IVF With Low AMH
What is AMH?
AMH or Anti Mullerian Hormone is produced by the granulosa cells in the ovary. It is a marker of ovarian reserve. In this article, we will talk about IVF with Low AMH. To put it simply, AMH tells us about egg count. A low AMH suggests a Diminished Ovarian Reserve (DOR). However, this being a hormonal test, the result is interpreted after a complete picture is obtained by supplementing with an ultrasound. There is a common misunderstanding that fertility or infertility is gauged by Symptoms of Low AMH Levels. It is important to understand that a low AMH Treatment test is one of the many indicators of infertility and it is important to meet a fertility doctor to know more.
Low AMH Causes:
Low AMH levels could be caused by a variety of factors. Some of the common causes of low AMH levels include:
- Age: As a woman ages, her ovarian reserve naturally decreases, resulting in lower AMH levels.
- Genetics: Some women may have a genetic predisposition to low AMH levels.
- Ovarian Surgery or Treatment: Previous surgeries or treatments that affect the ovaries, such as chemotherapy, can result in low AMH levels.
- Polycystic Ovary Syndrome (PCOS): Women with PCOS may have low AMH levels due to the presence of multiple small follicles that do not develop properly.
- Endometriosis: Endometriosis is a disease in which the tissue that generally lines the uterus grows outside of it. Women with endometriosis may have low AMH levels due to damage to the ovaries.
Symptoms of Low AMH Level:
Low AMH levels do not typically have any symptoms. However, women with low AMH levels may experience difficulty getting pregnant or may have irregular periods. In some cases, women may also experience early menopause.
Also Read: Symptoms of Low AMH Level
Low AMH Treatment:
There is no cure for low AMH levels, but there are several treatments for Low AMH available to help increase a woman’s chances of getting pregnant. Some of the treatment options include:
- IVF (In-Vitro Fertilization): IVF is a procedure in which eggs are retrieved from the ovaries and fertilized with sperm in a laboratory. The finally prepared embryos are then transferred to the uterus.
- Donor Eggs: In cases where a woman’s own eggs are not viable, donor eggs can be used for IVF.
- Ovarian Stimulation: Ovarian stimulation involves using medication to increase the number of follicles in the ovaries, which can improve the chances of getting pregnant.
- Natural Supplements: Some women may benefit from natural supplements, such as DHEA, which can help improve AMH levels.
Also Read: Low AMH Treatment
Low AMH and Pregnancy:
Women with low AMH levels may have a more difficult time getting pregnant, but it is not impossible. With the help of fertility treatments and the expertise of a fertility specialist, many women with low AMH levels have been able to conceive and carry a healthy pregnancy. In conclusion, low AMH levels can be a source of concern for women who are trying to conceive. It is important to consult with a fertility specialist to discuss possible treatment options and develop a plan that works best for each individual. With the right treatment, it is possible for women with low AMH levels to achieve their dream of becoming a mother.
What is an AMH Test?
IVF With Low AMH- The AMH Test is a Blood test done to find out the egg reserve in a Woman. Women have a finite Egg reserve which reduces with Age and eventually at Menopause there are no eggs. Hence, the AMH test is done to find out the remaining quantity of eggs.
Why is an AMH Test Done?
AMH test is done by a Fertility Doctor with the following 5 key objectives.
- Determine the number of Eggs to determine the fertility treatment procedure
- Ageing rate of ovaries vis-à-vis the natural rate.
- Planning the dosage of injections required during IVF.
- A clearer estimation of the number of eggs that would be retrieved during IVF.
- A criterion to suggest the planning of pregnancy time or Egg Freezing.
What is the Normal AMH Test Result?
Normal AMH Levels According to the Age:
| Age | Normal AMH level |
|---|---|
| <24 months | <4.5 ng/mL |
| 24 months – 12 years | <10.0 ng/mL |
| 13 – 45 years | 1.0 – 10 ng/mL |
| 45 years | <1.0 ng/mL |
What is a good AMH level for IVF?
A good AMH for IVF is 1.5 ng/ML and an AMH level below 0.5 is considered LOW. As a general guideline, the following levels (in nanograms per millilitre) represent the lower limit of AMH by age in women.
