If you’ve been going through infertility treatments, you have likely been bombarded with a number of acronyms from your fertility specialist (i.e. FSH, IUI, LH, ICSI etc.) and while they all have their importance and we should all do our best to understand what they mean, there is one acronym you should take the time to learn, if you haven’t already.
What is the AMH Test?
AMH or anti-mullerian hormone, is a hormone secreted in the granulosa cells of follicles and is fast becoming the “go to” measurement for ovarian reserve. A simple blood test is all that is needed to measure your AMH level and many clinics will include it when you get your regular Day 3 blood-work. AMH also correlates to the antral follicle count (AFC) which is another method of determining a woman’s fertility potential. If you haven’t been asked to do an AMH test, ask your doctor if it is something you should do.
Why Should You Get Your AMH Level Tested?
Getting your AMH level can help you and your partner decide what the best course of action may be for your fertility situation. For example, say you get your levels tested and they are in the optimal range, this may allow you to hold off on going right into IVF and to perhaps try less invasive procedures such as IUI or trying naturally. Your AMH level will also help determine how well (or not so well) you will respond to any stimulating medications (a high AMH will generally respond well to follicle stimulating medications). On the other side, receiving a low AMH number can be difficult to take but it will make your plan that much more clear rather than wasting months of your time trying methods that have a low success rate. Some specialists speculate that in the future, women in their twenties will test their AMH to ensure they have time to pursue a career before having children. Those with low AMH levels may consider having a family earlier in an attempt to avoid difficulties conceiving.
FSH vs AMH: Which is Better?
In the past (and still), most fertility clinics will do a Day 3 blood test to test the FSH levels of females along with other hormones related to fertility. Your FSH number can indicate how hard your body is working to produce and grow follicles…a high number (above 10 or 12 depending on the clinic) indicates that your body is working extra hard to produce follicles and may be a sign that your fertile potential is decreasing. A low FSH (below 10) should indicate that your body is still responding well to its own internal hormones and may indicate a higher fertility potential.
However, there are some problems with the FSH test. For example, the FSH levels of females fluctuate throughout the menstrual cycle and can vary from month to month, which is why most clinics attempt to do the test on day 3 of the menstrual cycle. In addition to that, estrogen may suppress a high FSH level into a normal range, creating an inaccurate result…and wasted time doing treatments that may not work.
An AMH test is ideal as levels are consistent throughout the cycle so you don’t have to wait until day 3 to do one. In Ontario (where I practise), you have to pay out of pocket to get the results of this test but the cost is usually under $200.
AMH levels vary and are dependent on age and the presence of certain conditions (i.e. PCOS – I know of clients who have had an AMH level over 90 pmol/L). It is important to note that two different units of measurement are used so when you receive your AMH results, so be sure to get the unit it was measured in or else you may be very confused.
Here is a chart* outlining the two different measurements as well as the ranges.
Ovarian Fertility Potential
|Optimal Fertility||28.6 – 48.5||4.0 – 6.8|
|Satisfactory Fertility||15.7 – 28.6||2.2 – 4.0|
|Low Fertility||2.2 – 15.7||0.3 – 2.2|
|Very Low / undetectable||0.0 – 2.2||0.0 – 0.3|
|High Level||> 48.5||> 6.8|
My AMH is Really Low, Should I Stop Trying?
Don`t get me wrong, AMH testing is not the best test ever…it`s simply the best we have at the moment for measuring ovarian reserve and the likelihood of your ovaries responding to medication. Much like any other test processed in a lab, mistakes can be made and tests sometimes need to be performed twice to ensure reliability. The following article looked at women with low AMH levels and still found that pregnancy was a good possibility! Read Here. Don`t let a low AMH take away your hope of having a family…there is still a reasonable chance that a pregnancy can occur.
What is Age Specific AMH?
Age specific AMH is a way of factoring in the age of the individual in relation to their AMH level. For example, an average AMH for a 22 year old will be different then an average AMH for a 42 year old. To think that a 42 year old should have an AMH like a 22 year old is not logical. Researchers are working on a method of factoring in age when examining AMH levels. Read more here…
Can I Raise My AMH Naturally?
AMH levels can be hard to change (much like it is hard to stop the aging process) but certain research indicates that the following factors may play a role. Don’t expect your AMH to skyrocket but following the advice of a natural healthcare practitioner with experience in fertility would be a wise addition to any fertility treatments you may be considering.
Specific vitamins have been connected to a higher AMH level. In the following study, those suffering from a vitamin D deficiency where significantly more like to suffer from a low AMH compared to those without vitamin D deficiency. Read study here. It is interesting to note that in this study, AMH levels decreased by 18% depending on the season (i.e. winter months) and these effects were mitigated with the supplementation of vitamin D. For my clients in Canada, this is important news and is a big reason why I encourage all of my clients to take a dose of 4000IU per day of vitamin D in the winter months.
Supplementing with DHEA is also showing a lot of promise for those with low AMH. Please talk to your fertility specialist about supplementing with DHEA as taking this on your own is not recommended. Read this article for more information about DHEA and low ovarian reserve. There are saliva tests available which is a non-invasive way to measure your DHEA levels. Once you know your levels, you can then consider a DHEA supplement. Click on the following link for more information about DHEA saliva tests.
Also, diet may play a role. In one study, it was seen that AMH levels were lower in women suffering from Crohn`s disease compared to a control. Since Crohn`s disease can reduce the amount of nutrients absorbed, one can hypothesize that a nutrient dense diet (perhaps with the help of supplements) may provide the optimum environment for an AMH level to rise. This connection may be a bit of a leap, but maintaining a proper diet certainly will not hurt. Read the study here.
Certain diseases like Lupus can also lower AMH levels. Read study here. Since Lupus is an inflammatory condition, one may again hypothesize that reducing systemic inflammation may also help rise AMH levels. Acupuncture is an effective therapy to reduce inflammation and would be ideal in cases where inflammation exist. Clearly, more research needs to be done in this area.
Cigarette smoking has been shown to decrease AMH levels compared to a control…yet another reason to stop smoking (do we really need more reasons?). Read study here.
As a practitioner of Traditional Chinese Medicine and a Nutritional Consultant, I encourage regular acupuncture, Chinese herbs and a solid diet and supplement regime. Currently, there are not a lot of studies examining acupuncture and Chinese herbs and their effects on AMH levels but I believe that they contribute to the best possible health of an individual, resulting in an optimal AMH. Talk to a fertility acupuncturist and see if Chinese herbs and acupuncture are right for you.
In conclusion, if you are getting involved in fertility treatments and you have not been offered the chance to do an AMH test, ask your specialist if it is right for you. After all, it`s an inexpensive way to get a much clearer picture of what your ovarian reserve may be. The result of this test will certainly help you make better informed decisions for you and your future family.