THE AMH TEST
WHAT YOU REALLY NEED TO KNOW

A low AMH test can be devastating news for hopeful parents. Medical literature shows that falling pregnant naturally, or with IVF, has very low success rates.

AMH levels do not define “possible or impossible.”

AMH levels for IVF stimulating drugs need to be 1.96 ng/ml and above to work well, AMH levels do not need to be so high for natural pregnancies. IVF requires higher AMH levels to gather as many eggs as possible. Your ovaries only need enough AMH to grow one good one per month. Women with AMH 0.42 ng/ml can fall pregnant without IVF.

TWO THINGS TO CONSIDER WHEN LOOKING AT AMH VALUES.
  • What are the normal AMH levels for your age?
  • What are good AMH levels for IVF stimulating drugs?
Low AMH levels have everything to do with IVF success rates
Not how many eggs you have left.

Females at birth can have one million eggs that can undergo folliculogenesis. This is where primordial follicles get turned into mature follicles. By the age of 38 a woman has 25000 eggs left and by 51 only 1000. On average 10 – 15 primordial follicles start growing in each ovary every month. Every month only one egg is ovulated. Your ovaries recycle the others eggs as waste and are not used again. At this rate, a woman at 51 with 1000 eggs would still have 50 months of ovulation left. However, this is not how it works.

Three hormones recruit the growing the egg.

AMH (anti-mullerian hormone) grows the primordial follicle into a semi-mature follicle. Inhibin-B and Follicular Stimulating Hormone (FSH) takes over and grows the best follicles.

It is the health of your hormones that matter most to fertility. The amount of eggs you have left is an expression of how well your hormones are working. Hormone manipulation is the cornerstone of IVF treatment.Proper hormone balance is the key to natural fertility. Dr Scott Martin.
So what does this have to do with IVF and low AMH?

Your body grows 20 – 30 eggs per menstrual cycle and selects one for ovulation. IVF stimulating drugs attempt to raise 10 or more for fertilization. If your body has a hard time producing one good quality egg, how can it be expected to grow 10?

AMH and FSH tests help IVF doctors determine how well IVF stimulating drugs are likely to work. The reference ranges of these AMH and FSH tests are for IVF outcomes. You do not need the same levels of AMH and FSH for a natural pregnancy. The research done by Advanced Fertility Solutions shows you can have AMH levels of 0.42 ng/ml and fall pregnant. Information on the minimum level of AMH necessary to fall pregnant is not available. This is for two reasons. Many women we tested with low AMH levels fell pregnant, and their AMH level not tested again. The results recorded are from women who had subsequent blood serum AMH levels tested again at 3-month intervals of treatment.

Conclusions
  • Women choose IVF to overcome pregnancy problems.
  • IVF stimulating drugs place demands on the body that a natural pregnancy does not.
  • IVF stimulating drugs lower AMH levels.
  • As we age, we decline and so do AMH levels and the ability to have babies.
  • The information published on AMH levels in scientific literature relates to the effectiveness ​of IVF drugs, not natural pregnancies.
  • Falling pregnant with below optimal AMH levels is possible.
  • Most of the time you need help.
AMH levels decline steadily with age. Reversing prematurely low AMH levels is realistic.
Natural fertility rates in women by age group.
Percentages of IVF success rates per age. This chart is not representative of women with low AMH levels. Success rates of IVF are lower than natural pregnancy rates from 43 years onward.
LOW AMH SCORES MEAN DIFFERENT THINGS DEPENDING ON WHO IS TALKING.

Information about proper AMH levels relates to the effectiveness of IVF stimulating drugs. It does not necessarily correlate to natural pregnancy AMH levels. Low AMH levels do not mean you can’t fall pregnant. It makes it harder, but not impossible.

The chart below was taken from a 2010 study and IVF success rates on women with low AMH levels. It compares full-term pregnancies (LB), adds chromosomal abnormalities (TOP) and miscarriages (SAB).

Success rates of women with low AMH per value. LB = Live Births. SAB = Spontaneous Miscarriages. TOP = Terminated pregnancies due to chromosomal abnormalities
Diminished Ovarian Reserve and Poor Ovarian Responders.

Low AMH levels in IVF means that stimulating drugs are less likely to work. This is where Diminished Ovarian Reserve and Poor Ovarian Responder terms come in. If you have Diminished Ovarian Reserve (DOR) or are a Poor Ovarian Responders (POR), you will also have low AMH levels.

Let’s look at what these terms mean and how they affect you.

LOR/DOR – Low or Diminished Ovarian Reserve.
It sounds like it has to do with how many eggs you have left in your ovaries, but it doesn’t. It has to do with how many eggs your ovaries are currently producing on their own. Eggs growing in your ovaries are called the Antral Follicles. Measuring them is called the Antral Follicle Count (AFC).

Antral Follicular Counts compared with IVF stimulation expectations.
The Antral Follicle Count

Your Antral Follicle Count is measured via ultrasound. Measuring the AFC pushes the limits of ultrasound technology. This is due to the resolution capabilities of the ultrasound compared with the small size of these follicles. 22-35 Antral Follicles over both ovaries is optimal. Lower than that and IVF stimulating drugs are not as effective. In this case, you can be defined as a “Poor Ovarian Responder” (POR).

POR – Poor Ovarian Responder.

This is where you have undergone a stimulated cycle of IVF and produced less than five eggs. If you have Diminished Ovarian Reserve, you are likely to be a Poor Ovarian Responder.

Low AMH – Low Anti-Mullerian Hormone.

AMH underpins the production of your antral follicle count. The lower your AMH, the fewer follicles you produce. This relates to Diminished Ovarian Reserve. If you have DOR the harder it is for IVF drugs to work. You become a POR.

WHAT YOU NEED TO KNOW

Low AMH Facts
10 Low AMH Facts You Need to Know

Low AMH is no the end to your fertility; it is a problem to overcome. Low AMH levels are a big problem for IVF…they don’t have to be your problem too. Here are 10 things you should know right now.

Why your Doctor says you can't get pregnant
Why does your doctor say, “You can’t raise AMH levels?”

Visiting your doctor is the first port of call for most people when sick. Today the idea that “If my doctor can’t help me, then no-one can,” is standard for many people.

Low AMH & IVF: Your Essential Guide Pt 1.
Low AMH & IVF: Your Essential Guide Pt 1

A low AMH diagnosis is a real blow for hopeful parents. Medical treatments to help these women are expensive with very low success rates. Current comprehension on the issue is poorly understood by both patients and doctors alike.

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