- 45 years old: 0.5 ng/mL
- 40 years old: 1 ng/mL
- 35 years old: 1.5 ng/ mL
- 30 years old: 2.5 ng/mL
- 25 years old: 3.0 ng/mL
How much is Too low AMH Level?
| Interpretation | AMH levels |
|---|---|
| Very High AMH Level (Symptom of PCOS, test is advisable) | >3.0 ng/ml |
| High AMH Level (Ideal for IVF treatment) | 3.5 – 5.0 ng/ml |
| Normal AMH Level | 1.0 – 3.5 ng/ml |
| Low AMH Level (Assisted Reproduction is likely operable) | 0.3 – 0.6 ng/ml |
| Very low AMH Level | <0.3 ng/ml |
IVF With Low AMH:
In vitro fertilization (IVF) is a fertility treatment where eggs are retrieved from a woman’s ovaries and fertilized with sperm in a laboratory. IVF is commonly used to treat infertility caused by a variety of factors, including low anti-mullerian hormone (AMH) levels. AMH is a hormone produced by the follicles in the ovaries, and low levels of AMH can indicate a reduced ovarian reserve, which can make it difficult for a woman to conceive naturally. IVF with low AMH is possible, but it may be more challenging than IVF for women with normal AMH levels. The success rate of IVF with low AMH varies depending on the individual’s age, the number of eggs retrieved, and the quality of the eggs and sperm. Women with low AMH may have a lower number of follicles and eggs, which can make it more difficult to retrieve enough eggs for successful fertilization. In some cases, IVF with low AMH may require a higher dose of fertility drugs to stimulate the ovaries to produce more follicles. This can increase the risk of ovarian hyperstimulation syndrome (OHSS), a condition where the ovaries become swollen and painful. In other cases, IVF with low AMH may require multiple cycles of IVF to increase the chances of success. Women with low AMH may also consider other fertility treatments, such as donor eggs or embryos. Donor eggs or embryos are fertilized with the partner’s or donor’s sperm and implanted into the woman’s uterus. This can be a successful option for women with low AMH who are unable to conceive with their own eggs. In conclusion, IVF with low AMH is possible, but it may be more challenging than IVF for women with normal AMH levels. Women with low AMH may require a higher dose of fertility drugs or multiple cycles of IVF to increase their chances of success. They may also consider other fertility treatments, such as donor eggs or embryos. It is important for women with low AMH to discuss their options with a fertility specialist and determine the best course of action for their individual situation.
What are the challenges in IVF with Low AMH?
The challenges in IVF with low AMH IVF in couples are the following 3…
- Cycle cancellation: In 10-15% of couples, the response to stimulation with injections may not be appropriate and the IVF cycle may have to be canceled.
- Lowe number of eggs retrieved.
- No good-quality embryo formed.
Low AMH and Pregnancy chances after IVF?
During IVF, when an optimal number of eggs is retrieved (10-15), the chances of pregnancy are good. If the number of eggs retrieved is less, then the chances of pregnancy also decline, since not every egg is fertilized and progresses to form a good-quality embryo. That said, the quality of eggs is also a major determinant of the success rate. At Little Angel IVF, with individualized treatment protocols, patients with as few as 1-3 eggs have also had successful pregnancies. Couples with Low AMH can be subdivided into two groups.
- Those who are young and have low AMH have less quantity but good quality of eggs. Their chances of pregnancy are better.
- Those who are old and have low AMH they have both poor quantity and quality of eggs. Their chances of pregnancy are less.
- With minimal stimulation IVF protocols or mini-IVF, many couples with low AMH have had successful pregnancies.
Also Read: What is a Good AMH Level to Get Pregnant?
Is there any treatment for low AMH?
Yes, there is a treatment for low AMH. However, it is important to note that as one age, one has fewer eggs. The AMH levels decrease as one ages and it is a Natural process. Low AMH means fewer eggs and not no eggs. Low AMH levels do not mean that one can not get pregnant as the truth is that only 1 Egg is required for fertilization.
IVF With Low AMH- Can low AMH levels be improved?
Yes, low AMH levels can be improved. There are drugs that may help improve AMH levels. Certain trials have shown some positive results with DHEA supplements. However, it has not been well documented and has its limitations, especially in patients with very low AMH. Vitamin D and Coenzyme Q10 supplements also, to a certain extent, aid in improving fertility outcomes. But one can work on the egg quality by adopting a healthy diet and lifestyle, avoiding smoking and maintaining a healthy weight. Even if the eggs are few in number but if they are of good quality, it maximizes the chances of pregnancy.
How can I improve my AMH levels at home?
