Today we explore one of the most important tools in the fertility trade: the AMH Test!

What is an AMH Test?

Anti-Müllerian Hormone or AMH is a protein hormone secreted by the cells of the developing antral and pre-antral follicles (or egg sacks) in the ovaries, although AMH is made in the reproductive tissues of both males and females. Once secreted from these growing follicles, AMH stops more immature ones from getting recruited into the maturation process, so that not all the eggs mature all at the same time.  The level of AMH in the blood can help doctors estimate the number of follicles inside the ovaries, and therefore, the woman’s egg count (also known as the Ovarian Reserve.)

An AMH test gives you some insight into the remaining quantity of eggs and number of fertile years you may have, but it cannot say much about the quality of those eggs. The great thing is that egg quality can be improved with lifestyle choices. To best interpret your results, you should compare your own level with other women of the same age with your doctor or fertility specialist.

AMH has been used as an ovarian reserve marker since 2002– it can be used in conjunction with specialized ultrasound to give the most accurate picture of your future fertility. The ultrasound assesses the number of follicles between 2mm and 10mm.

AMH levels are remarkably stable and are only minimally affected by the menstrual cycle, oral contraception, or pregnancy. As a result, blood samples can be taken at any time throughout the cycle. 

Essentially, an AMH test will help answer a few vital questions related to your fertility journey:

• Do you have enough eggs for a successful IVF?
• Should you change your diet and lifestyle to get pregnant?
• Are there any undetected health issues intervening with a successful pregnancy?

How is an AMH test done?

An AMH is a very simple laboratory blood test that measures your hormone levels. It requires 3 ml of blood and, as AMH levels do not change during the menstrual cycle, the test can be performed on any day. Reports come back usually within a couple of hours up to a couple of days depending on the clinic or hospital where you’re taking the test. 

If your local hospital and private clinics don’t offer this testing, you may have to travel to another city or to another clinic to do the test. If you have to do this, keep in mind that you don’t have to undergo any special treatment or following a special diet regimen in order to be prepared for the test. However, if you want to schedule other infertility treatments, make sure to coordinate your appointments with other treatments that are related to the days of the menstrual cycle.

You will be presented with a report indicating whether the levels of AMH are: Normal, Low or Raised. This reading, in conjunction with the Pelvic Morphology Scan, will give your doctor the information they need to discuss your options regarding future conception. No doctor referral is required to take an AMH test.  

When should I get an AMH test?

If you are on the journey to conceive, the AMH test is useful if:

• you have been trying to conceive for over six months, and want to check your ovarian reserve is appropriate for your age
• you are considering IVF or other fertility treatments, as low levels of AMH could indicate a potentially poor response to IVF. Conversely, a high level may indicate an exaggerated response to the IVF medication
• you have had chemotherapy or ovarian surgery and want to know if it has affected your future fertility
• you suspect an ovarian tumor
• you would like to conceive in the future, and just want to understand your current position

AMH tests may also be used to:

• Predict the start of menopause. It usually starts when a woman is around 50 years old.
• Find out the reason for early menopause
• Help find out the reason for amenorrhea, the lack of menstruation. It is most often diagnosed in girls who haven’t started menstruating by the age of 15 and in women who have missed several periods.
• Help diagnose polycystic ovary syndrome (PCOS), a hormonal disorder that is a common cause of female infertility, the inability to get pregnant
• Check infants with genitals that are not clearly identified as male or female
• Monitor women who have certain types of ovarian cancer

How much do they cost?

Generally under $100, although not covered by Medicare.

What if I have a low AMH?

If you have a low AMH level, indicating poor egg reserve, your GP may consider referring you to a fertility specialist for further explanation.

In healthy women, the Anti-Müllerian hormone levels initially increase until early adulthood, and then slowly decrease with increasing age until becoming undetectable. It happens approximately 5 years before menopause when the pool of growing follicles is exhausted.

The AMH level interpretation is given below, but don’t try to make any conclusions on your AMH levels yourself– leave it to your doctor.

