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Anti-Müllerian hormone (AMH) Levels

Generally, a low AMH level is below 9 pmol/L (4 ng/mL), although this is greatly variable. Egg quality will vary from woman to woman. Some with a very low AMH level can still produce a good egg, conceive and have a healthy pregnancy, with the right treatment.

Prevalence

Women from 35 years of age onwards are more likely to have low AMH levels. This is something that I see more and more often in my clinic. More and more women from a younger age are being diagnosed with low AMH levels and poor ovarian reserve. It often goes unchecked as it’s the last thing that is tested.

Symptoms

  • Poor egg quality
  • Reoccurring early miscarriages
  • Failed IVF cycles
  • Reduced pregnancy rates

AMH test

A blood test can be taken at any time in the menstrual cycle to measure AMH levels. However, levels will be higher in the first part (follicular) phase of your menstrual cycle.

Causes

The cause of a low anti mullerian hormone levels in Chinese medicine are outlined below. In western medicine, it’s often related to age or having underdone chemotherapy. Chemotherapy greatly damages yin and blood leading to a jing deficiency, which relates to AMH. Aging is due to a deficiency of some kind, as listed below:

  1. Genetics (jing deficiency)
  2. Excessive conceptions (jing deficiency)
  3. Overwork (yin deficiency)
  4. Poor diet (qi and blood deficiency)
  5. Excessive exercising or physical work (yang deficiency)

As we get older, we become more and more deficient. Life wears us out. It is therefore important to maintain a healthy lifestyle throughout our life, as the Chinese still do. Unfortunately, when most people are young, then tend to feel invincible and will work long hours, party all night and drink too much alcohol and eat junk food. This eventually catches up with the body. It often comes as a shock to most women diagnosed with low AMH levels, at a time in their life when they feel they know who they are and what they want, only to be told that their body is starting to show signs of aging and fertility is now a challenge.

Risks

Having a low AMH level will increase the likelihood or having an early miscarriage due to defective chromosomes within the egg. There is also an increased possibility of the baby having a birth defect, i.e. Downs syndrome or them having impaired fertility later in life.

How to increase your AMH levels

Supplements such as DHEA have shown to increase ovarian follicles and increase the chances of pregnancy. I've seen this in my clinic with woman having an increased antral follicle count after taking DHEA. The dosage for DHEA ranges from 25-75mg a day. Do not take if you have higher than normal levels of testosterone.

Acupuncture for low AMH levels

In women with a low AMH level, western doctors often recommend a donor cycle. This can be hard on some couples. However, in my clinic, in some women it is still possible to treat them enough for them to fall pregnant naturally. However, it can take several months of treatment using acupuncture, Chinese herbs, dietary and lifestyle advice. AMH is really a measure of egg quality rather than quantity. Eggs still in a line like a conveyor belt waiting their turn to mature. This process takes around 85 days.

The quality of the egg when it comes to mature is dependent upon the body’s health within those 85 days. If the body’s health can be increased to a level at which all bodily needs have been met and there is energy and blood left over, then it can be used to influence the quality of the emerging embryos. In such cases, all aspects of life should be optimized including diet, lifestyle, supplements and the taking of Chinese herbs with accupuncture.

For women undergoing fertility treatment such as IVF treatment with low levels, less stimulation is used to try and get less eggs but of a better quality. Often referred to as ‘natural’ or ‘soft’ cycles, the dosage of the IVF drugs is lower and gently encourages a smaller number of eggs to ripen. In such cases, it is vital for women to prep before starting an IVF cycle months before with accupuncture and Chinese herbs, as well as optimising dietary and lifestyle aspects

TCM for low AMH levels

Research has shown that acupuncture is able to regulate AMH levels in women, improve their ovarian reserve and chances of getting pregnant. Women with PCOS will naturally have higher than normal levels due to multiple follicles being present. Acupuncture is able to normalise AMH levels in women with PCOS.

References

Wang Y, et al. (2016) Electroacupuncture for reproductive hormone levels in patients with diminished ovarian reserve: a prospective observational study. Acupunct Med; 0:1–6. doi:10.1136/acupmed-2015-011014.

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