What is Low Egg Reserve (AMH)?, Causes and Treatment

The decline in egg count in women is a common cause of infertility today. From a certain age, both the quantity and quality of a woman's eggs decrease, which can reduce the chances of fertilization and hinder the ability to conceive. This condition, indicating a decrease in the fertility hormone known as AMH (Anti-Müllerian Hormone), can sometimes also occur in young women. To learn more about low egg reserve, continue reading the rest of the text.

What is Low Egg Reserve (AMH)?

Low egg reserve, often indicated by low levels of anti-Müllerian hormone (AMH), is a condition that affects a woman's reproductive capacity. AMH is a protein produced by small follicles in the ovaries and is used as a marker of ovarian reserve. Ovarian reserve refers to the remaining quantity and quality of a woman’s eggs.

A low AMH level suggests a reduced number of eggs available for fertilization. This can make it more challenging for women to conceive, whether naturally or through assisted reproductive technologies like IVF. Low egg reserve can result from various factors, including age, genetics, certain medical conditions, and lifestyle choices.

Women with low egg reserve may face difficulties with conception, an increased risk of miscarriage, and may respond less effectively to reproductive treatments. However, low AMH levels do not necessarily mean a woman cannot conceive; rather, it is an indicator of a reduced reproductive potential.

What Should the AMH Hormone Level Be?

The ideal or "normal" AMH (anti-Müllerian hormone) level can vary based on the laboratory and the test method used, as well as factors like the individual’s age. In general, AMH levels are categorized as follows:

• High Normal or Elevated Range: Approximately 2.0 to 6.8 ng/mL (nanograms per milliliter) or higher. Elevated AMH levels may indicate a larger ovarian reserve and may be associated with conditions like polycystic ovary syndrome (PCOS).
• Mid-Range (Typical Normal Range): Approximately 1.0 to 2.5 ng/mL. This is considered the typical normal AMH range for healthy women of reproductive age.
• Low Normal Range: Below 1.0 ng/mL. Although still within a normal range, lower AMH levels may suggest a somewhat decreased ovarian reserve.

The interpretation of AMH levels should be done in consultation with a healthcare professional, especially if a woman is concerned about her fertility or considering assisted reproductive treatments like IVF.

What Are the Causes of Low AMH?

Low levels of anti-Müllerian hormone (AMH) can be influenced by various factors, and in many cases, the exact cause may not be immediately apparent. Common factors associated with low AMH levels include:

• Age: AMH levels naturally decrease as a woman ages. Older women typically have lower AMH levels, which is seen as a sign of diminished ovarian reserve.
• Early Ovarian Aging (Premature Ovarian Insufficiency): Some women experience a significant decline in ovarian reserve earlier than expected, known as early ovarian aging or premature ovarian insufficiency. This can be triggered by genetic factors, autoimmune diseases, or certain medical treatments.
• Polycystic Ovary Syndrome (PCOS): While PCOS is often associated with high AMH levels, some women with PCOS may have lower-than-expected AMH levels, indicating that AMH levels can vary within this condition.
• Certain Medical Treatments: Some cancer treatments, such as chemotherapy and radiation, can harm the ovaries and lead to low AMH levels.
• Genetic Factors: Genetic factors can play a role in determining a woman’s ovarian reserve and AMH levels.
• Lifestyle Factors: Smoking and exposure to environmental toxins can adversely affect ovarian reserve and, consequently, AMH levels.

It is important to remember that low AMH levels are not always an indicator of infertility, and many women with low AMH can still conceive. General health and other factors like age also play a significant role in determining fertility.

When Should You Have an AMH Test?

The timing of an anti-Müllerian hormone (AMH) test depends on your specific situation and why you are considering the test. Common scenarios where AMH testing is typically conducted include:

• Fertility Assessment: Many women undergo AMH testing as part of a fertility evaluation. If you are questioning your fertility status and likelihood of conceiving, this test can generally be done at any time during the menstrual cycle. It is not cycle-dependent, so it can be performed whenever convenient.
• Assessment of Ovarian Reserve: For women concerned about ovarian reserve or planning reproductive treatments like in vitro fertilization (IVF), the AMH test is typically done in the early days of the menstrual cycle, usually between days two to five. This timing provides a more accurate assessment of ovarian reserve.
• Assisted Reproductive Technologies: If you are considering assisted reproductive technologies such as IVF, your healthcare provider may recommend an AMH test as part of the initial evaluation to determine the best treatment plan.
• Monitoring Ovarian Function: In situations where medical conditions or treatments may affect ovarian function, AMH testing can be performed at various times as needed for monitoring.

Consulting a healthcare provider, particularly a fertility specialist, is essential to determine the best time for an AMH test based on your circumstances and reasons for testing. They can guide you on timing and interpreting results to help you make informed decisions regarding reproductive health.

Is There a Treatment for Low Ovarian Reserve?

There is no specific medical treatment that can significantly increase a woman's ovarian reserve if it is naturally low due to aging or other factors. However, there are various options and approaches to consider based on an individual's situation and goals:

• Fertility Preservation: Women with low ovarian reserve who wish to have children in the future may consider fertility preservation methods, such as egg freezing (oocyte cryopreservation). This allows them to store their eggs at a younger age, potentially of higher quality, for use in future reproductive procedures.
• In Vitro Fertilization (IVF): IVF may still be an option for women with low ovarian reserve. Although the quantity of eggs may be limited, the quality of the remaining eggs is crucial. Many women with low ovarian reserve have successfully conceived through IVF.
• Donor Eggs: In cases of significantly diminished ovarian reserve or poor egg quality, using donor eggs from a young and healthy donor can be a viable option for achieving pregnancy.
• Hormonal Stimulation: Some women with low ovarian reserve may be candidates for mild ovarian stimulation protocols during IVF. This can help increase the number of eggs retrieved in a single cycle.
• Consulting a Fertility Specialist: For those with low ovarian reserve, consulting with a fertility specialist is highly recommended. Specialists can provide a thorough evaluation, discuss options, and create a treatment plan tailored to the individual's specific situation.
• Lifestyle and Holistic Approaches: Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and stress reduction, can support overall reproductive health. Some individuals explore holistic treatments or alternative therapies, although the effectiveness of these methods can vary.

Can Premature Menopause Be Prevented?

Premature menopause, generally defined as menopause occurring before the age of 40, is primarily influenced by genetic and hormonal factors and cannot be entirely prevented. However, individuals can take steps to promote reproductive health and possibly delay the onset of early menopause. Maintaining a healthy lifestyle with a balanced diet and regular exercise can be beneficial. For those at risk, reproductive preservation methods like egg freezing are also an option. Managing underlying medical conditions and discussing hormone replacement therapy with a healthcare provider can offer additional options.

Individuals experiencing concerns related to low AMH levels or premature menopause may consult a healthcare provider for more information on these topics.