February 25, 2025 • 23 mins
No single marker for fertility causes as much anxiety and stress as the AMH. If your AMH is low, you've likely thought that you're "running out of eggs" and that you won't be able to get pregnant naturally.
In this episode, I talk about why that is incorrect. Here is what to expect:
- What AMH actually is
- What AMH actually do
- What does it mean if AMH is low
- Can AMH be increased?
- Factors that influence AMH
Please let me know what you think. I would love to hear from you!
Follow me on instagram @dradriennewei
Website: www.adriennewei.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Practically Fertile Podcast.
I'm Adrienne Wee, doctor ofacupuncture and Chinese medicine
, functional medicinepractitioner and functional
nutritionist.
I specialize in using anevidence-based method, blending
principles of East Asianmedicine and modern functional
medicine to help women optimizefertility and get pregnant.
(00:22):
I believe in a world whereevery woman who wants to be a
mother becomes one.
If you're tired of being toldthat you're infertile and you
want to take the right steps toget pregnant naturally and
quickly, this podcast is for you.
One of my patients, bridget herAMH was 0.29 and she was able to
(00:43):
conceive naturally at the ageof 43.
Another patient, darcy her AMHwas 0.7 and she conceived
naturally at the age of 42 andthen again naturally two years
later at the age of 44.
Gabriela I worked with hervirtually.
She was 36 years old and herAMH was 0.08, and she was able
(01:07):
to conceive naturally after twomonths.
So I know that AMH is probablyone of these markers that causes
you a lot of anxiety about yourchances of getting pregnant.
If you've been told that yourAMH is low, you might think that
it means you're running out ofeggs and that you can't get
pregnant naturally.
And I'm telling you thesestories because number one
(01:31):
having low AMH does not mean youcan't get pregnant, naturally.
Number two AMH numbers canincrease.
And number three AMH isactually not a measure of your
true ovarian reserve.
In this episode, I'm going toexpose the shocking truth about
the AMH and tell you what yourdoctors don't tell you.
(01:53):
So let's get started.
What exactly is AMH?
It stands for anti-mullerianhormone, and what's really
interesting about it is thatthis hormone is involved in the
fetal development process.
Both male and female fetusesare born with the mullerian duct
(02:15):
, which eventually turns intothe female reproductive duct,
including cervix, uterus,fallopian tubes.
Cervix, uterus, fallopian tubesAround eight weeks of gestation
, amh production for the malefetus help to produce a protein
that triggers a self-destructiveprocess that then dissipates
(02:35):
the mullerian duct, and thisprotein is only produced by the
male fetus and not the femalefetus.
So then the mullerian ductturns into the structure that
contains the cervix, uterus,fallopian tubes.
So how does the AMH become amarker for ovarian reserve?
The AMH production is very lowfor women at birth, but it
(02:58):
increases gradually as the womangets closer to puberty.
We focus a lot on the ovulationprocess, but in reality, the
follicle that matures thenreleases the egg.
It has been growing for thelast five to six months, maybe
even longer.
So let's start from thebeginning of the follicle
development process.
(03:18):
It all starts when you were inyour mother's womb.
Around six months of gestation,primordial follicles, or very
small follicles, start to form.
All of the primordial folliclesare formed between six to nine
months of gestation and this, myfriend, is your true ovarian
(03:39):
reserve.
And these follicles, theyremain dormant until puberty,
when they're activated.
But naturally a lot of themwill be lost from the time you
were born to the time when youget your first period.
So on average, you might beborn with 1 to 2 million
primordial follicles, but youmight only have 400,000 left at
(04:01):
puberty.
There's no way to measure theexact number of these primordial
follicles.
When a primordial follicle isactivated or awakened, it
becomes a primary follicle.
Then the primary folliclebecomes a pre-antral follicle,
120 to 90 days before ovulation,120 to 90 days before ovulation
(04:29):
, and then it becomes the antralfollicle.
These antral follicles are whatcycle day three ultrasounds
measure For IVF cycles.
The higher the number of antralfollicles, the better the
outcome.
So these antral follicles thengrow and the rest of the process
you're familiar with.
There's a dominant follicle.
Ovulation then, during theluteal phase is when the
implantation happens or doesn'thappen.
If there's no implantation,you'll start your period and
(04:53):
then the whole cycle starts overagain.
In the background, there'sactually a lot happening.
There's a constant supply ofpre-antral follicles that are
waiting to become antralfollicles, and it's on these
pre-antral follicles that theAMH is being produced.
Amh is only produced by thesefollicles and nowhere else, and
(05:15):
that is why AMH is so popularand is used as a marker for
ovarian reserve.
