When woman is told that her AMH is too low, her fertility is compromised and she can never have children, this is terrifying and her world must be collapsed.
What is AMH? AMH is short for anti-mullerian hormone. It is a substance made by small follicles called antral follicles in women’s ovaries. These follicles are in early stage of follicle development. Once the follicles grow bigger than 8 mm, they no longer produce AMH. The more small follicles are developing, the higher AMH levels are. Vice versa, the higher AMH means there are more small follicles in the ovaries. Since AMH is produced only in smaller follicles and its blood levels are constant, AMH has been used to measure the size of the pool of growing follicles in women. AMH blood levels reflect the size of the remaining egg supply.
If your AMH is low, there are less small follicles developing in the ovaries which means your egg supply is poor. With increasing women’s age, the size of their pool of remaining small follicles decreases. Low AMH reflects poor egg supply and less chance to get pregnant naturally. Low AMH value means poor response to ovarian stimulation and low IVF success rate. Some women may have problems of recruitment and development of follicles; in this case they have fewer follicles developed and their AMH tends to be low. Women with low AMH would have less chance to have good quality eggs. So they may have difficulty to conceive naturally. Women with low AMH level are likely to have poor response to ovarian stimulation for IVF and have fewer eggs retrieved. This reduces their chance to conceive via IVF.
Low AMH is caused by recruitment problem in follicles development. All eggs in women’s ovaries are at rest, they must be recruited for developing and maturing. If the follicles do not recruit enough there are less follicles developing. For example, in the case of premature ovary failure (POF) the ovary function is damaged and there are less follicles developing, AMH value is low in women with POF. What is important factor in follicle recruitment and development? Ovary microcirculation is the key factor in follicle recruitment and development. Good circulation helps bring nutrients to the follicles and take away the wastes produced in the follicles.
AMH is associated with menopause
Anti-mullerian hormone (AMH) is produced in small antral follicles. AMH concentration reflects ovarian aging. Can it be used to predict age at menopause (AMP)? If AMH falls below a critical threshold which corresponds to follicle depletion, will this leads to menopause? There was a large population study to investigate the relationship between AMH and AMP. In this study, there were 27563 women participated. AMH was measured in these women who attended fertility clinics. They found that the critical AMH threshold vary among women; AMH became undetectable about 5 years before the occurrence of menopause. This indicates that declining population average of AMH is associated with menopause.
Does low AMH means that you cannot have children? It is certainly not. Some women with immeasurable AMH still can get pregnant.
Do you need help if your AMH is low? Yes, though low AMH does not mean that you cannot conceive at all, you chance to conceive naturally and via IVF is indeed very low. Some women are trying for years without success.
Women with higher AMH values will tend to have better response to ovarian stimulation for IVF and have more eggs retrieved. Generally, having more eggs with IVF has a higher success rate via IVF.
If AMH is higher than normal, is this a good thing? No, if AMH is higher than normal, it may not be good either. For example, women with polycystic ovary syndrome, often have high AMH. There are problems in later stage of follicle development in this case. There are problems to select dominant follicles to develop and ovulate eventually. So the follicles stay in the small size and produce more AMH. In both cases, the quality of follicles is likely to be poor and this may cause problem of conceiving.
Contraception pills decrease AMH levels
Women are trying not to get pregnant by different approaches. Contraception pills are one of the popular options. When taking the pills, does anyone ever think how the pills work? Are there any side effects of the pills? Recently Kallio S et al from Oulu University Finland studied the effect of combined contraception on antimulleria hormone (AMH) levels. There were 54 healthy women completed the study. They received combined contraception treatment for 9 weeks. The drugs were given by oral, transdermal and vaginal methods. Blood samples were taken before, at 5 weeks and 9 weeks of the treatments. They found that AMH, FSH, inhibin B, LH and E2 levels had decreased significantly in all study groups after 9 weeks of treatment. Significant reductions were already detected after 5 weeks use of combined contraceptives. This study suggests that the decrease of AMH during the use of all combined contraceptives indicates that follicle development is arrested independently of administration route of the contraceptives.
There was another study by Bentzen JG et al from Copenhagen University Hospital who compared ovarian reserve parameters between users and non-users of hormonal contraception. They compared the AMH value, the antral follicle count (AFC) and the ovarian volume in 228 users versus 504 non-users of hormonal contraception. Users of hormonal contraception had 29.8% lower AMH concentration, 30.4% lower AFC and 42.2% lower ovarian volume than non-users. AFC in all follicle size was lower in user than non-user of hormonal contraception. These findings were more pronounced with increasing duration of hormonal contraception. No dose-response relation was found.