You can improve AMH levels at home by adopting a healthy lifestyle and eating habits. Avoiding smoking, and alcohol and maintaining a healthy weight help in improving AMH levels and especially the quality of Eggs. Even if the eggs are few in number but if they are of good quality, it maximizes the chances of pregnancy. One should eat food that is rich in Vitamin D.
Can you still ovulate with low AMH?
Yes, you can ovulate with Low AMH. A low AMH level means that you have fewer eggs and does not mean that you have no eggs. Ovulation occurs in a normal manner with low AMH.
Why should AMH Levels be low?
AMH declines with age in accordance with the natural ageing process. As the number of eggs in the ovaries of a lady declines, the AMH Levels also decline. There is a sharp decline after the age of 35 years as both the number and quantity of eggs decline in a woman. Low AMH may also be seen in young women who have
- Surgery for endometriosis or chocolate cysts
- Surgery for ovarian cysts
- Autoimmune diseases like SLE cause oophoritis and lead to premature ovarian failure.
Do AMH levels indicate Egg Quality?
AMH levels do not indicate Egg Quality. AMH is an indicator of Egg Quantity or in other terms the Egg Reserve. High AMH levels indicate more Egg Reserve and Low AMHL levels indicate less Egg Quantity. However, there is an ideal range of AMH levels and High is not always good. The quality of eggs is determined by other fertility tests that an infertility specialist doctor will suggest.
Does low AMH mean Infertility?
Low AMH does not mean infertility. AMH does not accurately predict natural fertility but is an indicator. A low AMH level only means that the Egg reserve is possibly low and hence based on the data, a fertility doctor decides on the course of fertility treatment.
When should AMH levels be checked?
AMH levels should be checked for Menopause, PCOS, Menstruation or Age-related factors.
- Menstruation: To find out the reason for absence or delay in periods/menstrual cycle.
- Menopause: To check for a relation to early menopause.
- PCOS: To detect polycystic ovary syndrome which affects infertility.
- Ovarian Cancer: To check the ovarian levels of women suffering from ovarian cancer.
Does stress affect AMH levels?
Yes, Stress affects AMH levels. Most documented medical research has shown that chronic stress is one of the reasons for decreasing AMH Levels as well as infertility. Chronic Stress affects and activates the following two known to damage ovarian follicles leading to decreased AMH levels.
- HPA: Hypothalamus Pituitary Adrenal
- SPA: Sympathetic Adrenomedullary Pathway
Known to damage ovarian follicles leading to decreased AMH levels.
Do AMH levels fluctuate month to month?
Since the AMH value almost remains the same throughout the menstrual cycle, the test can be done on any day of the menstrual cycle. Also, AMH levels do not vary or fluctuate from cycle to cycle but remain more or less constant.
How quickly does AMH decline?
Every lady has a biological clock and according to the natural process of ageing the AMH begins to decline after 30 years. After the age of 35 years, there is a steep decline in AMH levels which falls rapidly.
Can low AMH cause early Menopause?
Low AMH predicts early menopause. Low AMH implies a decrease in ovarian reserve. That said menstrual cycles may occur over the next 10 years even with low AMH. Very low AMH predicts the time to menopause and indicates approaching the final period over the next one to two years.
Is AMH more important than FSH?
Yes, AMH is more important than FSH. AMH is a better indicator of the Ovarian reserve than FSH because AMH tests are constant and can be done any day of the menstrual cycle while FSH fluctuates throughout the Menstrual cycle and is usually done on Day 3.
Are FSH and AMH related?
Yes, FSH and AMH are related as these are both screening tests done to check the same outcome i.e., Ovarian reserve in a woman. That being said, AMH is a better ovarian reserve test than FSH since it detects a change in the ovarian reserve earlier on and also because there are fewer fluctuations in its value.
What are the AMH and FSH correlations?
AMH and FSH are inversely correlated. When the ovarian reserve declines, the AMH also declines but the FSH rises. The FSH hormone stimulates the ovaries to release an egg hence a high FSH means that the ovarian reserve is Less. IVF success with low amh
Has anyone gotten pregnant with low AMH?
Countless women have got pregnant with low AMH. At Little Angel IVF, after a thorough assessment and formulation of a tailor-made protocol, couples with AMH low as AMH 0.2 ng/ml have also conceived successfully.
Read More:- Low AMH IVF Success Stories
Does vitamin D improve AMH?
