Chances are, if you got the news from your doctor that your anti-Mullerian hormone (AMH) level was low, he or she said that your chance of having a baby with your own eggs was also low.
And chances are that this was your reaction: What do I do now?
That was my reaction when I received this very news this week 6 years ago.
(Actually, my reaction was, holy s*&!, what the f%$# do I do now? – but I digress)
I’m here to tell you that a low AMH result isn’t the end of your TTC world – in fact, you have as much of a chance at getting pregnant as anybody else.
My son and I are living proof. My AMH was 0.15 when I was TTC and he’s almost 5.
What is AMH?
Anti-Mullerian hormone is produced in small ovarian follicles and can be used to measure the pool of growing follicles a woman has at any given time. This means that the higher your AMH level, the more growing follicles you theoretically have (because more AMH is being produced) than someone whose AMH level is low.
Since the follicles house our eggs, reproductive endocrinologists (fertility doctors) have used AMH levels to measure a woman’s remaining egg supply, or ovarian reserve. Low AMH level means that less AMH is being produced, suggesting that there aren’t as many follicles to produce it, so ovarian reserve is deemed low.
And, since a woman’s ovarian reserve decreases as she gets older, AMH levels also go down as a woman ages. AMH levels can also be “too high,” suggesting polycystic ovaries, which can be detrimental for conceiving also.
So we naturally expect to see women of advanced maternal age with lowered AMH levels – but since AMH is measured on a spectrum, the test can give insight on remaining egg supply. AMH testing can also be useful for women of traditional childbearing age to determine normal fertility, reduced fertility, or premature ovarian failure.
My AMH was tested when I was 42, and came back at 0.15 ng/ml – even for a woman my age this was very low. For a woman over 40 anything below 1.0 ng/ml suggests a slim chance at conception, and the lower it is, the slimmer that chance is. My doctor said my egg supply was “undetectable.”
Relationship Between AMH and FSH
Follicle Stimulating Hormone (FSH) is another key hormone that doctors look at when evaluating your ability to conceive. FSH measures the health of your eggs, or egg quality – egg quality is also a component in ovarian reserve.
Generally, a higher FSH level means that your ovaries are working harder to produce follicles, which suggests decreased egg quality. The higher that number goes, the lower the quality of the eggs. FSH is measured on Day 2 or Day 3 of your cycle, when your ovaries are at rest.
Fertility clinics vary in their cutoff for “high” FSH; the clinic where I was treated established that FSH below 10 Miu/ML as desirable for conceiving, and over 10 suggested declined fertility.
So a healthy combination for fertility is low FSH and high (but not too high) AMH; high FSH and low AMH, according to doctors, means a very low chance of conceiving.
When I was tested at age 42, my FSH was high, at 16.4; my doctor used this information, along with my low AMH, to officially diagnose me with Diminished Ovarian Reserve. My doctor predicted I had less than a 2% chance of conceiving with my own eggs, and suggested I pursue IVF using donor eggs as my best chance to have a baby.
What does Low AMH mean for your ability to conceive?
In a word – nothing.
The conventional thinking is that low AMH means you’ll likely not conceive with your own eggs, for many reasons. First, since the goal of IVF is to harvest as many eggs as possible for your retrieval, if your egg supply is low there’s not a lot to begin with and even less that you’d end up with after stimulation. Add the expense and the physical and emotional toll of the process and it just may not seem worth it.
Studies have also shown that many women with low AMH respond poorly to stimulation medication, and more cycles tend to be cancelled.
To me, this means that if you have with low AMH you may not be a suitable candidate for IVF – this says nothing about your ability to conceive naturally.
While you may not have many eggs left, you only need one to make a baby.
And there’s no evidence to show that a woman with low AMH has a lower chance of a natural conception than other women her age.
In fact, new data from the Journal of the American Medical Association shows that women with low AMH and high FSH have the same ability of getting pregnant naturally as women with “normal” levels. The study showed that 65% of women aged 30-44 and with low AMH conceived naturally within 6 months, and 84% within 12 months (compared to 62% in 6 months and 75% in 12 months for women in the same age group with “normal” AMH levels).
So it’s possible. And I’m living proof of it.
I conceived via an IUI cycle within 12 months.
My son will be 5 in December.
And I’m not the only one. You can find stories just like mine online and in fertility support groups on social media.
So if you have low AMH you might not be the best candidate for IVF – but I believe you don’t have any less chance than anybody else at getting pregnant via natural conception.
What to do about Low AMH?
There’s been some debate over whether or not you can actually raise your AMH level through diet and supplementation. While I haven’t researched this extensively, my personal view is that since it measures egg reserve, it’s not going to change by any substantial amount.
Have a good cry about it, then let it go.
When I got my elevated FSH result, I was unshaken. I was like, okay, I can work with this. When I got my AMH result, though, I was devastated. I knew it was bad.
I got the news just before a long weekend at the beach with friends for Labor Day. I did a lot of solitary walks on the beach that weekend. I cried. I sobbed. I berated myself for waiting until I was over 40 to try to have a baby. I continued that way for a week. After a week or so, I was able to move from thinking about my journey to that point to my next steps. All that crying helped me get there.
Take control of what you can; let go of the rest.
After that week of processing the news of my low AMH diagnosis, I came to the following realization:
- I can’t control my age
- I can’t control my biology (that my eggs are mostly gone)
- I can’t control the choices I’ve made in my life to this point
- I can control the choices I make from here on out
- I can control things like how I eat, how I move my body, how I sleep, how I relate to my body, how I show up in the world
- I can control, in working with my doctor, my destiny on my fertility journey.
I’m a huge proponent of embracing the principles of a healthy lifestyle to improve your overall health. Things like:
- Balanced, whole foods-based diet
- Sensible exercise
- Adequate sleep
- Reducing stress
- Emphasizing self-care
I was already doing some of those things. Others I had to work at and begin to incorporate into my life. I made it my mission to be my healthiest self.
While adopting a healthy lifestyle might not improve your AMH level, it’ll pay dividends in the form of improved health and state of mind – you’ll feel better in your own skin. This will serve you in so many ways while you’re on the fertility journey, and beyond.
Think in terms of possibilities, not limitations.
It’s important to remember that your doctor’s prediction is just that – a prediction. Yes, there’s science and his or her years of experience to back it up, but it’s still just a prediction, not a fact. Your doctor is predicting you might not respond to IVF stimulation, but in reality you might.
I responded so well to medication that the day of what ended up being my final IUI, my doctor told me that he was so pleased with my response over the 6 months we’d been working together that if the IUI didn’t work, he’d support me trying a round of IVF using my own eggs before moving on to donor eggs. Quite a difference from the doom-and-gloom prediction he gave me just 6 months earlier!
Wishing you all the best on your journey.