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Low AMH - When to Worry


I get it, If you have been told you have Low AMH, then you will be worried.


No matter what I say.


But read on to get some advice about when to worry and what to do about it.


Just Starting to Try . . .


If you have only just started ttc, and found out that you have Low AMH, it could be a good thing.


This may come as a surprise as the world and his wife has such a dreadful opinion on the impact of Low AMH on fertility. However, research shows you are more likely to conceive quickly and easily with Low AMH than with Normal AMH (Steiner et al, 2017). Many of the people you know who conceived on their first month or two of trying would have had Low AMH.


How is this so? When ovaries are only growing a small number of follicles, they can potentially grow better quality follicles than ovaries that are growing a larger number of follicles. In my little black book of analogies, it's like expecting a Rolls Royce production line to produce a better quality car than a Ford Ka production line. Less, but better.


Low AMH and Been Trying for a While . . .


If you have found out you have Low AMH and been trying to conceive for several months (or even years), that is a different situation. If you are not conceiving quickly and easily with Low AMH, you need to figure out why. If nothing was 'wrong', you would have conceived by now.


So, if you have been trying to conceive for 4-6 months or longer, it is time to take a deep breath and dive into trying to work out what is going on and work out what you can do about it.


If you are over 40, I would shorten this down to 3 months (or ttc alongside starting to dig deeper).


If you are under 40 and anxious about your fertility, start to dig deeper alongside ttc.


What I would NOT recommend, is rushing into IVF on the account of Low AMH without taking the time to assess your health from a more holistic perspective. If there is something in the picture that is lowering AMH, it is likely to be having a significant impact on egg quality and potentially your ability to conceive and carry safely. Rushing into IVF with Low AMH is the last thing I would recommend - far too many couples come to us who have had unsuccessful IVF cycles with Low AMH.


The first thing to consider . . . . Sperm Health!


You could be one of those who would normally conceive easily and quickly, but you aren't because your partner's sperm is not up to scratch. This is more common than you would think. Because so many people assume that Low AMH causes infertility, they fail to take any indication of male fertility issues seriously, and we often find infections, varicocele and significant lifestyle factors have been overlooked.


Take a closer look at male fertility.

  • Run a semen analysis.

  • Consider running a semen microbiome test.

  • Consider running a sperm DNA fragmentation test.

  • Consider going to discuss sperm health with a fertility expert urologist or an expert holistic fertility support practitioner (like me).


Second thing to consider is your underlying health . . .


Many of these may not scream 'fertility' at you, but research shows that issues like these can have a significant impact on AMH. This means that these issues are having an impact on how many follicles survive the growth phase in the ovaries. This in turn shows how much these issues have an impact on follicle count and how much they impact fertility (if fewer follicles are surviving, those that do won't be as healthy as they have had to survive in difficult conditions):


  • Digestive health - IBS, IBD, Crohn's, Coeliac Disease etc


  • Sleep issues - are you getting good quality sleep, in bed asleep before 11pm on most nights?


  • Infection and Inflammation - systemic inflammation, inflammation or infection in the genito-urinary tract, BV (remember that around 30% of BV is asymptomatic!)


  • Nutrient Deficiencies - the big ones, like iron, vitamin D have evidence clearly linking them to low AMH and evidence linking them to poor egg quality and infertility.

  • Stress - some research shows that significant stress, or long term, unrelenting stress can have a negative impact on AMH.


There are more, but these are the most common ones that I see.


It can be really difficult to work out what is and isn't significant, what to pay attention to, what to ignore for now. That's where it can help to have a consultation with someone like me - I go through it all with a fine tooth comb, looking for clues which might indicate what to look at, what might be significant, what can be fixed, improved or removed from the picture.


What About IVF with Low AMH?


Low AMH and IVF are not naturally good bedfellows. IVF is easier to navigate with a higher number of eggs/embryos. But if you have found out that you have Low AMH by going for a Fertility MOT or Fertility Assessment at an IVF clinic, their advice will usually be that with low AMH you need to race straight in to IVF.


There is a very slim chance that your AMH is crashing (I have not yet seen AMH in someone under 40 where we haven't been able to stabilise it and improve it - but it is possible for AMH to keep falling). If that were the case, then there would be an argument for egg collection just to be sure that some eggs were achievable, but I would strongly recommend working with a holistic fertility support expert such as myself prior to attempting a transfer. My main concern would be that the egg quality would likely be poor, or the sperm quality poor and anything collected would have less potential to succeed.


My preference would be to monitor your day 2/3 hormones while you spend a couple of months investigating, hunting for infection, inflammation, deficiencies - and checking sperm health. Then once satisfied that there was nothing to worry about, then opting for IVF if not already pregnant.


Low AMH doesn't always mean you need to start to panic right now - and in my experience, in women under 40 it rarely means you need IVF!


References:

Steiner AZ, Pritchard D, Stanczyk FZ, Kesner JS, Meadows JW, Herring AH, Baird DD. Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age. JAMA. 2017 Oct 10;318(14):1367-1376. doi: 10.1001/jama.2017.14588. PMID: 29049585; PMCID: PMC5744252.

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