It shows how big the follicleselection pool is.
It is directly correlated tothe number of follicles that are
growing.
The idea is, the morepre-antral follicles you have,
there's more to choose from forovulation, and then that
(05:37):
increases the odds of gettingpregnant.
So it's all a numbers game, buthere's the real function of AMH
and how our body uses it.
The AMH is used to regulate thefollicle development process
that we just talked about.
It's meant to suppress the FSHso that not too many follicles
(05:58):
are recruited all at once, andthis will help to prolong the
reproductive lifespan of thefemale, because if too many
follicles are recruited at once,then you'll deplete the ovarian
reserve very, very quickly, andthis actually has been proven
with experiments with mice,compared to mice living in the
(06:18):
wild, the mice with no AMHthat's artificially induced.
The primordial folliclesdeplete and reach exhaustion at
a much younger age.
No one knows the exact numberof primordial follicles you have
.
There's just no way to measurethat, and that's why AMH is the
best marker to date, but itstill can't tell us how many
(06:41):
more follicles you have left.
So if you have low AMH, thechallenge is that your follicle
selection pool might be smaller.
So AMH is used to measure thefunctional ovarian reserve
rather than the ovarian reserve.
And, like we talked about before, amh and the antral follicle
(07:04):
count are useful tools fordoctors during an IVF cycle to
predict how many eggs can beexpected to be retrieved.
A question you might be askingright now might be well, you
just said that if the AMH is low, then more follicles are
recruited.
Then how come my antralfollicle count isn't higher,
(07:26):
according to the same logic?
Well, that's a really goodquestion.
Lower AMH a lot of times canmean a higher FSH level.
A higher FSH level means thatthe follicles are not going to
respond to this hormone and mostof them will stop growing and
die off.
But the FSH doesn't just act onthe follicles at the beginning
(07:49):
of the cycle.
It actually acts on thefollicles all the way back to
the pre-antral stage, 120 to 90days prior to ovulation.
So back to the example that Iused before, the mice with no
AMH.
The number of follicles thatmade it to the early enteral
stage is higher than the micewith AMH.
(08:10):
But once the follicles enterthe early enteral stage they
also stopped growing and theyjust die off.
And this process where thefollicles naturally die off, is
called atresia.
It can happen from activationtime of a primordial follicle
all the way up until the antralfollicle stage.
(08:31):
We know that influences fromthe external environment.
So things like diet, lifestyle,stress can influence how many
and how quickly the folliclesnaturally die off.
So more on that later.
But just because you have a lowAMH it doesn't always mean that
(08:52):
you have a high FSH.
You can have a low AMH butnormal FSH.
If your FSH is normal, eventhough your AMH is lower, that's
actually not a bad situation tobe in because that means that
your growing follicles willrespond to the FSH is normal,
even though your AMH is lower.
That's actually not a badsituation to be in because that
means that your growingfollicles will respond to the
FSH and grow appropriately, evenif the number of them is
(09:13):
smaller.
I want to touch on brieflyabout the other end of the
spectrum, which is when the AMHis too high.
The AMH is now becoming apopular marker to diagnose PCOS.
Not every single PCOS patientwill have high AMH, but it's
very common, especially in thetype of PCOS that causes
(09:35):
ovulation to stop.
One of the symptoms of PCOS ishaving many small follicles that
get stuck in the pre-antralphase and never grow to maturity
, and these are the folliclesthat produce AMH right.
So if the AMH is way higherthan the upper limit of normal,
(09:55):
it's usually suspected that it'scaused by PCOS due to the
follicles failing to grow past apre-antral stage.
The AMH will often return tonormal once the cycle is
regulated and the ovaries canovulate again, so this is
definitely not a permanentsituation.
Amh is not the only marker thatshould be used to test PCOS,
(10:18):
but it is a very useful one.
All right, the importantquestion is does having low AMH
mean that you can't get pregnant?
Absolutely not.
I hope you get that thought outof your head.
Remember the three stories thatI told you in the beginning.
Even the ASRM, american Societyof Reproductive Medicine, says
(10:40):
that AMH is not a predictor ofthe ability to get pregnant.
There are so many factors thatcan influence your AMH level and
your AMH level can increaseBecause if you can optimize your
reserve and increase the numberof quality follicles in the
selection pool prior toovulation, more of them will
(11:00):
survive and more of them willproduce AMH and more of them
will make it to the antralfollicle stage.
And yeah, of course your AMHwon't suddenly increase from 0.5
to 5, but it could make a bigdifference depending on what
your goals are Like.
If it increases from 0.5 to 1.5and you're doing IVF, that can
(11:25):
be the difference between 5follicles and 10 follicles.
