Low AMH Levels: Impact on Fertility and Treatment Options

Key Takeaways

• Low Anti-Müllerian Hormone (AMH) levels indicate a reduced ovarian reserve, which can lower the chances of conception.
• Low AMH does not directly cause infertility, it can hinder the release of mature, healthy eggs, making it more challenging to achieve pregnancy.
• Low AMH can be diagnosed through a simple blood test.
• Age significantly affects AMH levels, with other factors like stress and genetics also playing a role.
• Despite challenges, informed treatment planning and counselling can help navigate their fertility journey.

Anti-Müllerian Hormone (AMH) is produced by ovarian follicles. It is a key indicator of a woman’s ovarian reserve i.e. the number of viable eggs remaining. It is natural to get concerned if you have been diagnosed with low levels of AMH as this can affect fertility. But here is the good news: Although low levels of AMH may pose challenges in getting pregnant, it does not make it impossible. With the right treatments and support, many women with low AMH can still achieve successful pregnancies. Let us understand how.

AMH Value for Pregnancy

Below are some general guidelines regarding AMH levels and their implications for pregnancy potential.

AMH Level (ng/ml)	Pregnancy Potential
Over 1.0	Good
0.7 – 0.9	Fair
0.3 – 0.6	Diminished
Less than 0.3	Very low

 

However, these are just averages—successful pregnancies have occurred even with very low AMH. Your doctor can provide a more personalised assessment based on your unique circumstances.

What Do Low AMH Levels Mean?

Low AMH levels indicate a diminished ovarian reserve, meaning fewer eggs are available for fertilisation. Normal AMH levels range from 1 to 4 ng/ml. Levels below 1 ng/ml are considered low.

Although low AMH can complicate conception, it does not equate to infertility, as various other factors—including egg quality and overall health—also influence fertility. Testing AMH levels can provide valuable insights into fertility potential and help decide treatment options.

Types of Low AMH Levels

Low AMH levels can be categorised based on severity and age of onset.

Severity

Low AMH levels can be categorised into three types based on severity:

Severity	AMH Levels	Implications
Diminished Ovarian Reserve (DOR)	Below 1 ng/mL	A reduced number of eggs available for conception, potentially affecting fertility
Very Low AMH	Below 0.5 ng/mL	A significantly reduced ovarian reserve, often necessitating advanced fertility treatments
Ultra low AMH	Below 0.16 ng/mL	An extremely low ovarian reserve, commonly associated with substantial fertility challenges and lower chances of successful conception

Age of Onset

Based on the age of onset, low AMH levels can be categorised into the following types:

Condition	Description
Age-related low AMH	AMH levels naturally decline with age due to the depletion of ovarian follicles, a normal part of reproductive ageing.
Premature ovarian failure (POF)	Occurs in women under 40 with low AMH levels, indicating a premature loss of ovarian function that may lead to infertility.

Understanding the Causes of Low AMH Levels

Several factors can contribute to low AMH levels, including:

 

Factor	How Does it Impact?
Age	It is the most significant factor affecting AMH levels.  As women get older, their ovarian reserve naturally declines, especially after the mid to late 30s.  This is a normal part of the ageing process and doesn’t necessarily mean that one can’t conceive, though it may take longer time or require assistance.
Genetic Factors	Inherited genetic disorders (e.g., Fanconi anaemia, dyskeratosis congenita) and genetic mutations (e.g., BRCA2 mutation) can affect AMH levels.  Additionally, a family history of low AMH or early menopause can genetically impact an individual’s AMH level.
Autoimmune Diseases	Conditions such as lupus, where the immune system attacks healthy cells, including eggs, can lower AMH levels.
PCOS	Although women with PCOS may typically have higher AMH levels, some may experience low levels due to ovarian dysfunction or a rapid decline in AMH levels with age.
Premature Ovarian Insufficiency	This condition leads to the early depletion of ovarian follicles, resulting in low AMH levels.
Thyroid Disorders	Hypothyroidism or hyperthyroidism can affect overall hormonal health and potentially influence AMH levels.
Lifestyle Factors	While some causes of low AMH cannot be controlled, certain lifestyle factors can also negatively impact your levels.  These include excessive smoking, obesity, and vitamin D deficiency.
Cancer Treatment or Chemotherapy	Cancer treatments, such as chemotherapy and radiation, can damage the ovaries, leading to a significant reduction in AMH levels.
Surgical Procedures	Ovarian surgeries related to the reproductive system, such as ovarian cyst surgery, may reduce the number of follicles and thus lower AMH levels.
Environmental Factors	Exposure to toxins in the immediate environment can impact reproductive health.

