We are starting to see a lot of younger women at the clinic who are having fertility MOT and when tests are conducted, results come back showing very low egg reserves. This can be devastating for young women who believed they had ample time left to have a baby.
Any woman seeking an indicator of her fertility potential should try and find out what age her mother was when she had her menopause. Women generally go on having periods long after they are producing viable eggs and fertility stops up to ten years before a woman has her last period. So, subtracting ten from your mother’s menopausal age will give you a rough idea of when your fertility may be seriously compromised.
An AMH test helps to assess the ovarian reserve which gives an indication of a woman’s fertility potential. Anti-Mullerian Hormone (AMH) is a substance produced by the antral (resting) follicles in the ovaries which diminishes as a woman ages. We use the test at the clinic as part of our Fertility MOT check. The AMH test is a blood test that can be taken at anytime of the menstrual cycle and indicates a woman’s egg reserve – the higher the number the better.
The AMH test gives an indication of how your ovarian age compares with the average for a woman of a similar age. Women who have polycystic ovaries will get a false (very high) reading as the cysts produce an excess of anti-mullerian hormone, so the AMH test is not suitable for women with polycystic ovaries. Women taking the pill need to allow at least one cycle after stopping the pill before having a test.
Remember, AMH is only part of the picture in terms of fertility. The most significant factor by far is still the woman’s chronological age. Older women will have more chromosomally abnormal eggs and therefore an increased risk of miscarriage. A younger woman with a low AMH level is likely to have a much better fertility potential than an older woman with a higher AMH level – the egg quality being the key issue. A young woman may have a low reserve of eggs but she will have a better chance of a healthy pregnancy.
Some women find the test useful when they are thinking of having a baby to help determine how long they should try to conceive naturally. Others use it as an indicator to help decide whether to have another IVF cycle or not (IVF is very expensive and it’s often worthwhile to know what the chances are of the cycle being successful). However for every test there will be a result – and that could be good or not such good news and you may need support in interpreting the results and planning the way forward. For some women it may be appropriate to consider prioritising planning pregnancy or even moving to a more assisted route sooner rather than later. However, I’m always concerned for women who do not have a partner and take the test to find out what their future fertility is looking like, because if it is discovered that they have a low ovarian reserve, it can often cause stress and angst in a future relationship.
If we see a woman who has a low AMH level for her age (5pmol/l or less) we explore, discuss and plan the next steps to optimise her chances of having a baby. This may include the following further investigations:
- An ultra sound scan to check her Antral Follicle Count – Looking at the mind & body and improving any negative perceptions through the use of hypnotherapy. If a woman receives bad news about her ovarian reserve, her mindset becomes very negative and she tends to spiral down. Shock and devastation takes over and she can be left feeling helpless. This thinking can often lead to women giving up on sex, but I urge you to have as much sex as you can as we have seen many cases where woman with low AMH levels has conceived naturally.
- Acupuncture – We believe that acupuncture may help improve blood flow to the ovaries, as this reduces significantly with age. It also helps woman to relax and experience a greater sense of wellbeing.
- Nutrition – Many women we see know a lot about diets but not enough about nutrition in relation to fertility. I’m aware that a woman is born with all the eggs she is ever going to have, but I do believe you can improve the environment that the existing eggs are growing in by exploring and incorporating ‘anti-ageing’ foods and nutrients into your diet.
There’s no doubt that if a woman receives a less than great AMH test result it can be very upsetting. So it’s about being proactive, moving forward and making sure that you are doing everything you can to increase your chances of having your own genetic child before, if required, moving onto other means of assisted fertility such as egg donation.
Important note: for women who are not planning pregnancy, it is vital to continue to use effective contraception.