Low AMH Fertility Treatment
Ovarian Reserve & Aging
As a woman passes age 35, we call her Advanced Maternal Age, since pregnancy rates show a dramatic first decline, and adverse pregnancy outcomes increase. The current state of the art of evaluating potential egg quality and number-translation, the potential likelihood of a successful outcome, is to consider maternal age, cycle day three FSH/estradiol, and anti-mullerian hormone level, and basal antral follicle count. As with any new testing, AMH has yet to be understood in its role in determining ovarian reserve.
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.
What is AMH?
AMH (Anti-mullerian hormone) is a protein made by the cells that surround each egg. It is produced the most during the small pre-antral stages. AMH stops producing as follicles grow and nearly no AMH is produced once a follicle hits 8mm in size. The more eggs a woman has, the higher her AMH level should be, a simple blood test can determine a woman’s AMH levels.
Why test for AMH?
Well, AMH does correlate with the number of basal antral follicles, and thus in an IVF cycle, fewer eggs correlate with lower rates. When AMH is very low to undetectable, patients have panicked into doing donor eggs or rushing into an IVF before all their eggs are gone. Having an AMH below 1.0 is anxiety provoking, and the lower it goes, the higher the tension. Still, patients with very low AMH should be counseled that there per cycle outcomes should be very low, <10% delivery rate under age 40. I would expect an AMH below 0.4 to be considered very low.
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