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Anti-Mullerian Hormone (AMH) can be a telling sign of how fertile you are. But like all things related to pregnancy, there is usually more to the story if you look beneath the surface. In this article, we’re going to talk about AMH, how it can affect your pregnancy and what you can do to improve your chances of natural pregnancy.
AMH is a glycoprotein hormone that is produced by granulosa cells in ovarian follicles. These cells ‘stand guard’ around immature follicle cells. So, by measuring the amount of AMH secretion, doctors estimate how many immature follicles are remaining in a lady’s ovaries. The production of AMH is therefore indirectly correlated to fertility potential. AMH is a way to indirectly determine your egg count, and doctors use AMH as a test to determine how many future years a woman may remain fertile for.
AMH declines as one ages. While it is common for AMH to start declining around age 35, it is not uncommon for women in their late 30s to get pregnant, and there are cases of women becoming pregnant even in their 40s, even with lowered AMH levels.
AMH is measured in ng/mL, and, as previously mentioned, is associated with one’s fertility. Since AMH naturally declines over time, one must compare a lady’s AMH levels to a benchmark for her age group. Below is a graph of normal AMH levels by age group.
Ovarian reserve is defined as the number of eggs remaining in the ovaries. The levels of AMH in the blood correlates to the number of immature eggs in the body and hence AMH is used as a predictor of a woman’s ovarian or egg reserve. As with AMH, ovarian reserve also decreases over time. However, it does not determine the quality of the eggs.
The normal lab range for AMH is 2.2 -3.9 ng/ml. High levels of AMH is usually seen in women with PCOS and in certain ovarian tumors like granulosa cell tumors. Elevated levels of AMH may lead one to believe that a woman is more fertile, but this usually isn’t the case. You still only ovulate one egg per month. And you need only one egg to reproduce. AMH levels only matter when you need to undergo in vitro fertilization (IVF), as more the number of eggs retrieved, the greater the chances of conception success in IVF. Watch this video on how you can conceive naturally even with low AMH.
If your AMH is low, that doesn’t mean you can’t get pregnant. It is not unheard of for women to give birth in their late 30s or even their 40s, when AMH levels start to decline. Fertility clinics and doctors check AMH for a variety of reasons other than the ability to get pregnant, such as signs of PCOS (for high AMH levels) or menopause (for low AMH levels). A 2018 study showed that there was no association between low AMH and fertility, even when adjusting for age. Low AMH does not determine reproductive potential, and thus should not be a barrier to getting pregnant.
However, you should consult with a fertility specialist to rule out any differential diagnosis. Low AMH levels can be early signs of premature ovarian failure or menopause. While the chances to conceive aren’t zero, it can be significantly more difficult to become pregnant if you have low AMH levels.
Low AMH, like many conditions, can be treated. There are several root causes of low AMH: poor ovarian health, low thyroid hormone function, lack of proper nutrients in one’s diet, and chronic inflammation. Changing one’s diet, lifestyle, and use of supplements can help significantly overcome low AMH levels for natural pregnancy.
Several health conditions can affect the ovaries. Thankfully, these can be detected through comprehensive hormone testing. Conditions such as PCOS, luteal phase deficiency, premature ovarian insufficiency (POI), and poor egg quality assessed by AMH (although controversial) are some factors that lead to poor ovarian health. PCOS is the leading factor and can be present in cases where AMH is high. This is because PCOS leads the ovaries to produce an excessive number of androgens, which can disrupt fertility in women and keep many follicles in a half-mature stage, leading to high AMH in testing.
Luteal phase deficiency is defined as a shorter luteal phase (days from ovulation to bleeding), which is typically between 13-14 days, and can definitely create a less than ideal environment for pregnancy.
POI is defined as when your ovaries shut down hormone production at an early age (typically before 40). These conditions can often be improved by addressing the foundational health of the woman.
The communication between your hormones and brain (specifically the hypothalamus and pituitary glands) can affect hormone levels in the body and lead to low AMH. Low thyroid hormones can affect ovarian reserve measurements and fertility by affecting the process of follicular growth. Even when a woman’s thyroid lab reports are normal, subclinical hypothyroidism symptoms can lead to lower AMH. Natural ways to improve thyroid hormone function include adding vital nutrients like selenium, reducing body inflammation by switching to a sugar-free and gluten-free diet, and incorporating B Vitamins.
Some nutrients that are important to hormone signaling in addition to follicle and uterine lining development include iodine, iron, B vitamins, vitamin D, vitamin A, and zinc. You should take supplements after testing (we suggest you work with a good functional blood chemistry analyst for this) as randomly supplementing could cause an overload of nutrients which could also disrupt the pregnancy process. At Sepalika, we work with couples to optimize their nutrient status with precision level of vitamins and minerals.
Chronic inflammation can negatively affect your AMH levels, and there are multiple factors that can cause chronic inflammation, such as autoimmune conditions, food intolerance, inflammation from stress, blood sugar dysregulation, and more. To ensure proper AMH levels for fertility, you should also see if any of these conditions are present to determine what you and your doctor should discuss to keep AMH levels stable.
As with many conditions, the right fertility diet can help you treat low AMH. One of the biggest drivers for infertility is a diet high in sugar and refined carbohydrates. This prompts insulin production, which can drive inflammation, oxidative stress, and other conditions down the line that can not only affect your AMH levels but even the chances of you getting pregnant. A diet high in good fats and low in carbohydrates can help increase your chances at pregnancy and maintain healthy AMH levels.
It is also important to maintain a healthy lifestyle if you are pregnant. Increased physical activity is linked to hormonal balance and other aspects of improving fertility. Sometimes simple activities such as walking 30 minutes daily can have an immediate effect on not only your AMH levels but also your fertility overall. Stress has also been linked to complications during pregnancy, including low AMH levels.
Some supplements to consider for treating low AMH include vitamin D3, fish oil, CoQ10, and L-carnitine. Of course, these can also be found in many foods, so consider seeing a functional nutritionist to create a healthy diet plan if you plan to get pregnant. As with all things, these supplements should be taken in moderation—you don’t want to have an imbalance of nutrients and supplements if you plan to get pregnant.
At Sepalika, we work with women who experience low AMH and are struggling to conceive. Our focus in on building her foundational health via our Natural Fertility Program.