Low AMH Levels: understanding the impact on fertility

Low AMH levels are generally considered to be an indicator of a low ovarian reserve. It is quite normal for a woman’s AMH levels to decline as she gets older. In younger women this may be a sign of premature loss of fertility. Low AMH fertility treatment could consist of IVF together with hormone treatment.

High AMH levels for IVF are anything within the range of normal for a woman under 38. However, looking at what are the AMH levels in an individual is only part of the diagnostic process.

What is Anti-Müllerian Hormone (AMH)?

AMH refers to the Anti-Mullerian Hormone. This hormone is secreted by the granulosa cells surrounding the developing egg cells in the ovary. AMH levels provide information about your ovarian reserve, which is the quantity of egg cells remaining in your ovaries.

Therefore, a low level is considered to be a sign of a low ovarian reserve, i.e. few remaining follicles. This would be normal for a woman who is approaching menopause. Conversely, a woman who has polycystic ovarian syndrome, characterised by the presence of many small ovarian follicles, would normally be expected to show high levels of AMH.

How AMH impacts fertility 

As we have explained, high AMH levels indicate a higher quantity of oocytes, and vice versa. If these levels show diminished ovarian reserve, fertility may be at risk, and there is even a possibility of early menopause.

It is important to note that AMH is just one contributing factor to fertility. Other factors such as age and the cause of low Anti Mullerian hormone levels also play a role. Next, we will examine some effects resulting from low levels of this hormone.

Reduced egg quantity and quality

The decrease in ovarian reserve due to age is often accompanied by a lower quality of oocytes. Therefore, AMH indicates not only a reduced quantity of oocytes but also a higher likelihood of aneuploidy (chromosomic abnormalities).

Increased risk of miscarriage

Low anti mullerian hormone levels also entail an increased risk of miscarriage, although specialists emphasize the need to consider other factors as well. For instance, the risk may escalate if low AMH coincides with advanced maternal age.

Challenges in conception

The significance of AMH levels in the quest for pregnancy will depend on its origin. For instance, if the decline in levels is due to conditions such as polycystic ovary syndrome (PCOS), an appropriate treatment may increase AMH levels.

What AMH test results tells

Typically, AMH normal range of values range between 1 and 4 ng/ml. The assessment of ovarian reserve based on recorded parameters would be as follows:

However, it is crucial to consider the woman’s age when interpreting blood hormone results. The following are reference AMH values based on age:

It is important to note, as mentioned earlier, that AMH levels do not always correlate with age. Therefore, to make a comprehensive assessment of female fertility, additional tests will also be conducted. Follicle count, as well as tests for FSH, estradiol, or prolactin, are among them.

These measurements can also be used to help predict the response to fertility treatments such as in vitro fertilization.

Causes of Low AMH Levels

In general, there is no single answer to determine the origin of low anti-mullerian hormone levels. Below, we list some possible causes:

Age

As mentioned before, age is the most common cause of low anti mullerian hormone levels, as well as diminished ovarian reserve.

Pathologies: PCOS, endometriosis

PCOS or endometriosis can lead to high AMH levels, causing fertility problems.

Premature ovarian failure (POF)

Premature Ovarian Failure (POF) involves the cessation of ovarian activity in women younger than 40, and this can result in low AMH levels and infertility.

Oncological therapies, environmental factors

Chemotherapy, radiation or exposure to environmental toxins can have an impact on reproductive capacity and AMH levels.

Autoimmune diseases

Lupus or rheumatoid arthritis can inflame or damage the ovaries, leading to a decrease in AMH levels.

Treatment Options for Low AMH

For many women, a declining level of fertility and failure to conceive is the trigger to consult for advice. Providing your clinical consultant at IVI considers there is an AMH normal range level for IVF, in vitro fertilisation could well be the treatment recommended. If on the other hand the AMH levels and thus the ovarian reserve are so low that this form of intervention is unlikely to succeed, your clinician may advise you to consider the use of egg donation.

In vitro fertilization (IVF)

The process is relatively straightforward. These are the different steps of IVF:

• Ovarian stimulation. This consists of the administration of daily injections which cause the ovaries, instead of producing a single ovum, to create more oocytes. A more significant number of embryos can therefore be obtained. Depending on the stimulation protocol chosen, the treatment takes between 10 and 20 days. Our health professionals indicate the type of medication and appropriate dosages for each woman, based on each individual case. During the process follicle tracking is performed through transvaginal ultrasound scans, and serum levels in the blood are also measured to check on ovarian follicular growth and maturation.
• Retrieval of the eggs. This is scheduled when the follicles have reached the appropriate size. A hormone injection is administered to trigger ovulation and, approximately 36 hours afterwards, egg collection can take place. The patient attends the clinic and a light sedative is administered to prevent discomfort. The procedure takes 15 minutes and is carried out by a gynaecologist, an embryologist and the anaesthesiologist.
• Oocyte fertilisation. It takes place when the sperm is mixed with the retrieved eggs to allow fertilisation to occur. This can happen by one of two methods: conventional IVF, which consists of placing the eggs in contact with sperm in a petri dish or alternatively ICSI (Intracytoplasmic sperm injection) which consists of microinjection of the sperm directly into the mature egg with the help of a pipette.
• Embryo transfer into the uterus. This is a simple painless procedure for which no sedation is necessary. It takes just 15 minutes, after which the patient return home.

Egg and embryo donation

For those women who do not have a good AMH level for IVF or where IVF treatment has not been successful, using donor eggs is an alternative approach. Egg donation is the process in which women use eggs from a donor in order to have their own child. The donor’s eggs are fertilized with sperm, usually from the woman’s partner, to produce embryos. These are then transferred into the womb in the same way as with IVF, making pregnancy possible.

IVI has a network of clinics across Spain which have for many years been working with international patients who require egg donation. There are some significant differences in the regulatory framework regarding anonymity. Egg donation is anonymous in Spain, where IVI has one of the largest frozen egg banks in the world. We therefore have access to egg donors with all characteristics, with no waiting list. If you decide, with the help of your clinical consultant, that this is an option you would like to explore, you can familiarise yourself by reading more about IVI clinics in Spain.

In conclusion, AMH is a hormone that plays a vital role in female reproductive function. Low AMH levels can be a sign of decreased ovarian reserve and can occur naturally with age or due to certain medical conditions and treatments. It is essential to consult with a healthcare provider if you have concerns about your AMH levels or fertility.