My patient, konstantina she hadan AMH of 0.08, and her most
recent blood work showed thatthe AMH went up to 0.32.
And that's great because shewas told before that she would
have to do IVF with donor eggs,but now she's a candidate for
(11:47):
doing IVF with her own eggs.
So that is a huge, hugeaccomplishment.
And I've also had patientswhose AMH has gone from 0.3 to
1.4, 1.5.
So it's not uncommon for us tosee this type of results.
So if you have low AMH, how canyou increase the AMH and what
(12:11):
should you do to get yourselfthe best chances of getting
pregnant.
Let's talk about that.
Instead of focusing onincreasing the AMH number, you
should focus on optimizing thequality and the quantity of the
follicles that grow.
So let's go over some of thewell-known factors that will
affect AMH.
Age is a factor.
(12:32):
It's true that as you get older, the follicle depletion rate
increases, but that's not adirect cause of low AMH.
Young women can also have verylow AMH.
I have several patients rightnow who are in this situation,
and remember Gabriela.
She was only 36, but her AMHwas 0.08.
I have a 46-year-old patientright now.
(12:54):
Her AMH is 1.5, which is higherthan normal for her age.
Genetics is a factor as well.
You could be born with a lowreserve.
Remember all the primordialfollicles are formed between six
to nine months gestational age,while you were in utero.
Epigenetics is a huge factor.
(13:15):
One of my favorite topics thisis the environment that you're
living in, everything from dietto toxin exposure, to sleep
patterns, exercise and stress.
There's evidence that genesthat regulate follicle
development in women with lowreserve are often dysregulated,
meaning their actions becomeirregular, unpredictable and
(13:35):
inconsistent.
Major illnesses, chemo surgeriescan trigger your body to start
burning through the ovarianreserve.
The human body will alwaysprioritize survival over
anything else and unfortunately,reproduction is not one of the
necessities to survive.
If you've had surgery on theovaries, that would affect AMH,
(14:00):
because the primordial folliclesare stored in the ovaries, or
your AMH could be temporarilysuppressed Right after a woman
gives birth.
The AMH levels can be very lowImmediately after an IVF
retrieval cycle.
The AMH can be low if theantral follicles are not
replenished quickly enough.
And here's one that recentlycame out about AMH being
(14:25):
temporarily suppressed.
It's now confirmed that ifyou're taking hormonal birth
control, with the exception ofIUDs, your AMH could be
suppressed.
This has huge implicationsbecause a very popular home
testing kit company has made abusiness model out of this
testing young women's AMH andencouraging them to freeze their
(14:46):
eggs based on the results.
But your AMH while on birthcontrol could be lower than what
it should be.
So if you've done one of thesetests and your AMH is low, don't
panic.
Just get it retested a fewmonths after getting off the
birth control.
I want to share an interestingcase right now, actually my
patient Maria.
She took Clomid for a fewcycles and her AMH dropped to
(15:09):
0.2 and her FSH shot up to 70.
They told her that there's nohope and donor eggs is the only
option, and turned out, aftertwo months of stopping the
medication and gettingacupuncture, her FSH is now
under 10, which is very, verynormal, and she has had normal
periods, and we're just waitingto see what her AMH levels are.
(15:30):
So, as you can see, amh levelsare not set in stone.
They can go up and they can godown.
The important thing here is tofind out why the AMH levels are
low or has decreased Some of theinfluencing factors that we
just mentioned.
There isn't anything to be done,for example, age right, we
(15:52):
can't stop the aging process.
We also can't do anything aboutgenetics, but we can control
all these external factors likediet, lifestyle, toxin exposure,
stress.
Let's just talk about stressfor a second, because women who
experience higher levels ofperceived stress are found to
have lower antral follicle countand lower AMH.
(16:14):
But it's never talked aboutmuch, because who doesn't have
stress right?
Isn't it normal to have stress?
Of course it's very normal tohave stress, but how are you
handling the stress is thequestion.
Stress is very broad and it canbe emotional and physical
stress and everyday life stress,work stress, but the truth is.
(16:38):
It doesn't matter which form ofstress it is and where it comes
from.
The effect on our body is thesame, because our brains can't
tell the difference between thetype of stress.
When it feels like your survivalis threatened, it will go into
self-preservation mode and startshutting down whatever
functions are not necessary, andreproduction is usually the one
(17:00):
that gets shut down first.
And you might not see theimmediate impact of streks,
because as human we can toleratea lot of crap, right.
But look at it this way it'slike a pot of boiling water At
some point it's going to boilover if the burner stays on.
