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Helping you unlock the puzzle of infertility – one story at a time!

Towards a better understanding of the dreaded low AMH reading!

Women with infertility often have the wind taken out of their sails upon discovering from a blood test that their AMH number is low.  The reason it knocks the wind out of people is because western medicine interprets a low score to mean that the pool of eggs remaining in the ovaries is nearly depleted – which inevitably means menopause is close, and the window for having a baby is effectively closed – or at best nearly closed, but this is both true and untrue at the same time.

Allow me a minute to explain AMH from a more holistic point of view – in the worst case it won’t make any difference to you, but there’s a chance it will put some wind back in your sails.

We need to get a bit technical –

Ovaries don’t produce eggs as such, the eggs are already there at birth, existing in a state of suspended animation in what’s called the primordial pool.  They’re tiny and inanimate, and each egg is wrapped in a structure called a primordial follicle which protects and nourishes it.  These follicles, each with a single egg inside, are packed densely in the deep core of each ovary awaiting a signal to activate, whereupon they begin to mature and move from the deep core of the ovary to the outer surface in a sort of factory conveyor belt motion. 

This signal starts at menses when the monthly cycles begin and continue until menopause, rising and falling each month.  At puberty the pool of eggs is full, containing hundreds of thousands of them, and at menopause it’s basically empty.  Each cycle sees just a handful of eggs recruited from the primordial pool, and only one of those eggs gets to ovulate in any given month – the four or five others involute and get recycled into nutrients each cycle.  As you might imagine, the body has a mechanism for ensuring that the entire pool of eggs doesn’t get used up in one manic cycle – but rather stays around, albeit gradually depleting, for the duration of the woman’s fertile life.  Anti-Mullerian Hormone (AMH) is part of this control mechanism – and understanding how it works will help you think clearer if you ever get presented with a test score that takes the wind out of your sails.

AMH is produced in the ovaries, specifically by ‘granulosa cells’.  Granulosa cells are packed inside each follicle where they envelop the egg, providing it with energy and hormone signals to regulate its maturation.  The function of AMH is to slow down, or you might say to pace, the maturation process of the handful of follicles that are selected for maturation in any given month.  In other words there is a signal which says – “come on guys it’s time to mature”, but there’s another signal which says – “OK – not too many of you now, and not too fast”.  The first signal is FSH, and the second one is AMH.

If the body, in its wisdom – or potentially because it’s become dysregulated – decides that the egg maturation process is going too quickly, it will signal the granulosa cells to release more AMH in order to slow down the process.  AMH is essentially an inhibitory hormone in this regard.

Lots of women with PCOS will be familiar with very elevated AMH reading’s, whilst other women without PCOS, but who are experiencing infertility, will be familiar with very low AMH readings.

With PCOS – the ovulation process has become dysregulated such that too many eggs (or more accurately too many follicles) are being recruited and are developing too fast in any given monthly cycle (it is these fast-growing follicles that end up being referred to as Poly Cysts – where PCOS gets its name).  In this case the body instructs the granulosa cells to increase their output of AMH in order to slow down the process.

In other cases of infertility, a woman’s ovaries will be struggling to light a fire under the follicle and egg maturation process each month, such that either no follicles are being recruited to mature, or the maturation process itself is going too slowly.  In these cases the body instructs the granulosa cells to reduce the quantity of AMH they are releasing, in order to allow the maturation process go forward unimpeded.  You could think of this as the body taking off the speed limits so to speak.

In this light you can see that there is wisdom in your AMH readings – and the key would be to figure out why the body is regulating AMH in this way, rather than get worried about the test result number itself.

Of course one reason for a very low AMH reading – is exactly as the medical community describes it – the pool of eggs is running low, and menopause near – but what I am emphasising here is that this is only one reason out of a list of possible reasons for low AMH – and many of those reasons can be fixed or improved. 

The message from the mainstream medical community is that pregnancy is less likely to occur in women who have low AMH reading’s – but actually what the scientific papers really tell us is that pregnancy is less likely to occur – during IVF procedures – in women with low AMH readings.  The truth of the matter is that investigations into this phenomenon do not tell us that women with low AMH readings are significantly less likely to conceive and become pregnant using the natural approach – however this has become the de-facto message that’s given out, essentially the message has become conflated with the IVF message.

You only need one egg to be ovulated and get fertilised in order to get pregnant – the body is far more capable of selecting the healthy egg than the IVF procedure is – so having low AMH readings shouldn’t be taken as a sign of imminent failure if you are trying to conceive naturally, but instead should be taken as a tap on the shoulder that you might need to look into optimising the health of your ovaries.

A low AMH reading does not mean ‘game over’ – it means ‘game on’!

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