Low Anti-Mullerian Hormone (AMH)
What Does “Low AMH” Mean?
Low AMH is an important indication of diminished ovarian reserve (DOR). Blood test for this hormone is an integral part of fertility workup for this reason at any fertility center. However, many centers don't use age-specific hormone levels during ovarian reserve testing. Because a woman’s normal AMH and FSH levels change as she gets older, using a universal cut-off value to define low ovarian reserve may miss some younger women with beginning stages of premature ovarian aging (POA, premature loss of ovarian reserve). This can lead to critical delays in treatment and inappropriate ovarian stimulation protocols.
CHR has defined age-specific baselines for AMH and FSH levels to more accurately assess a woman’s ovarian reserve status. The figure illustrates the age-related decline in anti-Mullerian hormone, with the purple shaded area representing the normal ovarian reserve for each age.
This way, we are able to design IVF protocols according to each woman’s ovarian reserve status, not just based on her age. We strongly encourage women who are thus diagnosed with low anti-Mullerian hormone not to delay fertility treatment because this hormone and ovarian reserve continue to decline with age.
AMH and IVF Success Rates
Many fertility centers still do not offer fertility treatment with the patients’ own eggs to women whose AMH falls below the universal cut-off levels (or whose FSH is above the cut-off). This approach helps centers keep their published IVF success rates high, because women with lower pregnancy chances are excluded. However, it obviously leaves women with low anti-Mullerian hormone and/or high follicle stimulating hormone levels with no opportunity for treatment with their own eggs, rightly feeling abandoned.
CHR has no arbitrary cut-off values. We work with each patient to explore the best treatment options for her clinical circumstances and preferences. In fact, when we use the appropriate ovarian stimulation protocol and address other factors involved in a low AMH patient’s infertility, we have found that the IVF pregnancy rates can be much higher than what she was told by other fertility centers. Women with even undetectable levels of AMH have been able to conceive with their own eggs, when given appropriate pre-cycle preparation and stimulation protocols.
DHEA Supplementation with Low AMH Levels
Women with low AMH typically benefit the most from well-managed IVF protocols. Treatment plans for these patients at CHR most likely involve DHEA supplementation, which has been shown to be effective in improving IVF pregnancy rates when anti-Mullerian hormone is low.
Published CHR studies over the last 8 to 9 years have shown significant improvements in the level of AMH after DHEA supplementation. Women younger than 38 saw a bigger improvement in concentrations of this hormone after DHEA treatment, compared to older women. Improvements in anti-Mullerian hormone levels after DHEA supplementation were found to be one of the most reliable prognosticators for a successful pregnancy with IVF.
With the introduction of DHEA supplementation and research-driven treatment plans modified to best suit individual patients, CHR doctors have become world-renowned experts in diminished ovarian reserve treatment and diagnosis. “Diminished ovarian reserve” is an umbrella term that encompasses both premature ovarian aging (POA) and natural, age-related loss of ovarian reserve.
We serve many patients from all over the world who seek out CHR’s expertise in treating women with low AMH. While, unfortunately, not everyone becomes pregnant with their own eggs, we are happy to say that our clinical pregnancy rates are quite respectable considering that most of CHR’s patients came to us after having multiple failed IVF cycles elsewhere or being rejected by another center because their chances of pregnancy were considered “too low.”
Questions About Low AMH Treatment?
"Anti-Mullerian hormone levels are a strong indicator of ovarian reserve. Even women with low (or undetectable) AMH may still have a good chance of pregnancy at CHR."Dr. Norbert Gleicher
IVF with low AMH Levels
The probability of success with an in vitro fertilization (IVF) cycle largely depends on a woman's ovarian reserve and her ability to produce a large number of high-quality eggs in a cycle. Low AMH, as well as abnormally high FSH levels, suggests a compromised ability of the ovaries to produce a good number of high-quality eggs, denoting a relatively poor fertility prognosis and low probability of success with IVF. At CHR, our IVF success largely derives from 1) thoroughly individualized treatment plans, 2) pre-cycle supplementation to restore the ovarian environment, 3) aggressive stimulation protocols and 4) proactive management of (often interconnected) conditions that also affect fertility.
Very low anti-Mullerian hormone, usually defined as below 1.05 ng/mL, has been associated with extremely low pregnancy chances and many IVF centers flat out deny treatment to women with such low levels. However, recent CHR research published in the journal Human Reproduction suggests that even women with undetectably low levels of AMH (below 0.16 ng/mL) can still conceive and successfully carry pregnancies to term, if given proper treatment involving DHEA supplementation along with well-designed ovarian stimulation protocols.
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.
Last Updated: May 1, 2020