AMH stands for anti mullerian hormone and is released by intermediate follicles (eggs) inside your ovaries. It is currently being used as an indication of egg count and therefore to predict your chances of getting pregnant or your fertile age. The higher the number the seemingly more fertile you are, the lower, the less fertile and the faster you’re pushed into medical fertility intervention or told to hurry up on creating your family – whether you are ready financially, emotionally, mentally or not.
Okay, so what’s the issue?
A major issue is that there is limited research on its validity across the years that it has been in use, and only recently, scientists and doctors are starting to realise its limitations. New research suggests that while AMH is a good predictor of how many eggs you’ll retrieve in an IVF cycle, it is not a good predictor of natural conception chances.
The researchers found no correlation between a woman’s egg count and her ability to conceive naturally. This may be because it is only measuring intermediate developing follicles, and if they’re not developing (due to stress, illness etc) then your AMH may be low, and if those issues are addressed and follicles start adequately developing again, your AMH may increase. Personally, I have seen tests where an AMH was initially low, and then after a year of stress reduction, fertility friendly lifestyle interventions and acupuncture, it has increased. If testing your AMH shows how many eggs you have left, then how it can it go up when we know eggs only decline with age?
Dr Mary Birdsall, who is the chair and a specialist at Fertility Associates has written about AMH on their website and explains that certain circumstances which suppress the ovaries can lower AMH results – such as the OCP, pregnancy or breastfeeding. She suggests that you should not test during those situations. So with that in mind, low nutrient intake and stress ovulation so should we be asking research to look at optimal times to test, the impact of stress on AMH if we know it can affect ovulation, and what ethical risks there are when we find low AMH and push people toward IVF as their only option when we know there is no guarantee it will be successful? Surely the fact that if we can shut down the ovaries we will see low AMH is enough to question how acute or long term stress on the body (LEA, HA, RED-s, high cortisol) may impact AMH results?
I’m seeing more young people using social media to share that they are testing their fertility by using AMH, and depending on the results either holding off from starting their family, or rushing to freeze their eggs under pressure or stress. Not only does this influence others to use this test without full awareness of its limitations, it can add more pressure and financial stress onto many people who need less of this. AMH alone does not give you an indication of fertility, it gives you an indication of intermediate follicles – literally everything else that can impact fertility is separate to and often more important than AMH.
Back to the biggest study to date
To overview this recent study (which I want to acknowledge is only one and by no means the gold standard of research, but fertility is complex and hard to study) 750 women between 30-44 years of age were tracked and a total of 543 completed the study. Those with normal AMH were found to be no more likely to fall pregnant naturally than those who had diminished AMH. Please note, this was measuring pregnancy via natural conception, not those going through medical intervention fertility treatment. So it included low vs normal AMH levels, with no other underlying concerns.
While we can’t rely on one study alone to prove a point, the results are significant enough to take notice of, especially in the presence of clinical experience of many of my clients who have diminished AMH, failed IVF rounds and then go to conceive and carry a baby via natural conception. It is important to understand that this study gives us reason to question the status quo of AMH testing, and rethink how it is used in practice. As it stands, using AMH results as a predictor of egg quantity may mean that some folks are being incorrectly convinced that they have a low fertility when in fact they don’t. If you have a test showing a low AMH, and by old standards a low egg count, then you may feel pressured to start a family sooner than you were prepared for, and might cause you to rush you into invasive and expensive treatments, or even make you consider freezing your eggs – all of which cause stress and strain in so many areas regardless of whether conception was your goal, or not.
If you’re going down the path of IVF based solely on an AMH result, then fertility specialists and researchers agree that AMH is a great predictor of how many eggs you’ll retrieve in a single cycle.
So surely we can ask the questions: Would it better that I only use IVF if I have a normal-high AMH result? Am I better to try naturally if my AMH is low since my chance at a good number of eggs in an IVF round is actually lower with low AMH? Am I better to work on natural fertility health if I have low AMH to boost my chance of a healthy natural pregnancy?
So you’ve had your AMH tested and it’s low. What should you do?
First of all, take a deep breath. As you have just learned, AMH alone cannot give you an accurate fertility picture.
We need to assess other hormones, your health history, current stress factors, emotional state, dietary and lifestyle routine and habits, and delve into all the potential fertility predictors outside a single test.
If you have no other health issues that could increase your risk of fertility complications, then the best thing to do is likely focus on maintaining a fertile body, eat well, supplement wisely, establish or maintain healthy ovulation, and manage stressors where we can. Importantly, how about we also look at the sperm role in healthy conception, miscarriage and pregnancy that many health professionals and couples are happy to ignore.
Before you invest upwards of $10k in fertility treatments, or rushing to freeze your eggs despite having no other medical reason to do so, maybe a couple hundred dollars with a fertility-trained nutritionist or dietitian might be a better place to start. If IVF is the goal or next step, then you’ll be in even better shape prior to starting your treatment, and this is undoubtedly helping lead toward a healthy pregnancy which ever way it happens.
Science is ever changing and evolving as we learn more, and my fear right now is that we simply don’t know enough about an AMH result. Right now, research is showing a significant inconsistency to allow it to become the sole fertility predictor, in a life already riddled with stress and reminders of how we as fertile bodies, must always have something wrong with us.