IVF and Ovarian Reserve: Maximizing Success with Low AMH
In vitro fertilization (IVF) has transformed the field of reproductive medicine, giving hope to infertile couples. However, for women with low anti-Mullerian hormone (AMH) levels, the IVF journey can be more difficult. AMH is a hormone produced by the ovaries, and low levels indicate a reduced ovarian reserve, which can affect IVF treatment success. But don’t worry, there are strategies to increase your chances of success even if you have low AMH.
What is the anti-Mullerian hormone (AMH)?
AMH is Anti-Mullerian Hormone, It is a glycoprotein hormone secreted by pre-entral follicles and small antral follicles of the ovary, which helps in their growth and differentiation. By the time of puberty, a woman has about 100,000 oocytes. 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.
Why is anti-Mullerian hormone (AMH) level important in IVF?
This hormone indicates the number of eggs still present in a woman’s ovaries. Women with low AMH levels typically produce fewer eggs during ovarian stimulation, reducing the number of embryos available for transfer. However, it is critical to remember that quality is more important than quantity. Even a few high-quality embryos can result in a successful pregnancy with the right approach.
Causes of Low AMH Levels
There are various factors that can cause low AMH levels like Age, endometriosis, genetic factors, auto-immune diseases, and cancer treatment. Excessive smoking, environmental causes like pollution, and obesity can also lead to low AMH levels.
|Age||AMH levels naturally decline with age. By the time a woman reaches her mid-30s, her AMH levels may be low enough to affect her fertility.|
|Medical conditions||Certain medical conditions, such as polycystic ovary syndrome (PCOS), premature ovarian insufficiency (POI), and endometriosis, can also cause low AMH levels.|
|Surgery||Ovarian surgery, such as that performed to remove ovarian cysts, can also damage the ovaries and lead to low AMH levels.|
|Diet and lifestyle||A poor diet, obesity, and excessive stress can also contribute to low AMH levels.|
|Genetics||In some cases, low AMH levels may be due to genetics.|
What are the symptoms of Low AMH levels?
The best way to recognize AMH level is a blood test, but there are some symptoms:
|Irregular menstrual cycles||May experience shorter or longer menstrual cycles than usual. They may also experience changes in the amount of blood flow or the duration of their periods. Women with low AMH may also have fewer periods in a year.|
|Difficulty conceiving||This is because AMH is an important predictor of ovarian reserve, and women with low AMH may have fewer eggs available for fertilization. As a result, women with low AMH may experience infertility or subfertility.|
|Early menopause||May experience early menopause which can have significant implications for their fertility and overall health.|
|Poor response to ovarian stimulation||Poor response to ovarian stimulation. It can make it difficult to achieve a successful pregnancy.|
|Elevated follicle-stimulating hormone (FSH) levels||The hormone that stimulates the ovaries to produce eggs is known as FSH. When AMH levels are low, the body may produce more FSH to compensate for the low ovarian reserve. High FSH levels can indicate that the ovaries are not responding well to hormonal signals, which can make it difficult for women to conceive.|
|Reduced egg quality||Low AMH levels can also be a sign of reduced egg quality. As women age, the quality of their eggs naturally declines, but women with low AMH levels may experience a more significant decline in egg quality at a younger age.|
|Increased risk of pregnancy complications||Low AMH levels can be a sign of reduced ovarian reserve, which can increase the risk of miscarriage, preterm birth, and other pregnancy complications. Women with low AMH levels may also have a higher risk of delivering a baby with a low birth weight.|
What is an AMH test?
An AMH test measures levels of anti-mullerian hormone, which is indicative of a person’s egg count. A provider may utilize an AMH test for the purpose of diagnosing an ovarian mass. The number of eggs you have does not accurately predict your fertility. An AMH test is a blood test that is straightforward and uncomplicated.
What does an AMH test tell you?
An AMH test provides information on the quantity of eggs and the potential aging of the ovaries. It is possible that it indicates a reduced timeframe for fertility.
An AMH test can also provide information about your response to injectable fertility drugs, which are used to stimulate the ovaries and prepare multiple eggs for in vitro fertilization (IVF).
What is a normal AMH level?
