AMH, Ovarian Reserve, & Continued Follicle Production

AMH, Ovarian Reserve, & Continued Follicle Production

Among the many hormone tests performed to determine infertility, there is a blood test that measures the levels of AMH (Anti-Mullerian Hormone) also known as MIS (Mullerian Inhibiting Substance). Why are doctors wanting to know what AMH level you have? AMH levels are tested to help doctors determine ovarian reserve.

AMH is produced directly by the granulosa cells in the follicles. AMH is first made in the primary follicles as they advance from the primordial follicle stage. AMH levels continue to rise and AMH production is highest in preantral and small antral stages (less than 4mm diameter) of development. Past this point of growth AMH levels decrease and eventually stops as the follicle continues to grow. Follicles over 8mm diameter produce almost no AMH.

A woman’s body contains millions of follicles at birth, but over time the number of follicles may decline. Doctors use this test to measure the amount of growing follicles in the ovaries. Women with low levels of AMH indicate low levels of follicles and produce lower levels of immature eggs. It is very normal for an older woman to have a lower AMH level, because it is a known fact that both the health of the follicles and the number of follicles declines over time.

Women with many small follicles, typical in women with PCOS, usually have higher levels of AMH. A test result of high AMH may indicate PCOS and is also used to determine excessive or poor response to ovarian hyperstimulation (hCG trigger shot/IVF preparation).

Low levels of AMH in women under the age of 40 may also indicate Premature Ovarian Failure. Premature Ovarian Failure (POF) is also known as Ovarian Hypofunction and is defined as a loss of normal ovarian function before the age of 40.

Anti-Mullerian Hormone Test Results = Chance of Conception
Doctors use this test result to determine if you are a good candidate for IVF. It may help them to determine if they should go forward with IVF or not. It may also be used to determine if you may be able to conceive naturally on your own.

    High (often PCOS) = Over 3.0 ng/ml
    Normal = Over 1.0 ng/ml
    Low Normal Range = 0.7 – 0.9 ng/ml
    Low = 0.3 – 0.6 ng/ml
    Very Low = Less than 0.3 ng/ml

I am never one to take a test result that sounds negative and allow it to define my life. If you have a low AMH level, there is still a chance you will go on to have a baby! No one can know for sure if you will have a child or not. You can choose to have a positive outlook. It is important to realize that this type of test is relatively new and not completely understood by the doctors themselves. Do not worry about the cut off values of the above table, these are general guidelines. For example, the difference between a 0.6 and a 0.7 ng/ml test result puts a woman in a “different range” in this table, but there is very little difference in her fertility potential.

There are other tests that can be used in combination with the AMH test to help determine if in fact ovarian reserve may be low. According to the studies I am going to share below, the word reserve in relation to the ovaries may become obsolete in the future.

Research Shows Human Females Produce Eggs Throughout Their Reproductive Years

It is extremely important to protect your egg count and health now. It is possible to increase the health of your eggs, which may help protect egg die off, which may help to sustain egg count.

Studies on mice have shown that female mammals can produce egg cells throughout life. The studies showed that follicles may not originate in the ovaries themselves, but within the bone marrow. Scientist gave mice with diminished ovarian reserve bone marrow transplants and they began producing follicles once again. These studies are hopeful for the future of infertility, especially POF.

In a follow-up study performed by Massachusetts General Hospital, lead by Jonathan Tilly, PhD, director of the Vincent Center for Reproductive Biology in the MGH Vincent Department of Obstetrics and Gynecology pointed out, “The discovery of oocyte precursor cells in adult human ovaries, coupled with the fact that these cells share the same characteristic features of their mouse counterparts that produce fully functional eggs, opens the door for development of unprecedented technologies to overcome infertility in women and perhaps even delay the timing of ovarian failure.”

These follow-up studies give hope for the future of female infertility, as well as how to treat it. While bone marrow and/or blood transfusions used to restore follicle production is not currently being practiced, the advancement of the this technology over the years is exciting and hopeful!

How Does Egg Health and Count Decline?
AMH levels are not thought to determine the quality of the eggs, which is good. So how can someone with a low AMH level increase the amount of follicles they have or support the health in maintaining the ones you currently have?

As we age the health of our eggs is affected by environmental toxins, poor food choices, circulation, free-radicals, stress, hormonal balance, illness, injury, genetic factors, autoimmune disorders, ect. It is very normal for the health of our cells to decline as we age, but we can also work to protect and support long-term health, which includes our egg health. To learn the full scope of the best ways to improve egg health naturally please read over our complete Increase Egg Health Guide because increasing egg health may help you to sustain the follicles you currently have. Supporting overall health will also help to support egg production over time because the health of the body directly impacts reproductive health.

References:
1. http://en.wikipedia.org/wiki/Ovarian_hyperstimulation#cite_note-11
2. Anti-Mullerian Hormone Testing of Ovarian Reserve Richard Sherbahn MD: http://www.advancedfertility.com/amh-fertility-test.htm
3. “Harvard researchers have found new evidence that female mammals can produce egg cells throughout life”, Harvard University Gazett.2005 http://www.news.harvard.edu/gazette/2005/08.25/99-eggs.html
4. Egg-Producing Stem Cells Isolated from Adult Human Ovaries ScienceDaily (Feb. 26, 2012) http://www.sciencedaily.com/releases/2012/02/120226153641.htm