So when your body reaches thatpoint, several things can happen
(17:26):
.
It can affect the menstrualcycle at the highest level,
which is the hypothalamus, andthat's where the signal to have
a menstrual cycle comes from.
So the hypothalamus is affected.
Then there's no FSH, noovulation, no menstrual cycle
and no baby.
And when your brain decidesthat you're in survival mode,
(17:48):
then it will start to triggerprocesses to burn through the
ovarian reserve much morequickly, more follicles will be
activated and they will also dieoff very quickly.
Many of my patients tell me thatthey're not stressed, and then
we dive deeper and find out thatthey're not sleeping well.
There's tossing and turning,there's a lot of anxiety attacks
(18:09):
throughout the day, there areheadaches, daily, feeling of
tightness in the chest.
These are all warning signsthat our body is sending us.
And, yes, you can take a pillto sleep or relieve anxiety.
You can take Advil for theheadaches.
But if you don't fix the issueat the root and understand where
your stress is coming from,you're going to get stuck on
(18:30):
this merry go-round of forevertaking medication that have a
lot of side effects.
All right, so enough aboutstress.
From a TCM perspective, itdoesn't matter that you have low
AMH.
What matters is what is thepattern of imbalance that's
causing low AMH?
Is it because your qi is notflowing?
(18:51):
Is it because it's deficient?
Is your blood deficient?
Is your yin deficient?
So once you discover the rootcause, which is the patterns of
imbalance, then it's simple totreat it with targeted nutrition
, lifestyle changes and thingslike that.
So that's why you shouldn'tworry that you're never going to
get pregnant.
The problem is that youprobably haven't found the root
(19:12):
cause.
One more thing that I want tomention here is vitamin D.
Vitamin D is pretty importantfor hormone balance and
fertility.
Majority of vitamin D is madeon our skin from the sun, and
wearing sunscreen and stayingindoors more can definitely
deplete the reserve.
(19:32):
There's a lot of evidence thatvitamin D deficiency is linked
to certain symptoms of PCOS,like insulin resistance, high
testosterone, ovulationdysfunction.
It has been associated with anincreased pregnancy rate, live
birth rate from IVF, decreasedrisk of miscarriage and also
(19:52):
decreased risk of variouspregnancy complications.
But there has not been a clearrelationship established between
AMH and vitamin D because a lotof data out there are
conflicting.
Some studies show that in thesummer, the AMH is higher for
certain women.
Some studies show no differencebetween vitamin D
supplementation and the AMH ishigher for certain women.
(20:13):
Some studies show no differencebetween vitamin D
supplementation and the AMH.
So it appears that vitamin Ddoes help with the production
and balance of sex hormones likeprogesterone, estrogen,
testosterone, but might notnecessarily help with FSH, amh
or the antral follicle count.
It is, however, an importantvitamin regardless, and I
(20:34):
haven't run into many women withlow vitamin D status lately
because I think more people arebecoming more aware of the
impact that low vitamin D has onhealth and fertility and
they're actively supplementing.
Finally, you might be wonderingif there's an optimal time to
test for AMH.
Unlike hormones like FSH, lhand estrogen that need to be
(20:55):
tested on day three to get themost accurate baseline reading,
amh stays relatively stablethroughout the cycle because
it's produced by a pool offollicles that are waiting to be
selected in the months to come,and there's always a pool of
follicles waiting.
There is some variability, butvery, very minor, not enough to
(21:18):
matter, so you can get your AMHtested at any time.
Now, as we wrap up here, I wantto remind you that the AMH is
just one data point.
It doesn't represent yourability to get pregnant.
It's not the end-all be-all.
If your AMH has been found to below, just know that there are
many reasons, and some of whichcan be reversed.
(21:40):
You can't change the actualreserve, but what's important is
that you do everything you canto nurture what you have, to
nurture the pool of folliclesthat have been recruited, so
that more of them make it to theenteral follicle stage and more
of them are available forselection to become the dominant
(22:03):
follicle.
If you don't know where tostart, start by identifying the
triggers of stress in your lifeand how you're managing them.
There will always be stress.
That's not going to change aslong as you're alive, but your
reaction to them is what helpsyour body determine whether to
prioritize survival orreproduction.
(22:26):
All right, fertile friend, hopeyou found this episode valuable
and I hope that I have decreasedsome anxiety about having low
AMH.
If you like what you're hearing, please subscribe so that you
don't miss an episode, and youcan also follow me on Instagram
at Dr Adrienne Wee.
Thank you so much for tuning in.
(22:46):
Take care of your amazing selfand remember you're one fertile
cycle away from getting pregnant.
