Female fertility is
dependent on a variety of factors and hormone level is the key one amongst
these factors. There was a time when FSH or follicle stimulating hormone was
regarded as the parameter for hormonal testing, but the latest in the hormonal
brigade is Anti Mullerian Hormone, more popularly known as AMH. Medically, AMH
is defined as a hormone produced by the follicles, during the primordial
(earliest) stage of the follicular development.
AMH level has a direct
influence on the fertility of a woman as it determines the number of follicles
which will be produced by her ovaries, which in turn would determine her
available egg supply. Low AMH level is responsible for a lesser number of
ooytes (eggs) left with the woman and thus, reduced fertility. Therefore AMH
level is now seen as a more reliable way of determining the fertility of a
woman (in terms of egg quantity and quality) and then deciding the line of
treatment that has to be followed in infertility cases.
Why
is AMH testing considered more accurate than FSH testing?
A woman battling with
infertility has to be evaluated extensively for finding out the exact reason of
the condition. The latest amongst the diagnostic tests recommended for such
patients is AMH testing. Currently, AMH testing has become a more accurate
evaluation as compared to FSH testing. The reason is that FSH levels keep
fluctuating during the menstrual cycle and can bring reliable results when
checked only at particular time during the cycle.
Conversely, AMH levels
remain steady during the entire menstrual cycle, which makes it a much more
reliable parameter for judging the ovarian reserve of the woman. Moreover, AMH
level is the direct indicator of the oocyte production, which means that it is
a better way to check the fertility of the patient. In fact, a woman may have
optimal FSH levels but still may not be able to conceive because her AMH is
low.
Normal
AMH level and chances of conception
AMH levels are tested
using a blood test, which indicates the level of the hormone in the blood. This,
in turn reflects the size of the ovarian reserve of the woman (in layman’s
language, the size of the remaining egg supply in the ovaries of the woman). As
the woman progresses in age, the AMH level starts falling as this reserve keeps
on diminishing, which is the reason why fertility deteriorates in advanced
maternal age.
For women under 35
years of age, the range between 1.5 ng/ml and 4.0 ng/ml is regarded as the
normal AMH level. Those who are nearing menopause have very low AMH level,
lesser than 0.5 ng/ml, a reading which indicates that their chances of
conception are bleak. On the other hand, high readings of AMH (in the range of
more than 4.0 ng/ml) show that the woman has numerous follicles of very small
size, as seen in the patients of polycystic ovarian disease.
What
if your AMH level tests bring very low readings?
Typically, low AMH
levels mean that the woman does not have many eggs available for conception.
But there is no reason to panic when tests bring very low readings. When
something like this happens, the specialist would first confirm the reports by
recommending a repeat test from another lab and then some ultrasound scans.
Another advanced blood test called clomid challenge test can also be done.
At the same time, it is
important to be aware that low AMH levels do not necessarily mean that the
woman cannot have a baby at all. Women of younger age have good chances in
particular, if they get the right kind of treatment. A course of DHEA
(dehydropiandrosterone) has shown proven results as a treatment option for
women with poor ovarian reserve. But the medicine should not be taken by the
patient without being assessed by an expert fertility specialist.
How
do your AMH levels influence the chances of IVF success?
If you are a potential
candidate for IVF, you need to know how your AMH levels are going to influence
the chances of success of the procedure. Obviously, those with higher levels
are likely to be better off because they will respond to the ovarian stimulation
in a better manner and produce more eggs for retrieval. The greater the number
of eggs retrieved, the better are the chances of getting that one high quality
embryo which can be implanted in the uterus for a successful pregnancy to take
place.
However, this in no way
implies that women with low AMH levels should lose hope because they do have
chances of getting pregnant naturally or with artificial reproductive
techniques, however few these maybe. In fact, IVF gives such women better
chances to conceive because it makes the optimal use of the few eggs which are
left in their ovarian reserve. In cases where even IVF brings no hope for such
patients, donor eggs may be considered as the next option.
If
you have very low AMH levels, you can still get pregnant with the right treatment.
You can seek a free second opinion from Dr Manika Khanna, the expert fertility
specialist at
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