Why do I have low AMH levels?

There are multiple factors that might be contributing to your low AMH. Here are some of them:

• Age. AMH naturally decreases as you get older. There might be a link between your fertility and age, as AMH starts decreasing after the age of 35.
• History of hormonal disorders and medical conditions related to the reproductive system also might affect your AMH levels.
• Women with a history of ovarian surgery due to endometriosis, ovarian cysts, or ovarian torsion, ectopic pregnancy, have a higher risk from low anti-Müllerian hormone level.
• Stress is one of the biggest negative influences on AMH. Women who are living under constant stress and mental pressure often find it hard to conceive until their stress levels reduce.
• Improper nutrition. Unhealthy diets saturated with fats and processed foods aren’t good for your AMH levels. Obesity also has a negative effect on AMH levels.  
• Vitamin deficiency, particularly vitamin D, is known to have a connection with fertility issues and AMH levels.

The most prominent factor that contributes to low AMH levels will be your age. As women age, the number of follicles/eggs available for reproduction gradually declines, and together, AMH levels decline with age. This change usually happens around the age of 35. Reproductive endocrinologists can assess how well a woman’s ovaries are functioning, by evaluating her AMH levels. Women with low AMH levels have a condition called diminished ovarian reserve (DOR). Women with low AMH have lower pregnancy chances (with or without IVF) than women with normal AMH at their age. With low AMH levels, fertility treatment must be carefully tailored to each patient’s ovarian reserve status (as well as other compounding factors) in order to be successful. 

Anything that disrupts the feedback cycle of follicular development and AMH secretion can cause low AMH. This can be due to an autoimmune attack on the ovaries (the patient’s own immune system attacking the ovaries), or it can be genetic. One of the more recent research findings at CHR was the involvement of the FMR1 gene in regulating how the ovarian reserve changes over time for each woman: Women with a particular type of FMR1 gene were more likely to develop DOR at a younger age. Depending on the cause of low AMH and DOR, CHR physicians develop different treatment approaches in order to maximize the chances of pregnancy with IVF for women with low AMH levels.

How can I raise my AMH levels?

If you were told by your doctor that you have lower AMH levels than those needed to achieve a successful pregnancy, you are basically told that your ovarian reserve isn’t high enough and that you may face problems with conceiving. A well-tailored IVF protocol should give you a better chance of getting pregnant. Still, there’s a lot you can do to boost your AMH levels.

Low AMH basically means that you have a low ovarian reserve. This is normal to some degree with the aging process, particularly over the age of 40. However, if you’re trying to conceive you should do everything you can to increase your AMH levels which will give you a better chance of getting pregnant. While no one can predict or put an exact number to how many eggs will you have available and what your account is right now, there is still a way to increase their quality and count. 

Here are a couple of ways for you to increase AMH levels naturally:

Vitamin D supplementation

Studies have shown that women with sufficient vitamin D were more likely to face Low AMH. You can boost your vitamin levels with supplementation or through a natural diet. You should still take a blood test to measure your vitamin D levels.

L-arginine supplementation

L-arginine supplementation is known to improve ovarian function. However, to make a difference with your ovarian functioning you should take 4 to 5 milligrams of this supplement. If you are getting treatment from any conditions like endometriosis, autoimmune disease, or infections, make sure to check if they’re affecting your ovarian functions.

Abdominal massage

Increasing circulation to ovaries is important to increase ovarian functioning. Abdominal massage can help with that.

Acupuncture and Acupressure

Homeopathic medicine can be helpful with ovarian function. You can also learn self-acupressure so that you can practice it at home without any additional costs. Acupressure will help increase circulation into your ovaries. Any acupuncture treatments, however, should only be done by a licensed acupuncturist.

Stress reduction

As you’re trying to conceive, you will have to get as much rest as possible. Allowing yourself more rest and taking better care of yourself, getting counseling, and pretty much do everything you can to de-stress will increase your AMH levels. You can refer to our previous pieces on healthy eating and meditation for even more tips!