Welcome to the Practically Fertile Podcast.
I'm Adrienne Wee, doctor ofacupuncture and Chinese medicine
, functional medicinepractitioner and functional
nutritionist.
I specialize in using anevidence-based method, blending
principles of East Asianmedicine and modern functional
medicine to help women optimizefertility and get pregnant.
(00:22):
I believe in a world whereevery woman who wants to be a
mother becomes one.
If you're tired of being toldthat you're infertile and you
want to take the right steps toget pregnant naturally and
quickly, this podcast is for you.
One of my patients, bridget herAMH was 0.29 and she was able to
(00:43):
conceive naturally at the ageof 43.
Another patient, darcy her AMHwas 0.7 and she conceived
naturally at the age of 42 andthen again naturally two years
later at the age of 44.
Gabriela I worked with hervirtually.
She was 36 years old and herAMH was 0.08, and she was able
(01:07):
to conceive naturally after twomonths.
So I know that AMH is probablyone of these markers that causes
you a lot of anxiety about yourchances of getting pregnant.
If you've been told that yourAMH is low, you might think that
it means you're running out ofeggs and that you can't get
pregnant naturally.
And I'm telling you thesestories because number one
(01:31):
having low AMH does not mean youcan't get pregnant, naturally.
Number two AMH numbers canincrease.
And number three AMH isactually not a measure of your
true ovarian reserve.
In this episode, I'm going toexpose the shocking truth about
the AMH and tell you what yourdoctors don't tell you.
(01:53):
So let's get started.
What exactly is AMH?
It stands for anti-mullerianhormone, and what's really
interesting about it is thatthis hormone is involved in the
fetal development process.
Both male and female fetusesare born with the mullerian duct
(02:15):
, which eventually turns intothe female reproductive duct,
including cervix, uterus,fallopian tubes.
Cervix, uterus, fallopian tubesAround eight weeks of gestation
, amh production for the malefetus help to produce a protein
that triggers a self-destructiveprocess that then dissipates
(02:35):
the mullerian duct, and thisprotein is only produced by the
male fetus and not the femalefetus.
So then the mullerian ductturns into the structure that
contains the cervix, uterus,fallopian tubes.
So how does the AMH become amarker for ovarian reserve?
The AMH production is very lowfor women at birth, but it
(02:58):
increases gradually as the womangets closer to puberty.
We focus a lot on the ovulationprocess, but in reality, the
follicle that matures thenreleases the egg.
It has been growing for thelast five to six months, maybe
even longer.
So let's start from thebeginning of the follicle
development process.
(03:18):
It all starts when you were inyour mother's womb.
Around six months of gestation,primordial follicles, or very
small follicles, start to form.
All of the primordial folliclesare formed between six to nine
months of gestation and this, myfriend, is your true ovarian
(03:39):
reserve.
And these follicles, theyremain dormant until puberty,
when they're activated.
But naturally a lot of themwill be lost from the time you
were born to the time when youget your first period.
So on average, you might beborn with 1 to 2 million
primordial follicles, but youmight only have 400,000 left at
(04:01):
puberty.
There's no way to measure theexact number of these primordial
follicles.
When a primordial follicle isactivated or awakened, it
becomes a primary follicle.
Then the primary folliclebecomes a pre-antral follicle,
120 to 90 days before ovulation,120 to 90 days before ovulation
(04:29):
, and then it becomes the antralfollicle.
These antral follicles are whatcycle day three ultrasounds
measure For IVF cycles.
The higher the number of antralfollicles, the better the
outcome.
So these antral follicles thengrow and the rest of the process
you're familiar with.
There's a dominant follicle.
Ovulation then, during theluteal phase is when the
implantation happens or doesn'thappen.
If there's no implantation,you'll start your period and
(04:53):
then the whole cycle starts overagain.
In the background, there'sactually a lot happening.
There's a constant supply ofpre-antral follicles that are
waiting to become antralfollicles, and it's on these
pre-antral follicles that theAMH is being produced.
Amh is only produced by thesefollicles and nowhere else, and
(05:15):
that is why AMH is so popularand is used as a marker for
ovarian reserve.
It shows how big the follicleselection pool is.
It is directly correlated tothe number of follicles that are
growing.
The idea is, the morepre-antral follicles you have,
there's more to choose from forovulation, and then that
(05:37):
increases the odds of gettingpregnant.
So it's all a numbers game, buthere's the real function of AMH
and how our body uses it.
The AMH is used to regulate thefollicle development process
that we just talked about.