Yes, Vitamin D improves AMH as a deficiency of Vitamin D is associated with reduced fertility in women. Studies have shown the positive effects of Vitamin D in improving AMH Levels. However, it is to be noted the improvement of AMH levels is minimal and not very substantial. Foods that are rich in Vitamin D or Vitamin D supplements are known to arrest the decline in AMH Levels.
Can AMH be falsely low?
Some researchers have shown AMH to be falsely low when a contraceptive pill is taken. One must visit a trusted pathology lab to get the AMH test done so that the results shown are accurate.
To Conclude, One does need to be anxious just because the AMH level is low. Fertility is strongly related to Egg Quality and not the number of Eggs. One may have Fewer eggs but Egg quality is the key determinant. We hope the above FAQ related to AMH will give insight to patients seeking clarity.
Also Read: AMH Test Price
Will IVF work if AMH is low?
VF can still be effective with low AMH (Anti-Müllerian Hormone) levels, though it may pose challenges. A study in ‘Human Reproduction’ noted that women with low AMH have lower egg retrieval rates, but pregnancy rates per embryo transfer remain comparable. Success rates vary, and women with low AMH might require individualized IVF protocols.
What IVF protocol is best for low AMH?
For low AMH patients, the GnRH antagonist protocol is often recommended, as it can enhance pregnancy rates. This approach is based on evidence by a study of 300 low AMH patients at our IVF clinic in Noida. The GnRH Protocol with an average Success Rate of 60% is among the highest as compared to other protocols like Natural IVF Cycle, High Dosage Protocol and DHEA Supplementation. Tailoring IVF treatment to individual hormone profiles is key for success in Low AMH cases.
What are the Protocols for IVF with Low AMH?
There are 4 common protocols for IVF with Low AMH.
1.GnRH Antagonist Protocol: This protocol involves using Gonadotropin-Releasing Hormone (GnRH) antagonists to prevent premature ovulation. It is particularly effective for women with low AMH as it allows for better control over the stimulation process. Studies have shown that this protocol can lead to improved outcomes in low AMH patients, with pregnancy rates per cycle ranging from 60% to 65%.
2.Natural or Modified Natural IVF Cycle: This approach involves minimal or no use of stimulating drugs, relying on the natural growth of a single egg. It is a suitable option for women with very low AMH, offering a more gentle and potentially less costly alternative. Success rates per cycle can be lower, typically around 55-60%, but it is a viable option for those who respond poorly to conventional stimulation.
3.High-Dose Stimulation Protocol: This involves higher doses of fertility medications to stimulate the ovaries. While it can lead to the retrieval of more eggs, there is a risk of poor egg quality. The success rates vary widely and depend on individual responses to the medication. The Average Success rate at our Fertility Clinic in Noida is 50%
4.DHEA Supplementation: Some clinics recommend DHEA supplements before starting IVF to improve ovarian response. There is some evidence suggesting that DHEA can increase the number of eggs retrieved in low AMH patients. However, the average Success rate is around 45%.
It is important to note that success rates in IVF, particularly with low AMH, vary significantly based on individual factors like age, overall health, and specific fertility issues. Consulting with a fertility specialist is crucial to determine the most suitable protocol. They can provide a personalized approach based on the patient’s unique fertility profile, maximizing the chances of successful conception.
Is it worth doing IVF with low AMH?
IVF offers a viable route to pregnancy for women with low AMH, despite a reduced ovarian reserve. Research from various regions supports this. An Indian study published in the ‘Journal of Human Reproductive Sciences’ shows that women under 35 with low AMH can achieve reasonable success rates with IVF. European research, as detailed in ‘Human Reproduction’, corroborates these findings, suggesting enhanced fertility prospects with appropriate IVF protocols. In the United States, studies published in ‘Fertility and Sterility’ highlight the effectiveness of customized IVF treatments in such scenarios. These studies collectively reinforce the potential of IVF as a beneficial option for women worldwide facing fertility challenges due to low AMH levels.
Is IVF with low AMH Successful?
While the global average success rate of IVF is around 40%, for those with low AMH, it’s typically 10-15% lower. This means success rates can be approximately 30-35% in such cases. However, with specialized IVF protocols and strategies tailored to low AMH conditions, achieving a successful pregnancy is still a realistic possibility.
Ways to Improve IVF Success with Low AMH
Below are the 5 ways to Enhancing IVF Outcomes in Low AMH Cases
1.Extended Follicular Phase Stimulation: This technique involves administering hormone injections for about 9 to 10 days from the start of the menstrual cycle. The goal is to stimulate the ovaries to produce more eggs, which can then be used for embryo creation, either in the current or a future cycle.
