When my doctor told me I may be infertile, I told her she was lying. It wasn't a great day, to be honest. It was a gut reaction, and turns out that she wasn't lying. I even got my own copy of the blood test results. My AMH levels were low, she said. AMH is an indication of ovarian reserve and mine waI was at the end of my fertility season, she said.
It was definitely a shock and took me a while to understand what she was saying. There's a hormone in your blood that can be used to give an indication of how fertile you are, called AMH. AMH stands for Anti-müllerian hormone, which is secreted in the granulosa cells of follicles. Follicles are the cavities in your ovaries that eggs grow in. Your AMH levels starts high, when you're at your most fertile age and as you get older, declines as your ovarian reserve does. It's measured with a simple blood test, typically included with the regular Day 3 blood work if you're doing an IVF round.
To confirm, AMH typically correlates to your antral follicle count. That is to say, how many antral follicles you have on Day 3 (measured with an ultra sound). It's another method to confirm your fertility potential.
It used to be that FSH (Follicle Stimulating Hormone) was used to gauge ovarian reserve, but FSH fluctuates a lot throughout your cycle as it's used to kickstart your ovaries into action. AMH on the other hand is a fairly stable measure that doesn't have the same fluctuation from month to month and is considered a much more accurate guide.
What my not-lying doctor was trying to say was that at age 30, I had an AMH level of 6.4. I had a low ovarian reserve, also known as diminished ovarian reserve, or low fertility. Essentially, I don't have that many eggs left.
AVERAGE AMH LEVELS (across all ages, pmol/L)
Optimal Fertility: 40.04 - 67.9
Satisfactory Fertility: 21.98 - 40.04
Low Fertility: 3.08 - 21.97
Very Low/Undetectable Fertility: 0.0 - 3.07
AVERAGE AMH LEVEL BY AGE (pmol/L)
Age 25 - 24
Age 30 - 17.5
Age 35 - 10
Age 40 - 5
Age 45 - 2.5
Source: Lister Fertility Clinic
At first I thought low ovarian reserve was the be all and end all of our fertility journey. We're done before we even started - I was never having a baby. That's actually not the case - I still have some eggs left even if not very many, and we were reassured that pregnancy was still possible. Having this information was helpful for planning our IVF cycles as AMH can help predict your response to stimulant drugs during IVF.
If you have a low ovarian reserve (like me) you might need some help developing more eggs and require a higher dose of stimulants. If you have a high ovarian reserve, you may have a very high level of fertility and require a much lower dosage of stimulants.
Because AMH is just a hormone, it's unlikely that increasing the hormone levels will also raise your ovarian reserve. In saying that, there are a few interesting cases that do effect AMH level.
- Vitamin D deficiency is linked with falsely low AMH. In fact, it was found that AMH levels decreased by 18% depending on the season, and these effects were mitigated with the supplementation of Vitamin D. If you're concerned, get your Vitamin D levels checked.
- DHEA has been shown to help with women with low AMH. DHEA (Dehydroepiandrosterone) is a hormone produced by the adrenal glands and ovaries and is involved in the production testosterone and estrogen. As DHEA levels tend to decline naturally with age, it's thought that supplementation can help with fertility.
Source (If it helps, I used Fertinatal DHEA, available here on Amazon)
- Smoking has been shown to decrease AMH levels.
- Occasionally there can be minor fluctuations within the bounds of lab error. If you're unsure, insist on a second test.
I will say this though - learning about my low AMH levels kicked off this sense of urgency. I didn't have that many eggs left and I was only losing more as each month ticked by. Because of this we got into IVF right away and we didn't necessarily take a considered approach.
What I'd say now is if you're faced with a low AMH level, even though it feels like it's best to rush - take some time and consider your situation and what you want to do. We've been a year in our IVF journey and my AMH levels haven't changed. We've learnt that taking a month or two to research and understand our situation and emotionally come to terms with low fertility levels is an option, even if it doesn't feel like it.
As always, I'm not a professional or a doctor - my experience is just that, my experience. I've done an awful lot of reading and research which I'm happy to share. If you do have concerns about AMH, talk to your doctor.