH Treatment Options: Success Rates

• Natural conception: 20-30% chance if under 35 and ovulating regularly; drops sharply after 40.
• IUI with ovulation induction: 10-20% per cycle, depending on age and other factors.
• IVF with own eggs: 15–30% per cycle, varying significantly with age and AMH severity.
• Donor egg IVF: 60-70% per cycle, largely independent of the recipient's AMH levels.
• Multiple IVF cycles: Cumulative 50-70% after 3 cycles with own eggs.

What Happens After IVF for Low AMH?

Following IVF treatment for low AMH, your care team monitors pregnancy progress closely. Successful pregnancies from IVF with low AMH generally progress normally, though some women may require additional hormonal support during early pregnancy.

If initial IVF cycles are unsuccessful, your fertility specialist will review the response and adjust protocols for future attempts. This might involve changing medications, or timing or considering alternative approaches like donor eggs.

Can You Still Get Pregnant with Low AMH?

Yes, pregnancy with low AMH is absolutely possible. While it may require more time, strategic planning, or medical intervention, many women with low AMH levels successfully conceive and deliver healthy babies.

The key is receiving proper evaluation, understanding your individual prognosis, and pursuing appropriate treatment without unnecessary delay. Early intervention often improves outcomes, particularly when age is a factor alongside low AMH.

Conclusion

Understanding low AMH and its implications for fertility empowers you to make informed decisions about your reproductive journey. While low AMH levels present challenges, they're not an insurmountable obstacle to parenthood. The key lies in early assessment, appropriate treatment selection, and maintaining realistic but hopeful expectations throughout the process.

Whether through natural conception, fertility treatments, or alternative family-building options, many paths to parenthood remain available. Working with experienced healthcare providers who understand the complexities of low AMH ensures you receive personalised care tailored to your unique circumstances.

At Metropolis Healthcare, we understand the importance of accurate, timely diagnostic testing in your fertility journey. Our comprehensive portfolio of over 4,000 tests includes specialised hormone assessments and fertility panels designed to provide the precise information you and your healthcare provider need. With convenient home sample collection available across our extensive network of 10,000+ touchpoints throughout India, accessing reliable AMH testing and other fertility-related diagnostics has never been easier.

FAQs

What is considered a low AMH level?

AMH levels below 1.0 ng/mL are generally considered low, though interpretation varies with age and individual circumstances, and specialist evaluation is required.

Can low AMH be treated with natural remedies?

While lifestyle improvements support overall reproductive health, no natural remedies have proven effective for significantly increasing AMH levels.

How can I improve my AMH levels?

• Focus on maintaining optimal overall health through proper nutrition and exercise
• Avoid smoking and limit alcohol consumption
• Manage stress effectively through relaxation techniques
• Consider appropriate supplements after consulting your healthcare provider

At what age does AMH start to decrease?

AMH begins declining from birth but becomes more noticeable after age 30, with accelerated decrease typically occurring after age 35.

What is the role of AMH in IVF?

AMH helps predict ovarian response to stimulation medications and guides treatment protocol selection for optimal egg retrieval outcomes.

References
1.    https://www.who.int/news-room/fact-sheets/detail/infertility
2.    https://medlineplus.gov/lab-tests/anti-mullerian-hormone-test/
3.    https://my.clevelandclinic.org/health/diagnostics/22681-anti-mullerian-hormone-test
4.    https://academic.oup.com/jcem/article/105/11/3361/5890022?login=false
5.    https://pmc.ncbi.nlm.nih.gov/articles/PMC4870438/