Low Amh: Ivf Not Always Needed

Low AMH does not mean you cannot get pregnant.

What is AMH?

AMH (Anti Mullerian Hormone) is a hormone secreted by the ovaries. AMH indicates the “ovarian reserve”. It is checked by a blood test. This blood can be checked at any time.

What is Ovarian Reserve?

“Ovarian reserve” means the number of eggs inside the ovaries of a woman at a particular time.

In women, the eggs are produced in the ovaries before the women is born. After birth, no new eggs are produced. On the contrary, in each month, a number of eggs are destroyed. From adolescence, (after starting of the period), in each month only one egg grows, becomes mature and gets released (“Ovulation”) from the ovaries by rupturing the walls of the ovaries.

Thus, in each month one egg is ready to meet the sperms and give rise to pregnancy. At the same time, the destruction of eggs continues. As a result, when a woman reaches the age of 45-50 years, almost no eggs are left behind. Thus, the woman achieves menopause (permanent cessation of menstrual period) at 45-50 years, after which natural pregnancy is not possible.

How Ovarian Reserve is tested?

The best test for Ovarian Reserve is the “Age”. As the age increases, the reserve declines. This decline is slow till 35 years and is very fast after 40 years.

AMH is also a marker of Ovarian Reserve.

Another important marker is AFC (Antral Follicular Count). AFC means the number of eggs seen in the ovaries, which is checked by inserting the ultrasound probe inside the vagina (TVS- Transvaginal Sonography) during the period. This test is not painful. In women with low ovarian reserve, AMH and AFC both can decrease.

Sometimes, we check blood for FSH during the period. High FSH means ovaries are not functioning well.

What should I do if I have low AMH?

LOW AMH DOES NOT MEAN YOU NEED IVF. AMH alone cannot decide the mode of treatment. AMH is a number. We are treating the patients (the couples), NOT the numbers. Therefore, we need to check the patient’s age, duration of Infertility, AFC, husband’s sperms and conditions of the Fallopian tubes.

If all of these are favourable, you may try with medicines (Ovulation Induction) and/or IUI. If these are not successful, then only plan for IVF.

However, the above factors are not good, then you can consider IVF.

Therefore, whether you need IVF or not, depends on several factors. AMH alone cannot decide the need for IVF. So, think twice before jumping for IVF only for low AMH. Remember, the chance of pregnancy after each IVF cycle is 40-50%.

This couple was referred to us by our Gynaecologist colleague from Howrah. They were trying for pregnancy for 8-9 months and the lady had low AMH. Her age was only 32 years and AFC was good. The condition of the Fallopian tubes and Husband’s sperms were good.

We gave them oral medicine Clomiphene Citrate for Ovulation Induction but this medicine did not work (no eggs were growing after taking that tablet). They were desperately thinking for IVF.

After discussion, we gave them oral tablet Letrozole next month. The ovaries were responding well. We advised them to try it for 2 months further. But after 1 month, they came with good news.

Please pray for them.

PS- published with kind permission from the patient.

Posted in fertility, infertility, sexual well being, women's Health.

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