As a fertility dietitian, I understand that receiving the news you have low AMH (or low ovarian reserve) can be very shocking and disheartening, but also generates a whole bunch of questions like…
Does it mean I will go through menopause early?
Does this hurt my chances of having a baby when I want to? Now or in the future?
Do I need to drop everything and freeze my eggs whilst I still have some?
I have witnessed countless clients in our virtual clinic at The Dietologist, navigate these very questions and thoughts, so I wanted to share this guide on how to navigate the “I Have Low AMH” news and provide some facts and reframes to help you decide on what’s right for you without the ridiculous rush and pressure!
What is AMH?
Anti-Mullerian hormone (AMH) is a hormone produced by the ovarian follicles (potential future eggs!). Its measurement often indicates ovarian reserve, or the number of eggs “left” in the ovaries.
Don’t worry this number does not equal the physical number of eggs, it is a proxy marker of ovarian reserve.
However, it’s important to remember that low AMH is not a definitive sentence for infertility. It tells us not much at all about how easy or hard it may be to conceive, some people with a very low AMH conceive quickly & easily and others with high AMH have delays, and vice versa!
AMH was originally designed to be used to design IVF protocols and provide a rough estimate of how many eggs one can expect to retrieve in a single round of egg collection once the ovaries have been stimulated.
There are steps you can take to optimise your fertility journey and focus on egg quality, rather than quantity.
Sadly, we can’t grow back more eggs, the number only ever declines as we get older (unfortunately) so instead, focus on what can be changeable – egg health!
What Are the Symptoms of Low AMH?
In most cases, there are no symptoms of low AMH.
Low AMH levels are often discovered during tests before commencing fertility treatments like IVF or egg freezing. Keep in mind, there is not a single test that can assess your ability to conceive or not, if only it were that simple! And that includes your AMH.
Whilst, it is essential to note that low AMH does not cause any specific symptoms on its own, sometimes there may be strong indications such as:
- Amenorrhoea: periods going MIA or becoming less regular, which can often get misdiagnosed as PCOS.
- Infertility: this can occur as a result of your ovaries not producing normal amounts of estrogen or releasing eggs regularly and is often what can lead to the AMH test being requested by your doctor in the first place (Revelli et al., 2016).
- Menopausal symptoms: feeling moody, not sleeping well, irritability, hot flushes, night sweats, low libido, periods suddenly becoming irregular (Note: these symptoms may be more severe compared to women experiencing natural menopause)
- Psychological issues: you may experience higher levels of depression and anxiety (this may also be related to the news itself of finding out you have a low AMH) (O’Brien, Kelleher, Wingfield, 2018).
Common Causes of Low AMH
Several factors can contribute to low AMH levels.
These include:
- Your age
- Genetic factors
- Some autoimmune disorders
- Certain medical treatments such as chemotherapy and cancer therapies.
- Ovarian surgery
- Endometriosis and/or laparoscopic excision around the ovaries
- Unexplained, usually called primary ovarian insufficiency (POI)
Remember, these causes may not apply to every individual, so it’s crucial to consult with your healthcare provider for a personalised understanding of your situation.
Also note, that if you have a vitamin D deficiency can also falsely lower your AMH level, correcting this can improve your AMH and make it more accurate to interpret, but it doesn’t mean you grew back more eggs!
Get more help with low AMH by listening to our podcast episode here: Episode 56 of Fertility Friendly Food The Podcast
Important Factors to Know About Your AMH results
The Number of Eggs You Have Cannot Be Increased
Whilst your AMH level may fluctuate a little naturally, the number of eggs you have does not increase over time. No food or supplement can increase egg count (sadly!), but we can focus on nourishing that egg as much as possible to support its egg quality through diet, lifestyle & targeted supplementation – read on for more!
Vitamin D Status & AMH
Low levels of vitamin D can potentially affect fertility markers, including AMH levels. Vitamin D deficiency may lead to a false low AMH result, indicating a diminished ovarian reserve when that might not be the case. If you have received a low AMH result and suspect a vitamin D deficiency, consult your healthcare provider or fertility specialist to work on your vitamin levels before re-testing your AMH levels again.
Biotin or Vitamin B7 Status & AMH
If you’re currently taking biotin supplements or considering them, it’s crucial to keep your healthcare provider or fertility specialist in the loop. These are often found in “hair, skin and nails” type supplements or even some prenatal vitamins. High levels of biotin may result in a false elevation of AMH levels.
Shifting The Focus to Egg Quality
While low AMH levels may indicate a decreased quantity of eggs, it’s essential to remember that quality matters just as much (if not more) than quantity.
By focusing on optimising egg quality, you can enhance your chances of successful conception.
Avoid the following to support egg health:
- Smoking
- Excessive alcohol consumption
- Environmental toxins
- Foods high in saturated & trans fats
Boost Your Antioxidants to Support Egg Health:
Boost dietary antioxidants with fruits, veggies, extra herbs and spices and omega-3 fatty acids to avoid oxidative stress and support egg health.
For those over the age of 35 years old, speak to your healthcare provider or see a fertility dietitian about other supplementation options such as Coenzyme Q10 or ubiquinol to see if it’s right for you to help support egg quality.
A quick note on the broader effects of Low AMH
There are some other health implications to consider if you have been given low AMH test results, outside of fertility.
Possible Early Menopause
Those with low AMH may experience some menopausal symptoms, such as hot flashes, mood changes, and changes in bone density, at an earlier age than those with higher AMH levels. However, we don’t know the rate of ovarian reserve decline for each individual (Nelson et al., 2023).
Bone Health
Low levels of AMH may indicate a higher risk of decreased bone density and osteoporosis (Karlamangla et al., 2022).
Reduced estrogen production can impact bone health, highlighting the importance of monitoring bone density and considering preventative measures such as calcium and vitamin D supplementation, weight-bearing exercises, and regular screenings.
Polycystic Ovary Syndrome (PCOS)
Although low AMH levels are often associated with diminished ovarian reserve, in some cases, they can be found in individuals with polycystic ovary syndrome (PCOS). Typically, people with PCOS have high levels of AMH (Sivanandy & Ha, 2023).
PCOS is characterized by hormonal imbalances, cysts on the ovaries, and various symptoms, including irregular menstrual cycles, excessive hair growth, and acne.
Ok so, What Do I Do About My Low AMH Now?
Having low AMH test results can be emotionally challenging, but it doesn’t mean your fertility journey is going to be a challenge. It is very possible to conceive with a low AMH! Trust me, I’ve seen it countless times before.
Speak to your doctor or fertility specialist about the best options and next steps for you.
By focusing on egg quality and adopting a holistic approach that encompasses nutrition, lifestyle, and emotional well-being, you can optimise your chances of conceiving.
Remember, every fertility journey is unique, and seeking guidance from qualified professionals will provide invaluable support along the way.
Want to work on your nutrtion to improve your fertility and egg quality, book a consultation with one of our expert certified fertility dietitians & nutritionists for individualised nutrition & supplementation advice.