It's meant to suppress the FSHso that not too many follicles
(05:58):
are recruited all at once, andthis will help to prolong the
reproductive lifespan of thefemale, because if too many
follicles are recruited at once,then you'll deplete the ovarian
reserve very, very quickly, andthis actually has been proven
with experiments with mice,compared to mice living in the
(06:18):
wild, the mice with no AMHthat's artificially induced.
The primordial folliclesdeplete and reach exhaustion at
a much younger age.
No one knows the exact numberof primordial follicles you have
.
There's just no way to measurethat, and that's why AMH is the
best marker to date, but itstill can't tell us how many
(06:41):
more follicles you have left.
So if you have low AMH, thechallenge is that your follicle
selection pool might be smaller.
So AMH is used to measure thefunctional ovarian reserve
rather than the ovarian reserve.
And, like we talked about before, amh and the antral follicle
(07:04):
count are useful tools fordoctors during an IVF cycle to
predict how many eggs can beexpected to be retrieved.
A question you might be askingright now might be well, you
just said that if the AMH is low, then more follicles are
recruited.
Then how come my antralfollicle count isn't higher,
(07:26):
according to the same logic?
Well, that's a really goodquestion.
Lower AMH a lot of times canmean a higher FSH level.
A higher FSH level means thatthe follicles are not going to
respond to this hormone and mostof them will stop growing and
die off.
But the FSH doesn't just act onthe follicles at the beginning
(07:49):
of the cycle.
It actually acts on thefollicles all the way back to
the pre-antral stage, 120 to 90days prior to ovulation.
So back to the example that Iused before, the mice with no
AMH.
The number of follicles thatmade it to the early enteral
stage is higher than the micewith AMH.
(08:10):
But once the follicles enterthe early enteral stage they
also stopped growing and theyjust die off.
And this process where thefollicles naturally die off, is
called atresia.
It can happen from activationtime of a primordial follicle
all the way up until the antralfollicle stage.
(08:31):
We know that influences fromthe external environment.
So things like diet, lifestyle,stress can influence how many
and how quickly the folliclesnaturally die off.
So more on that later.
But just because you have a lowAMH it doesn't always mean that
(08:52):
you have a high FSH.
You can have a low AMH butnormal FSH.
If your FSH is normal, eventhough your AMH is lower, that's
actually not a bad situation tobe in because that means that
your growing follicles willrespond to the FSH is normal,
even though your AMH is lower.
That's actually not a badsituation to be in because that
means that your growingfollicles will respond to the
FSH and grow appropriately, evenif the number of them is
(09:13):
smaller.
I want to touch on brieflyabout the other end of the
spectrum, which is when the AMHis too high.
The AMH is now becoming apopular marker to diagnose PCOS.
Not every single PCOS patientwill have high AMH, but it's
very common, especially in thetype of PCOS that causes
(09:35):
ovulation to stop.
One of the symptoms of PCOS ishaving many small follicles that
get stuck in the pre-antralphase and never grow to maturity
, and these are the folliclesthat produce AMH right.
So if the AMH is way higherthan the upper limit of normal,
(09:55):
it's usually suspected that it'scaused by PCOS due to the
follicles failing to grow past apre-antral stage.
The AMH will often return tonormal once the cycle is
regulated and the ovaries canovulate again, so this is
definitely not a permanentsituation.
Amh is not the only marker thatshould be used to test PCOS,
(10:18):
but it is a very useful one.
All right, the importantquestion is does having low AMH
mean that you can't get pregnant?
Absolutely not.
I hope you get that thought outof your head.
Remember the three stories thatI told you in the beginning.
Even the ASRM, american Societyof Reproductive Medicine, says
(10:40):
that AMH is not a predictor ofthe ability to get pregnant.
There are so many factors thatcan influence your AMH level and
your AMH level can increaseBecause if you can optimize your
reserve and increase the numberof quality follicles in the
selection pool prior toovulation, more of them will
(11:00):
survive and more of them willproduce AMH and more of them
will make it to the antralfollicle stage.
And yeah, of course your AMHwon't suddenly increase from 0.5
to 5, but it could make a bigdifference depending on what
your goals are Like.
If it increases from 0.5 to 1.5and you're doing IVF, that can
(11:25):
be the difference between 5follicles and 10 follicles.
My patient, konstantina she hadan AMH of 0.08, and her most
recent blood work showed thatthe AMH went up to 0.32.
And that's great because shewas told before that she would
have to do IVF with donor eggs,but now she's a candidate for
(11:47):
doing IVF with her own eggs.
So that is a huge, hugeaccomplishment.
And I've also had patientswhose AMH has gone from 0.3 to
1.4, 1.5.
So it's not uncommon for us tosee this type of results.
