Ep.69: AMH - Can it tell you if you’re infertile?
Welcome back to the Woven Well podcast!
First of all, I have to thank you for the great response and support for our new Woven Affiliate, Elizabeth. There’s been so much that’s happened in the last year that I could never have seen coming, but I’m so grateful for. Elizabeth is a part of our Affiliate Mentorship program and is doing great. It’s so fun to be a guide to her as she works towards becoming a Fertility Care Practitioner. I have no doubt she’ll be on the podcast again!
Okay, let’s get down to today’s Episode! Have you ever heard of AMH?
If you’ve been trying to conceive and ever had bloodwork done, they likely tested this level.
And some doctors put a lot of weight on this one result.
Are any of you watching the most recent season of Ted Lasso? I’m not recommending the show to all audiences by mentioning it - I dont want to get any angry emails - but, I’m going to use an example from it just now, so if you dont want to hear any spoilers for season 3, episode 5, skip ahead a few seconds -
Rebecca would like to have a baby. She went to the doctor, who told her it may still be possible. She’s about 47, but she’s still having periods. Then, she gets the call. They did lab results. It’s impossible.
First of all, that’s frustrating for me. What could possibly have come up in that lab test that suddenly revealed it was impossible for her to get pregnant?
Yet, if there’s one lab result that doctors like to use to say if a woman can or cannot get pregnant - it’s AMH. It’s often given as the determination for a couple’s hopes of being pregnant. But does it actually tell us if a woman can conceive? What does it help us understand, and how important it is?
AMH stands for Anti-Muellerian Hormone, and it tests the level of this hormone in your body. This hormone is produced by antral follicles, which are sometimes referred to as the “resting” follicles - recruited, but not yet growing for a particular cycle. You can see them on an ultrasound, and the more you have of these resting follcles, the higher your AMH level. So, ladies with PCOS or polycystic ovaries will naturally have a higher AMH level - and this may be one of the tested levels in suspected cases of PCOS.
Here’s the thing, though: What AMH has been primarily studied for over the last several decades is how it helps Reproductive Endocrinologists predict success with IVF. What they’ve found is that Low AMH suggests poor response to IVF.
When a woman goes through in vitro fertilization, she often starts by hyper stimulating the reproductive system to produce dozens of follicles - as many as possible getting to the size needed for ovulation. That’s because they want lots of good sized follicles to mechanically fertilize to see if they will begin developing so that they can insert them directly into the uterus.
AMH has been a pretty fair indicator about whether or not the ovaries will respond to this kind of hyper stimulation. Fewer resting follicles means fewer follicles to stimulate, after all. But there is a difference between antral follicles (resting) and primordial follicles (sleeping). Each primordial follicle has an immature egg that can still potentially develop and ovulate in the future.
The research done on AMH levels has primarily been related to whether or not the ovaries will respond to hyperstimulation. So while it’s been very helpful in determining if IVF is possible, it gives us almost no information about whether natural conception is possible.
Here at Woven Natural Fertility Care - the organization behind Woven Well - we are all about natural conception.
And I hope that this is freeing news: a low AMH level does not automatically mean that you cannot get pregnant naturally.
A low AMH level at a fertility clinic will likely get you the suggestion to get a donor egg or to adopt. But low AMH level at a Napro clinic doesn’t mean the same.
The exception being an extremely low level which suggests a truly minimal ovarian reserve. But that number may be lower than you think.
Dr. Phil Boyle, a Napro OBGYN from Ireland who’s currently doing research and work in North Carolina, did a study about 10 years ago on the role of AMH in natural conceptions. He’s published this information, and while there’s a lot more testing left to do - the sample size was very small - the results were very telling. One of the scenarios is even worth sharing.
A 36 year old woman came in to his clinic in Ireland after 6 years of trying to conceive without any success. She had seen a Reproductive Endocrinologist and received an AMH lab result of .07 pmol/l. For reference, the scale typically runs from 1-3pmol/l. She was told there was no hope. Her only options were to get hormone replacement therapy, use donor eggs and do IVF, or adopt. But now she was at Dr. Boyle’s clinic and his approach was completely different. Instead of viewing AMH as a level that restricts possibilities, he used it to shed more light on the health of her body and what may be going on. He utilized that information, as well as the Creighton cycle charting that he required, to create a treatment plan specific to her body and health. He ran more lab work, started her on specific supplements for her needs (things like Vitamin D, Omega 3s, folic acid), gave her a targeted ovulation stimulation protocol with the use of Letrozol/Femara, and responded to her particular body’s needs for inflammation reduction through low doses of prednisone and low dose naltrexone. He tracked her follicle growth and rupture, tested her hormones throughout the cycle, and supplemented any necessary hormone levels. They conceived on their second cycle charting.
This is why I got frustrated when Rebecca’s character got that phone call on Ted Lasso. Spoiler alert: Even her number was low - and .07 is low! - that doesn’t mean pregnancy is impossible. Now, of course, she’s single and going to a reproductive endocrinologist, so she probably was looking at IVF as her only option.
For couples trying to conceive, this is not the case. There are lots of great, successful options out there! IVF is marketed as this be all end all way to get pregnant, but the overall success rates are pretty low. Instead, we recommend other, comprehensive, restorative medical approaches that look at your body and health as a whole.
So what would we recommend?
Get to know your body and health intimately. Let’s gather as much helpful information as possible! Your fertility is not determined by one number alone.
Connect with a trusted medical professional who wants to help you conceive naturally by restoring your reproductive health.
Tailor your treatment plan to your body and your needs specifically.
This is why we mention, so often, how important it is to have a medical team that you trust and who values your feedback, your awareness, and your personhood. We need medical providers who want to restore your health to the best of their ability, and help you to conceive, if that’s your goal. The approach can make all the difference in the world.
Woven Natural Fertility Care works very closely with trusted Napro and restorative health doctors across the country. We would love to help you chart your cycles with the Creighton system to get further insight into what’s going on in your reproductive health and fertility. These are the same charts that your Napro doctor, just like Dr. Boyle, will want to see, as well.
You can begin by attending our online Introductory Session, which you can register for at wovenfertility.com/join-us!
And even if that’s not your goal, I hope this has been a helpful episode that puts even a little more information in your hands.
AMH is helpful! It gives us valuable data! But it may not be what tells you if you can get pregnant or not.
Thanks for listening today! If you like this episode or our podcast, I’d love it if you’d take just a tiny second to review the podcast. It helps out all the things - algorithms and such - but also lets others know that this is a safe place to learn about fertility and consider their faith in the process. I’d love it if you’d rate us, and share your thoughts.
As always, thanks for listening as we continue to explore together what it means to be woven well.