Does acupuncture help follicles recruitment and development? During the follicle recruitment and development process, ovarian blood supply is the key. Good blood supply to follicles helps the process, because this helps provide enough nutrition to follicles and take away waste produced in the follicles. As we have already known that acupuncture improves ovarian blood flow to produce high quality of follicles and increased numbers of follicles and egg quality. This will improve the chance of conceivingnaturally or via IVF.
Case report: Low AMH, conceived naturally with the help of acupuncture
When you heard that your AMH is low and it is not possible to conceive with your own eggs. Is this really that bad? Actually a low AMH value does not necessarily mean that you cannot get pregnant naturally. You need to make more efforts than anyone else. Here is a story that a woman got pregnant naturally with low AMH. This is a simple story, but you can see the efforts that she made under the pressure of uncertainty and the lack of time.
There was a 39 year old woman who had been trying to conceive for a year without success. A fertility test found out that her AMH was very low (below 1) which was nearly immeasurable. She was determined to get pregnant naturally. She had paid attention to her diet and made sure her diet was healthy. She also had moderate exercise to keep healthy. By chance she found out that acupuncture could help and she kept going to acupuncture treatments on weekly basis. She made great effort and really believed herself. By the end of six months of acupuncture treatments, she got pregnant naturally.
Kallio S et al Fertil Steril (2013) 99:1305-10
Bentzen JG et al Reprod Biomed Online (2012) 25: 612-9
Dolleman M et al J Clin Endocrinol Metab (2013) 98:1946-53
Welcome to my blog
Acupuncture specialist for Fertility, Facial rejuvenation, Pain relief.
Based at Kensington and Harley Street Central London.Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Over 25 year research and clinical experiences
Doctor who is passionate about acupuncture
I love what I do, I am good at it and I am always there for my patients. If you come and see me, you will know why I am standing out.
This blog is to introduce latest development and research of acupuncture and offer a chance of awareness of more treatment options for your condition. The blog is for information purpose only.
- My specialised areas include fertility, facial rejuvenation, acne, various pain conditions, chronic fatigue, menopause and hormone regulation with acupuncture treatment.
Practice contact for appointments and addresses
Kensington: for appointments at Anamaya center Kensington (Mondays, Tuesdays, Thursdays, Fridays, Saturdays) please call at 02030110355 or email at email@example.com
Address: 1 Adam and Eve Mews, Kensington, London W8 6UG
2 min walk from High Street Kensington underground stationHarley Street: for appointments at Harley Street (Wednesdays) please call ALO clinic at 02076368845 or email at firstname.lastname@example.orgAddressSuite 3 Harmont House20 Harley Street, London W1G 9PH5 min walk from Oxford Circus underground stationMy background: I became a qualified medical doctor 25 years ago in Western medicine in China and was well trained in Western medicine together with Chinese medicine in the best Medical University in Beijing, China. Particularly I was trained with Dr Zheren Xuan--famous orthopedics expert and founder of soft tissue surgery in China. Furthermore I had training in dermatology and oral and maxilofacial surgery in China. I am dedicated to treat patients with acupuncture and am recognized as one of the world leading acupuncture specialists.
I obtained a PhD degree in the University of Leeds in the UK.
I had post doctoral training and worked as a senior researcher in St George's hospital, London, UK.
I had frequently presented my research findings in the top international conferences in the field.
I have many publications including ebooks and articles.
I have many year clinical experiences. Over the years of practicing, I have developed unique treatment approaches for infertility, skin aging, acne, vulvodynia, neck pain, headache, migraine, shoulder pain, back pain, fatigue, hot flushes, Parkison's disease etc to achieve best treatment results. My devotion and skills are highly praised by my patients. These are examples that my patients say.
- My books--Know your ovary to get pregnant
- ----------------Get pregnant fast naturally
- ----------------Facial Aging, Facial Rejuvenation Acupuncture
- ---------------Acne treatment with acupuncture
- ---------------Vulvodynia, is vulval pain in your mind?
- ---------------Energy, fatigue and acupuncture
- ---------------Headaches, Neck pain and Shoulder pain