LOW AMH – Ovarian Reserve Testing

In the reproductive medicine field today women > 35 years age, come under the category of Advanced Maternal Age. Their pregnancy rates show a dramatic decline, and there is an increased risk of miscarriages. Several factors which impact the likelihood of a successful outcome are, maternal age, hormone levels on cycle day 3 FSH/estradiol, AMH antimullerian hormone level, and basal antral follicle count.

The common interpretation of AMH has been to assume it is a better indicator of ovarian reserve and as it declines, so does reserve. This dropping AMH is noted with age, especially over 35, and as this value drops below 1, and becomes 0.8 or 0.54 to 0.24 and ultimately <0.16, patients are routinely counseled to consider donor egg.

Women who are diagnosed with low AMH are encouraged not to delay fertility treatment because AMH and ovarian reserve continue to decline with age.

Another marker which is not utilized as much now for ovarian reserve was FSH.

FSH stands for follicle stimulating hormone, and as the name suggests is a hormone to stimulate follicles secreted by the pituitary gland in the brain.

This hormone has a negative feedback loop between the pituitary and the ovaries, so once the ovaries respond to the signal from the pituitary via FSH to grow a follicle, this negative signal switches off the production of FSH keeping it in range.

In a situation where the ovaries are not responsive, the brain keeps putting out more FSH signal and we see a rise in the FSH, indicative of poor ovarian function.

This higher levels of FSH is normally associated with advanced maternal age, but it is not uncommon to see high FSH as a result of other ovarian pathology or hormonal imbalances. FSH fluctuates and needs to be tested on Day 2 or 3 of the menstrual cycle.

Supportive herbs, acupuncture and supplements will help to balance the hormones and provide a better chance at conception naturally or through assisted reproductive techniques such as IUI or IVF.

Ideally we recommend 2-3 months on the treatments to maximize the reproductive potential, this also depends on other factors stated above, which is why a detailed consultation helps offer individualized treatment regimens.