What is AMH?
Low AMH or low egg count can be tested by a simple blood test. AMH is a hormone that is released from small follicles (primordial follicles) of the ovary, which constitute the true ovarian reserve. This reserve contains all the eggs potentially available for fertilization throughout her fertile lifespan. AMH levels rise throughout childhood and peak at about 25 years old, then gradually decline until reaching undetectable levels prior to the menopause.
AMH is considered the earliest and most sensitive ovarian reserve test. AMH is the predictive parameter that is used to assess the quantity of ovarian reserve. That means the high AMH value reflects the high ovarian reserve (remaining eggs), and the low AMH value ( 1.2 ng/mL) reflects less ovarian reserve.
Whenever you have a low AMH or low egg count, kindly correlate it with your AFC (antral follicle count). AFC is another parameter of ovarian reserve. AFC is the sum of follicles in both ovaries as observed on ultrasound in the early days of your menses (days 2-4). You can visit your fertility doctor on Days 2–4 of menses.
Can I get pregnant naturally with low AMH?
Low AMH ( 1.2 ng/mL) can worry any couple. With low AMH, you can also get pregnant without low AMH treatment. But how long you should wait for a natural pregnancy depends on many other factors, like the age of the woman, the duration of infertility, or any associated male factor.
Kindly visit Origin Fertility Centre, one of the best IVF clinics in Hyderabad, to get an individualized plan of treatment.
With low AMH, your time to get pregnant should be shorter.
Is IVF necessary in all low-AMH cases?
All low AMH cases do not always need IVF. Again, low-AMH treatment cases depend on other factors like the age of the woman, the duration of infertility, or any associated male factor. The main intention will be to decrease the time to get pregnant for the woman. For that reason, a fertility specialist will advise you on treatment options like OI-TI, IUI, or IVF.
Can I get pregnant with my own eggs with low AMH, or do I need donor eggs for IVF?
In low AMH cases, with specialized IVF protocols, you can also get pregnant with your own eggs. The basic challenge in low AMH cases is to get a good number of embryos since the egg number will be lower. That’s where the role of the embryologist and the IVF lab quality control will come into play. But with new technologies and the latest IVF protocols, the world is moving towards self-egg IVF. And we are minimizing the use of donor eggs in IVF.
Intraovarian PRP and AMH:
Recently, intraovarian PRP has emerged in poor ovarian reserve patients and might play a vital role in improving their ovarian reserve (AMH and egg count). But still, we would say that there are not enough large clinical studies available on this to pursue it in clinical practize.
1) Can I measure AMH on any day of my menstrual cycle?
Yes, AMH can be tested anytime throughout the menstrual cycle.
2) What is the normal value of AMH?
ANS: Normal AMH levels vary with age. The average range of AMH, or egg size, for pregnancy is approx. 1.2 to 3.22 ng/ml. Still, with a low AMH value or low egg count, you can get pregnant naturally, but consult your fertility specialist to make a treatment plan for you. It’s possible but slightly difficult, and after seeing all the parameters of the couple, we should decide whether to wait or intervene.
3) Can I increase AMH?
ANS: No, AMH cannot be increased. But micro- and macronutrients help improve egg quality. Lifestyle modification also plays an important role in improving the signs of bad egg quality. There are multiple causes and symptoms of low AMH.
Vitamin D is a very important vitamin to improve egg quality and increase conception rates.
Case Study of our Centre:
After 2 tubal pregnancies and low AMH (0.4 ng/ml), finally a bundle of joy:
Low AMH is one of the more difficult situations to deal with. Mrs. X, 26 years old, and Mr. Y, 40 years old, visited Dr. Rinke S. Tiwari at Origin Fertility Centre in March 2022. The couple had a history of two tubal pregnancies and two laparoscopic salpingectomy procedures.
Journey at Origin Fertility:
March 2022: In view of the bilateral salpingectomy, the couple was advised to go for IVF. The husband’s semen analysis appeared normal. The only challenge was using a self-egg with low AMH, which was difficult. The couple was debating whether to use donor eggs in IVF, but after proper counselling, they were advised to use their own eggs. The plan was embryo pooling.
July 2022: First IVF done with the microdose flare protocol; egg pickup done; and one egg obtained. From one egg, getting one embryo was a difficult task. But with the expertise of our senior embryologist, one egg also resulted in one embryo, and that embryo was frozen.
August 2022: Sec. IVF done with the Antag protocol; egg pickup done; 5 eggs obtained; and 4 embryos frozen.
Nov. 2022: Endometrium was prepared for embryo transfer, and frozen embryo transfer was done. In the first attempt, only the patient got a positive result.
This was the story of the Origin fertility team’s efforts to counsel and encourage couples to go for self-embryonic IVF. With the latest technology, the world is moving towards self-embryo pregnancy. Donor eggs should be the last option for the couple.