2.Sequential (Dual) Stimulation: After the initial follicular phase stimulation, a short break of 3 to 5 days is taken. Then, a second round of stimulation follows for another 9 to 11 days. This approach can lead to a higher egg yield, often doubling the collection from a single cycle.
3.Egg Quantity and Quality Balance: With low AMH, initial cycles might yield 3-5 eggs, with subsequent cycles producing a similar count. Achieving 2-3 high-quality blastocysts for implantation becomes more feasible with this combined method, enhancing IVF success chances.
4.Improving Egg Quality: Besides medical interventions, lifestyle adjustments like a balanced diet, regular exercise, adequate sleep, and stress management can boost egg quality. Supplements like coenzyme Q10, DHEA, and antioxidants might also be beneficial, but consultation with a healthcare provider is essential before starting any supplements
FAQs: IVF With Low AMH
Q: Can I conceive with low AMH?
A: Yes, it is possible to conceive with low AMH levels, but it may be more challenging. Women with low AMH levels may require fertility treatments such as IVF, donor eggs, or ovarian stimulation to increase their chances of getting pregnant.
Q: What happens if AMH is low?
A: Low AMH levels indicate a low ovarian reserve, which means that the number of eggs in the ovaries is lower than expected for a woman’s age. This can make it more difficult for a woman to get pregnant.
Q: How to increase low AMH levels?
A: There is no guaranteed way to increase low AMH levels, but some women may benefit from natural supplements such as DHEA or CoQ10, or fertility treatments such as ovarian stimulation.
Q: I have low AMH. Does it mean I am infertile?
A: Low AMH levels do not necessarily mean that a woman is infertile, but it may make it more difficult to conceive. Fertility treatments may be needed to improve the chances of getting pregnant.
Q: Does Low AMH Levels Affect Fertility?
A: Yes, low AMH levels can affect fertility. Women with low AMH levels may have a reduced number of viable eggs, which can make it more difficult to conceive naturally.
Q: How to Raise AMH Levels Naturally?
A: While there is no guaranteed way to raise AMH levels naturally, some women may benefit from natural supplements such as DHEA or CoQ10.
Q: What is Considered a Low AMH Level?
A: A low AMH level is typically considered to be below 1 ng/mL, but this can vary depending on the laboratory and the woman’s age.
Q: Can Low AMH Cause Miscarriage?
A: Low AMH levels do not directly cause miscarriage, but they can be associated with a lower number of viable eggs, which can increase the risk of pregnancy loss.
Q: Can Endometriosis Cause Low AMH Levels?
A: Yes, endometriosis can cause low AMH levels due to damage to the ovaries.
Q: Can Low AMH Cause Infertility?
A: Low AMH levels can make it more difficult to conceive naturally, but it does not necessarily mean that a woman is infertile. Fertility treatments may be needed to improve the chances of getting pregnant.
Q: Can you have regular periods with low AMH?
A: Yes, it is possible to have regular periods with low AMH. AMH levels are not directly related to menstrual cycles, so having low AMH does not necessarily mean irregular periods.
Q: Can I conceive naturally with low AMH?
A: Yes, it is possible to conceive naturally with low AMH, but it may be more difficult. Low AMH levels indicate a lower ovarian reserve, which means there may be fewer eggs available for fertilization. However, it is still possible to conceive as long as ovulation occurs and there are healthy sperm present.
Q: Do you still ovulate With low AMH?
A: Yes, women with low AMH levels can still ovulate. AMH is a hormone produced by the follicles in the ovaries, but it does not directly affect ovulation. Ovulation is regulated by other hormones such as estrogen and luteinizing hormone.
Q: Does low AMH mean low follicle count?
A: In general, low AMH levels are associated with a lower follicle count. AMH is produced by the follicles in the ovaries, so a lower AMH level indicates that there are fewer follicles. However, it is important to note that AMH levels can fluctuate and that other factors such as age and hormonal imbalances can also affect follicle counts.
Q: What do Low AMH and High FSH mean?
A: Low AMH levels and high FSH (follicle-stimulating hormone) levels may indicate a diminished ovarian reserve, which means that the number of eggs in the ovaries is lower than expected for a woman’s age. This can make it more difficult to get pregnant naturally, and fertility treatments may be needed.