So if you have low AMH, how canyou increase the AMH and what
(12:11):
should you do to get yourselfthe best chances of getting
pregnant.
Let's talk about that.
Instead of focusing onincreasing the AMH number, you
should focus on optimizing thequality and the quantity of the
follicles that grow.
So let's go over some of thewell-known factors that will
affect AMH.
Age is a factor.
(12:32):
It's true that as you get older, the follicle depletion rate
increases, but that's not adirect cause of low AMH.
Young women can also have verylow AMH.
I have several patients rightnow who are in this situation,
and remember Gabriela.
She was only 36, but her AMHwas 0.08.
I have a 46-year-old patientright now.
(12:54):
Her AMH is 1.5, which is higherthan normal for her age.
Genetics is a factor as well.
You could be born with a lowreserve.
Remember all the primordialfollicles are formed between six
to nine months gestational age,while you were in utero.
Epigenetics is a huge factor.
(13:15):
One of my favorite topics thisis the environment that you're
living in, everything from dietto toxin exposure, to sleep
patterns, exercise and stress.
There's evidence that genesthat regulate follicle
development in women with lowreserve are often dysregulated,
meaning their actions becomeirregular, unpredictable and
(13:35):
inconsistent.
Major illnesses, chemo surgeriescan trigger your body to start
burning through the ovarianreserve.
The human body will alwaysprioritize survival over
anything else and unfortunately,reproduction is not one of the
necessities to survive.
If you've had surgery on theovaries, that would affect AMH,
(14:00):
because the primordial folliclesare stored in the ovaries, or
your AMH could be temporarilysuppressed Right after a woman
gives birth.
The AMH levels can be very lowImmediately after an IVF
retrieval cycle.
The AMH can be low if theantral follicles are not
replenished quickly enough.
And here's one that recentlycame out about AMH being
(14:25):
temporarily suppressed.
It's now confirmed that ifyou're taking hormonal birth
control, with the exception ofIUDs, your AMH could be
suppressed.
This has huge implicationsbecause a very popular home
testing kit company has made abusiness model out of this
testing young women's AMH andencouraging them to freeze their
(14:46):
eggs based on the results.
But your AMH while on birthcontrol could be lower than what
it should be.
So if you've done one of thesetests and your AMH is low, don't
panic.
Just get it retested a fewmonths after getting off the
birth control.
I want to share an interestingcase right now, actually my
patient Maria.
She took Clomid for a fewcycles and her AMH dropped to
(15:09):
0.2 and her FSH shot up to 70.
They told her that there's nohope and donor eggs is the only
option, and turned out, aftertwo months of stopping the
medication and gettingacupuncture, her FSH is now
under 10, which is very, verynormal, and she has had normal
periods, and we're just waitingto see what her AMH levels are.
(15:30):
So, as you can see, amh levelsare not set in stone.
They can go up and they can godown.
The important thing here is tofind out why the AMH levels are
low or has decreased Some of theinfluencing factors that we
just mentioned.
There isn't anything to be done,for example, age right, we
(15:52):
can't stop the aging process.
We also can't do anything aboutgenetics, but we can control
all these external factors likediet, lifestyle, toxin exposure,
stress.
Let's just talk about stressfor a second, because women who
experience higher levels ofperceived stress are found to
have lower antral follicle countand lower AMH.
(16:14):
But it's never talked aboutmuch, because who doesn't have
stress right?
Isn't it normal to have stress?
Of course it's very normal tohave stress, but how are you
handling the stress is thequestion.
Stress is very broad and it canbe emotional and physical
stress and everyday life stress,work stress, but the truth is.
(16:38):
It doesn't matter which form ofstress it is and where it comes
from.
The effect on our body is thesame, because our brains can't
tell the difference between thetype of stress.
When it feels like your survivalis threatened, it will go into
self-preservation mode and startshutting down whatever
functions are not necessary, andreproduction is usually the one
(17:00):
that gets shut down first.
And you might not see theimmediate impact of streks,
because as human we can toleratea lot of crap, right.
But look at it this way it'slike a pot of boiling water At
some point it's going to boilover if the burner stays on.
So when your body reaches thatpoint, several things can happen
(17:26):
.
It can affect the menstrualcycle at the highest level,
which is the hypothalamus, andthat's where the signal to have
a menstrual cycle comes from.
So the hypothalamus is affected.
Then there's no FSH, noovulation, no menstrual cycle
and no baby.
And when your brain decidesthat you're in survival mode,
(17:48):
then it will start to triggerprocesses to burn through the
ovarian reserve much morequickly, more follicles will be
activated and they will also dieoff very quickly.