Recognising the Symptoms of Low AMH Levels

While low AMH itself doesn’t present with specific symptoms, it’s often associated with:

• Irregular Menstrual Cycles: Women may experience changes in their menstrual cycles, including duration and variations in blood flow, a sign of hormonal imbalances.
• Changes in Ovulation: Some women might observe changes in ovulation patterns, which can manifest as irregular ovulation or anovulation (lack of ovulation).
• Early Menopause: Some women with low AMH may enter menopause earlier than expected, which can significantly affect fertility and overall health.
• Difficulty Conceiving: Low AMH levels are linked to a reduced number of available eggs, making conception more challenging and potentially leading to infertility or subfertility.
• Reduced Egg Quality: Women with low AMH may face a decline in egg quality, increasing the risk of miscarriage and chromosomal abnormalities.
• Elevated Follicle-Stimulating Hormone (FSH) Levels: Low AMH can lead to higher FSH levels as the body attempts to stimulate the ovaries to produce more eggs.
• Infertility: This is the most significant indicator. It is often noticed after attempting to conceive without success.
• Increased Risk of Pregnancy Complications: Lower egg quality and reduced ovarian reserve can lead to complications during pregnancy.
• Poor Response to Ovarian Stimulation: In fertility treatments like IVF, women with low AMH may not respond well to ovarian stimulation, resulting in fewer eggs being produced.
• Vaginal Dryness: This can occur due to hormonal fluctuations associated with low AMH levels.

While these symptoms can indicate low AMH levels, they are not definitive. Women experiencing any of these symptoms should consult a doctor for further evaluation and potential testing.

Diagnosing AMH Levels: Testing Methods and What the Values Mean

If you’re having difficulty conceiving, your doctor might suggest tests to assess your AMH levels and overall ovarian reserve. Low AMH can be detected through a blood test that measures the level of AMH in your body. For an accurate assessment of ovarian reserve, this test is usually conducted on specific days of your menstrual cycle.

Indication of results

AMH level (ng/mL)	Ovarian reserve
>1.5	Normal
1.0-1.5	Low normal
0.5-1.0	Low
<0.5	Very low or ultralow

Fertility Treatments for Low AMH Levels

Despite challenges, women with very low AMH levels still have reasonable chances of achieving a pregnancy. Here are some of the fertility treatment options available:

• In Vitro Fertilisation (IVF): IVF is considered the gold standard treatment for low ovarian reserve. It involves stimulating the ovaries to produce multiple eggs, which are then retrieved and fertilised in the lab. Despite low AMH, IVF can still be effective, though success rates decrease with age. There are two types of IVF protocols:

  • Standard IVF: Traditional IVF protocol.

  • Natural IVF or Mini Stim IVF: Lower-cost options with reduced medication, often preferred by women with very low AMH levels.

• Donor Eggs: For those with extremely low AMH who are older or have poor IVF responses, using donor eggs can significantly improve pregnancy rates. This option bypasses the issue of limited or poor-quality eggs from the woman’s ovaries.

• Intrauterine Insemination (IUI): IUI involves placing sperm directly into the uterus around ovulation. While typically less effective than IVF for women with low AMH, it is a less invasive and more affordable option that may still yield positive results for some.

• Ovarian rejuvenation with PRP: Platelet-rich plasma (PRP) therapy has been explored as a potential method to improve ovarian function, although its effectiveness is still under investigation.

• Ovulation Induction: Medications can be used to stimulate the ovaries to produce more eggs during the menstrual cycle, increasing the chances of conception.

• Egg Freezing: An increasingly popular option in fertility preservation, egg freezing involves stimulating the ovaries with hormones to produce several mature eggs. These eggs are then collected and frozen for future use. This procedure offers an opportunity to preserve fertility before further decline in egg count.
• Embryo Freezing: This is a variant of IVF where the embryos (fertilised eggs) are frozen for future pregnancy. This ensures that even if your egg count declines further, you will have embryos ready when you decide to conceive in future.

Consulting fertility specialists is crucial for a tailored treatment plan and optimal outcomes.

How Do I Maintain AMH Levels?

While there are no medications to increase the number of eggs in your ovaries, several lifestyle and natural treatments can help improve egg quality and quantity:

 

Things that Can Help	How?
Balanced Diet	A balanced diet with whole foods, healthy fats, and antioxidants can enhance AMH levels. Dairy consumption may slow AMH decline in regularly menstruating women. Omega-3 fatty acids, vitamin D, and antioxidants support reproductive health. These nutrients protect eggs from oxidative stress and help maintain ovarian reserve.
Yoga and Regular Exercise	It supports healthy weight and hormonal balance, essential for optimal AMH levels. Moderate exercise regulates hormones and improves blood circulation, benefiting ovarian function. Exercise reduces stress, which can disrupt hormonal balance and affect fertility.
Acupuncture	Studies suggest acupuncture may enhance ovarian function and AMH levels, though further research is needed. Choose a licensed practitioner with experience in fertility treatment if considering this option.
Dehydroepiandrosterone (DHEA) Supplements	DHEA supplements may improve egg quality and quantity for some women undergoing IVF. Consult your doctor to assess suitability, dosage, and ensure proper monitoring.
Avoid Environmental Toxins:	Avoiding environmental toxins like cigarette smoke and pesticides helps maintain healthy AMH levels. These substances disrupt hormonal balance and harm reproductive health.