Infertility Successful Pregnancy inspite of AMH

Daily at least one woman come to me with a blood report of Low AMH. The majority are being advised to go for treatment of ART (Artificial Reproductive Technique) i.e. IVF (commonly known as Test Tube Baby) with donor eggs. This is an extremely stressful situation for the woman being labeled as infertile due to a low number of eggs i.e. having a low ovarian reserve. They need proper counseling and stepwise treatment involving medical management followed by IVF in case there is no spontaneous conception even after medicines. Surprisingly, many such women conceive spontaneously within 1-3 months of medical treatment. There may be two subsets of patients presenting with low AMH - One group having a reduced quantity of eggs owing to the age of the patient etc and the Second group having reduced quantity as well as poor quality of eggs. The first group usually conceives spontaneously & go on to have a successful live birth later on. The second group on the other hand usually is unable to conceive on the first hand and even if conception occurs they are more prone to have a miscarriage later on. We don’t have any marker at present to differentiate these two subsets. Usually, women with previous spontaneous conception, prior normal pregnancy, having regular menstrual cycles and showing only isolated Low AMH as a marker of Poor Ovarian Reserve, have better chances of conceiving naturally and giving birth to a healthy baby after nine months.

Following is the list of few facts regarding AMH for women declared as infertile only due to Low AMH. I seriously want every woman with Low AMH report to read & understand these facts-
Blood tests for Estimating Number of eggs- AMH, FSH, LH, etc
- What do you mean by AMH?
AMH is an abbreviated form of Anti Mullerian Hormone. But this doesn’t matter at all for you. The most important fact for you here is that it is just ONE out of MANY hormones in your body which are used as markers of fertility in females i.e. representing several eggs in ovaries (Ovarian Reserve). Besides AMH, other markers of ovarian reserve are FSH, LH, Estradiol, etc seen in a blood test on the second day of your menstrual cycle. So, just isolated Low AMH is not that important if the rest of your hormones are normal.
Ultrasound markers- numbers of eggs and volume of ovary
Besides blood tests for above-mentioned hormones, there are other factors also seen in sonography like
- AFC (antral follicle count- number of small eggs seen in your ovary in ultrasound).
- Ovarian Volume - Another predictor of ovarian reserve.
Ovarian Reserve & Pregnancy-
Normally, every month there is the formation of one egg in either of the two ovaries in a woman. When this egg is released and gets a chance to meet a sperm in your fallopian tube, chances of pregnancy are high. As such, just technically speaking, we need only one good quality egg to conceive and achieve a successful pregnancy.
Why is AMH being done?
To begin with, AMH was used to predict the dose of injections to be given to the woman undergoing IVF. It was being used just as a predictor of the response of the ovary i.e. how many eggs can be expected in an IVF cycle to assess the success rate and counseling of the couple going for this expensive procedure. But now with the wide availability of this test, everyone is getting it done in all couples facing difficulty in conceiving. Though it can be used to limit the duration of the waiting period before referring any patient for IVF, it will be harsh to advice such women to go for donor eggs directly. This, in turn, raises stress level exorbitantly in such couples, many of them being left disheartened.
Menstrual Cycle and Age -
In a young female below 30 yrs of age getting regular periods, isolated Low AMH with normal levels of rest of the hormones, there is no reason to PANIC. She should be referred to an infertility specialist but it's not at all appropriate to dictate them IVF with donor eggs immediately.
Medical treatment -
There are many supplementary tablets & capsules proven beneficial in improving AMH levels & attaining spontaneous conception e.g. DHEA 75mg daily, Coenzyme Q10 300mg twice a day, etc. These medicines have to be taken for at least 3 months and many times there is spontaneous conception during this medical treatment. In case there is no spontaneous conception during this period then still there is an option of IVF with customized treatment guidelines for egg retrieval protocols in such women with low AMH. The option of donor eggs is the last resort only if we are not able to get good quality embryos using self eggs of the woman.
KEY Point is NOT TO PANIC even if you get a low AMH report. Better to plan a visit to an infertility specialist having expertise in such cases, for detailed consultation, appropriate and timely medical advice.
For further queries kindly visit www.drvaishalisharma.com or WhatsApp at +91 89802 37649 or call on +91 89802 24346 for appointments.

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