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Low Anti-Müllerian (AMH) Levels

On this page

  1. Overview
  2. Symptoms
  3. Testing
  4. Causes
  5. Treatment

1. Overview

Anti-Müllerian (AMH) is a measure of egg reserve. A low AMH level is considered to be below 9 pmol/L (4 ng/mL), although this various from country to country. Some women with a low AMH level can still produce a good egg, conceive and have a healthy pregnancy, with the right treatment, as good fertility is about the quality of the egg and not how many you have.

As a general rule, a woman’s AMH level starts to decrease from the age of 35. However, it varies from woman to woman. Some women can still have a good AMH level at 40 and others it starts to drop from 30. It varies and is based upon genetics, lifestyle, diet and if you’ve done IVF before. Women with PCOS will tend to have higher levels of AMH and they don’t ovulate, which consumes AMH.

2. Symptoms

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. However, this risk can be reduced by improving egg quality through treatment.

3. AMH test

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

4. Causes

In western medicine, it’s often related to age or having underdone chemotherapy or repeated IVF cycles. Chemotherapy and IVF greatly damages yin and blood leading to a jing deficiency, which relates to AMH. The cause of a low anti mullerian hormone level in Chinese medicine are outlined 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. Maintaining an optimal diet and lifestyle together with supplements and Chinese herbs can help to replace deficiencies in the body.

5. How to treat 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. It takes 85 days for an egg to grow from start to finish. Over this time, the quality of the egg will be based upon the woman’s underlying health. By improving the woman’s health during this period, it is possible to improve egg quality.

Supplements

Supplements such as DHEA have shown to increase AMH levels, improve the number of 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 DHEA if you have higher than normal levels of testosterone.

Other supplements that have been shown to increase egg quality is co-enzyme Q10 at 600mg a day.

Acupuncture

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.

TCM (Chinese herbs)

Chinese herbs in conjunction with supplements and acupuncture can help AMH levels and improve egg quality..

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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