AMH levels can differ based on age. AMH levels in women begin to increase during adolescence and reach their highest point around the age of 25. Following that, AMH levels decrease naturally.
AMH levels are measured by providers in nanograms per milliliter (ng/mL). Experts debate how to define typical AMH levels, but these are general ranges:
- Average: Between 1.0 ng/mL to 3.0 ng/mL.
- Low: Under 1.0 ng/mL.
- Severely low: 0.4 ng/mL.
It should be noted that there may be slight variations in results between labs due to the use of different equipment.
What is a good AMH level for your age?
AMH level of 1.0-4.0 ng/mL is considered normal for women of reproductive age. However, the specific reference ranges may vary depending on the lab that performs the test.
For actual numbers, consider these estimates, which are on the lower side of the spectrum for each respective age:
|Age||Normal AMH Level (ng/mL)|
Higher AMH levels aren’t always a good thing. AMH may be high in some people with polycystic ovary syndrome (PCOS).
Low AMH Treatment
Treatment for low AMH levels typically focuses on addressing the underlying cause and improving ovarian function in order to increase the chances of pregnancy. Here are some key points about low AMH treatment:
|Fertility medications||Stimulate ovaries to produce more follicles.|
|IVF||Harvest eggs from ovaries, fertilize them in the lab and transfer embryos to the uterus.|
|IVF with donor eggs||Use donor eggs from younger women with higher AMH levels.|
|Lifestyle changes||Maintain a healthy weight, eat a balanced diet, and reduce stress.|
|Supplements||CoQ10, DHEA, myo-inositol.|
|Surgery||Remove ovarian cysts or tumors.|
How we increase the IVF success rate with low AMH?
One crucial step in maximizing success with low AMH is to consult with a fertility specialist who has experience in treating patients with diminished ovarian reserve. These specialists can tailor the IVF protocol to your specific needs, taking into account your AMH levels and other relevant factors. They may recommend individualized stimulation protocols, such as using higher doses of fertility medications or longer duration of stimulation, to optimize follicle development.
Another important consideration is the use of additional techniques during IVF, such as preimplantation genetic testing (PGT). PGT can screen embryos for chromosomal abnormalities before transfer, increasing the chances of implantation and reducing the risk of miscarriage. This is particularly valuable for women with low AMH, as it helps to identify the most viable embryos for transfer.
Furthermore, lifestyle modifications can also play a role in maximizing success with low AMH. It is essential to maintain a healthy lifestyle by eating a balanced diet, exercising regularly, and managing stress. These factors can positively impact fertility outcomes and improve the chances of a successful IVF cycle.
Additionally, considering alternative treatment options, such as using donor eggs, can significantly increase the chances of success when dealing with low AMH. Donor eggs come from young, healthy women with optimal ovarian reserve, ensuring a higher probability of successful fertilization and implantation.
Lastly, it is crucial to approach the IVF journey with a positive mindset and emotional support. Dealing with fertility challenges can be emotionally draining, but having a strong support system can make a significant difference. Seek out counseling, join support groups, or connect with others who have gone through similar experiences. Remember, you are not alone in this journey.
In conclusion, low AMH levels do not necessarily mean the end of the road for couples trying to conceive through IVF. With the right approach, tailored treatment protocols, and the support of a skilled fertility specialist, success is still attainable. By maximizing the quality of embryos, considering additional techniques, adopting a healthy lifestyle, and exploring alternative options, couples can increase their chances of a successful IVF cycle. Stay positive, stay informed, and never lose hope.
If you require additional information, please feel free to contact our knowledgeable team.
Freour, T., Masson, D., Dessolle, L., Allaoua, D., Dejoie, T., Mirallie, S., … & Barriere, P. (2012). Ovarian reserve and in vitro fertilization cycles outcome according to women smoking status and stimulation regimen. Archives of gynecology and obstetrics, 285, 1177-1182.
Tremellen, K. P., Kolo, M., Gilmore, A., & Lekamge, D. N. (2005). Anti‐müllerian hormone as a marker of ovarian reserve. Australian and New Zealand Journal of Obstetrics and Gynaecology, 45(1), 20-24.