Low AMH. Am I running out of eggs? Do I have Diminished Ovarian Reserve or Premature Ovarian Failure?
First of all, what is Low AMH? AMH stands for Anti-Murllerian Hormone which is produced by small follicles in ovaries. A follicle is a small fluid-filled sac that contains an egg. As the conventional theory goes, the lower the level of AMH, fewer the small follicles and thus, fewer the eggs left in ovaries. Women are often given a diagnosis of low or diminished ovarian reserve or premature ovarian failure if AMH level becomes less than 0.3 ng/ml when they are still under age 40.
Can a woman still conceive with low AMH, Diminished Ovarian Reserve or Premature Ovarian Failure?
The answer is, sometimes it is possible if corrective treatment of acupuncture and herbs is given. Here are two of Dr. Lee’s cases.
A 35 year old woman named Kathy had a FSH level of 23.6 and AMH of 0.16 (the lowest measurable value at lab) was told by a RE that because her AMH was low and that she had diminished ovarian reserve and premature ovarian failure, the only way to conceive was through IVF with donor eggs. She came to see me in July 2011 and conceived naturally with acupuncture and herbal treatment three times within a year (first two ended in miscarriages). Her son was born in April 2013.
What does low AMH of less than 0.16 mean in her case? Did she have diminished ovarian reserve and premature ovarian failure. In her case, low AMH level implied that she had fewer follicles growing in that cycle. It does not mean that there are no eggs left in her ovaries nor does it imply her ovaries had failed. It is important to understand that before follicles get to the small sizes (2 to 5 mm) they remain in super small, in fact, microscopic sizes (30 to 60 micrometer) called primordial follicles. These primordial follicles do not produce measurable amount of AMH thus they are undetectable but, nevertheless, they are there in the tissue of ovaries. They will spend about 9 months in the ovaries to go through the primary and secondary stages before growing large enough to be called antral follicles visible on the ultrasound imaging. It is at this antral follicle size that they begin to produce measurable amounts of AMH.
Concluding an ovarian failure when one sees a low AMH is like saying the car factory is out of business when it rolls out fewer cars. It could mean that. But, there could be other reasons such as a strike by the work force or a shortage on some auto parts. The key to success in both cases, cars or eggs, is knowing how to resume the productions. This is where deep knowledge of both Chinese acupuncture and herbal medicine and Western medicine, extensive clinical expertise, intuitions and experience with proven success are required.
A 40 year old woman from San Diego came to my Irvine acupuncture clinic on 9/10/2011. Her FSH was at 38 mIU/ml in 8/2011. Her AMH was low at 0.3 mg/ml in 6/2010. Again she was told that because her low AMH and that she has diminished ovarian reserve therefore, IVF with donor eggs was her only option. She started her treatment with me driving from San Diego to Irvine weekly and became pregnant naturally with acupuncture and herbs on 11/4/11. Her son was born in July 2012.
She came back to see me for the 2nd child on 1/5/2013 at age 42+, with FSH=43, E2=74 and AMH<0.16. She conceived naturally again on 3/2/2013. She is now age 43 with due date in 12/2013. Her OB in San Diego was very surprised with her first pregnancy. But, he was totally blown away by her 2nd natural conception with acupuncture and herbal treatment at her age 43, FSH 43 and low AMH of less than 0.16 ng/ml. Again, her low AMH means she had fewer antral follicle growing during that cycle. But, it only take one follicle that contains a good egg to conceive if one knows how to help that egg.
Can AMH ever increase? Yes.
I am currently treating a 39 year old woman. Her AMH was at 0.21 in 2/2013. She started seeing me with acupuncture and herbs in early May 2013. Her AMH increased to 1.2 in late July same year or increased 6x higher in less than three months even though she is not pregnant yet.
A word of caution, the two cases above illustrate that one may still conceive naturally with low AMH when corrective acupuncture and herbal treatment is given. It does not however imply that everyone can conceive naturally with acupuncture and herbs treatment when AMH is low. Age still remains the most important factor in determining the egg quality and the outcome of a natural conception attempt and the pregnancy itself. Donor eggs are an effective option for older women with any level of AMH.