Many of my patients tell me thatthey're not stressed, and then
we dive deeper and find out thatthey're not sleeping well.
There's tossing and turning,there's a lot of anxiety attacks
(18:09):
throughout the day, there areheadaches, daily, feeling of
tightness in the chest.
These are all warning signsthat our body is sending us.
And, yes, you can take a pillto sleep or relieve anxiety.
You can take Advil for theheadaches.
But if you don't fix the issueat the root and understand where
your stress is coming from,you're going to get stuck on
(18:30):
this merry go-round of forevertaking medication that have a
lot of side effects.
All right, so enough aboutstress.
From a TCM perspective, itdoesn't matter that you have low
AMH.
What matters is what is thepattern of imbalance that's
causing low AMH?
Is it because your qi is notflowing?
(18:51):
Is it because it's deficient?
Is your blood deficient?
Is your yin deficient?
So once you discover the rootcause, which is the patterns of
imbalance, then it's simple totreat it with targeted nutrition
, lifestyle changes and thingslike that.
So that's why you shouldn'tworry that you're never going to
get pregnant.
The problem is that youprobably haven't found the root
(19:12):
cause.
One more thing that I want tomention here is vitamin D.
Vitamin D is pretty importantfor hormone balance and
fertility.
Majority of vitamin D is madeon our skin from the sun, and
wearing sunscreen and stayingindoors more can definitely
deplete the reserve.
(19:32):
There's a lot of evidence thatvitamin D deficiency is linked
to certain symptoms of PCOS,like insulin resistance, high
testosterone, ovulationdysfunction.
It has been associated with anincreased pregnancy rate, live
birth rate from IVF, decreasedrisk of miscarriage and also
(19:52):
decreased risk of variouspregnancy complications.
But there has not been a clearrelationship established between
AMH and vitamin D because a lotof data out there are
conflicting.
Some studies show that in thesummer, the AMH is higher for
certain women.
Some studies show no differencebetween vitamin D
supplementation and the AMH ishigher for certain women.
(20:13):
Some studies show no differencebetween vitamin D
supplementation and the AMH.
So it appears that vitamin Ddoes help with the production
and balance of sex hormones likeprogesterone, estrogen,
testosterone, but might notnecessarily help with FSH, amh
or the antral follicle count.
It is, however, an importantvitamin regardless, and I
(20:34):
haven't run into many women withlow vitamin D status lately
because I think more people arebecoming more aware of the
impact that low vitamin D has onhealth and fertility and
they're actively supplementing.
Finally, you might be wonderingif there's an optimal time to
test for AMH.
Unlike hormones like FSH, lhand estrogen that need to be
(20:55):
tested on day three to get themost accurate baseline reading,
amh stays relatively stablethroughout the cycle because
it's produced by a pool offollicles that are waiting to be
selected in the months to come,and there's always a pool of
follicles waiting.
There is some variability, butvery, very minor, not enough to
(21:18):
matter, so you can get your AMHtested at any time.
Now, as we wrap up here, I wantto remind you that the AMH is
just one data point.
It doesn't represent yourability to get pregnant.
It's not the end-all be-all.
If your AMH has been found to below, just know that there are
many reasons, and some of whichcan be reversed.
(21:40):
You can't change the actualreserve, but what's important is
that you do everything you canto nurture what you have, to
nurture the pool of folliclesthat have been recruited, so
that more of them make it to theenteral follicle stage and more
of them are available forselection to become the dominant
(22:03):
follicle.
If you don't know where tostart, start by identifying the
triggers of stress in your lifeand how you're managing them.
There will always be stress.
That's not going to change aslong as you're alive, but your
reaction to them is what helpsyour body determine whether to
prioritize survival orreproduction.
(22:26):
All right, fertile friend, hopeyou found this episode valuable
and I hope that I have decreasedsome anxiety about having low
AMH.
If you like what you're hearing, please subscribe so that you
don't miss an episode, and youcan also follow me on Instagram
at Dr Adrienne Wee.
Thank you so much for tuning in.
(22:46):
Take care of your amazing selfand remember you're one fertile
cycle away from getting pregnant.
Popular Podcasts
Bookmarked by Reese's Book Club
Welcome to Bookmarked by Reese’s Book Club — the podcast where great stories, bold women, and irresistible conversations collide! Hosted by award-winning journalist Danielle Robay, each week new episodes balance thoughtful literary insight with the fervor of buzzy book trends, pop culture and more. Bookmarked brings together celebrities, tastemakers, influencers and authors from Reese's Book Club and beyond to share stories that transcend the page. Pull up a chair. You’re not just listening — you’re part of the conversation.
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com