Female fertility is dependent on a variety of factors and hormone level is the key one amongst these factors. There was a time when FSH or follicle stimulating hormone was regarded as the parameter for hormonal testing, but the latest in the hormonal brigade is Anti Mullerian Hormone, more popularly known as AMH. Medically, AMH is defined as a hormone produced by the follicles, during the primordial (earliest) stage of the follicular development.
AMH level has a direct influence on the fertility of a woman as it determines the number of follicles which will be produced by her ovaries, which in turn would determine her available egg supply. Low AMH level is responsible for a lesser number of ooytes (eggs) left with the woman and thus, reduced fertility. Therefore AMH level is now seen as a more reliable way of determining the fertility of a woman (in terms of egg quantity and quality) and then deciding the line of treatment that has to be followed in infertility cases.
Why is AMH testing considered more accurate than FSH testing?
A woman battling with infertility has to be evaluated extensively for finding out the exact reason of the condition. The latest amongst the diagnostic tests recommended for such patients is AMH testing. Currently, AMH testing has become a more accurate evaluation as compared to FSH testing. The reason is that FSH levels keep fluctuating during the menstrual cycle and can bring reliable results when checked only at particular time during the cycle.
Conversely, AMH levels remain steady during the entire menstrual cycle, which makes it a much more reliable parameter for judging the ovarian reserve of the woman. Moreover, AMH level is the direct indicator of the oocyte production, which means that it is a better way to check the fertility of the patient. In fact, a woman may have optimal FSH levels but still may not be able to conceive because her AMH is low.
Normal AMH level and chances of conception
AMH levels are tested using a blood test, which indicates the level of the hormone in the blood. This, in turn reflects the size of the ovarian reserve of the woman (in layman’s language, the size of the remaining egg supply in the ovaries of the woman). As the woman progresses in age, the AMH level starts falling as this reserve keeps on diminishing, which is the reason why fertility deteriorates in advanced maternal age.
For women under 35 years of age, the range between 1.5 ng/ml and 4.0 ng/ml is regarded as the normal AMH level. Those who are nearing menopause have very low AMH level, lesser than 0.5 ng/ml, a reading which indicates that their chances of conception are bleak. On the other hand, high readings of AMH (in the range of more than 4.0 ng/ml) show that the woman has numerous follicles of very small size, as seen in the patients of polycystic ovarian disease (PCOD).
What if your AMH level tests bring very low readings?
Typically, low AMH levels mean that the woman does not have many eggs available for conception. But there is no reason to panic when tests bring very low readings. When something like this happens, the specialist would first confirm the reports by recommending a repeat test from another lab and then some ultrasound scans. Another advanced blood test called clomid challenge test can also be done.
At the same time, it is important to be aware that low AMH levels do not necessarily mean that the woman cannot have a baby at all. Women of younger age have good chances in particular, if they get the right kind of treatment. A course of DHEA (dehydropiandrosterone) has shown proven results as a treatment option for women with poor ovarian reserve. But the medicine should not be taken by the patient without being assessed by an expert fertility specialist.
How do your AMH levels influence the chances of IVF success?
If you are a potential candidate for IVF, you need to know how your AMH levels are going to influence the chances of success of the procedure. Obviously, those with higher levels are likely to be better off because they will respond to the ovarian stimulation in a better manner and produce more eggs for retrieval. The greater the number of eggs retrieved, the better are the chances of getting that one high quality embryo which can be implanted in the uterus for a successful pregnancy to take place.
However, this in no way implies that women with low AMH levels should lose hope because they do have chances of getting pregnant naturally or with artificial reproductive techniques, however few these maybe. In fact, IVF gives such women better chances to conceive because it makes the optimal use of the few eggs which are left in their ovarian reserve. In cases where even IVF treatment brings no hope for such patients, donor eggs may be considered as the next option.
If you have very low AMH levels, you can still get pregnant with the right treatment. You can seek a free second opinion from Dr Manika Khanna, the IVF specialist in Delhi at Gaudium IVF centre.