From the Guidelines
Low anti-Müllerian hormone (AMH) levels are associated with a significantly increased risk of miscarriage, particularly in women with AMH levels below 0.7 ng/ml, with an odds ratio of 1.63 [1.05–2.53] compared to those with higher AMH levels 1.
Implications of Low AMH Levels
Low AMH levels indicate diminished ovarian reserve, which can affect fertility and increase the risk of miscarriage. The risk of miscarriage is higher in women with low AMH levels, especially those under 35 years old, with an odds ratio of 1.24 [1.06–1.44] 1.
Fertility Treatment Options
If you have low AMH and are trying to conceive, it is essential to consult with a reproductive endocrinologist promptly, as fertility declines with age. Treatment options may include:
- Ovarian stimulation with medications like clomiphene citrate or injectable gonadotropins, often combined with intrauterine insemination or in vitro fertilization
- Supplements like DHEA, CoQ10, or vitamin D, although evidence for these is limited 1
Lifestyle Modifications
Lifestyle modifications, such as:
- Maintaining a healthy weight
- Avoiding smoking
- Reducing alcohol consumption
- Managing stress may help optimize fertility.
Monitoring Reproductive Health
Regular monitoring of reproductive health is crucial if you have low AMH and plan to become pregnant in the future, as very low AMH levels may indicate early menopause or primary ovarian insufficiency 1.
From the Research
Implications of Low Anti-Mullerian Hormone (AMH) Levels
- Low AMH levels have been associated with poor ovarian reserve, poor ovarian response to stimulation, and decreased success rates with fertility treatments 2, 3, 4
- Women with low AMH levels may have a shorter reproductive window and may be considered 'sub-fertile' 2, 3
- Low AMH levels have been linked to recurrent miscarriages, although the exact mechanism is not fully understood 2, 5
- AMH levels do not reflect oocyte health or chances for conception, but rather the quantity of remaining oocytes 3, 6
- A cut-off value of serum AMH level ≤1 ng/ml may predict poor ovarian reserve, poor ovarian response to stimulation, and IVF outcomes 4
Factors Influencing AMH Levels
- Age is the strongest driver in determining success rates with fertility treatments, and AMH levels decline with age 3, 4
- Body mass index (BMI) has an inverse correlation with AMH levels, but this does not reflect ovarian response 3
- Certain medical conditions, such as multiple sclerosis, may be associated with decreased AMH levels 5
- Hormonal contraceptive use and hypogonadotropic hypogonadism may lower AMH levels without being a true reflection of ovarian reserve 3
Clinical Implications
- Serum AMH levels should be offered to all patients as part of a recurrent miscarriage work-up to allow for realistic counseling and possible referral for assisted reproductive technologies (ART) 2
- AMH levels can be used to estimate expected response to ovarian stimulation and to predict IVF outcomes, but should not be used to withhold treatment 3, 4
- Further research is needed to establish how decreased AMH levels contribute to recurrent miscarriages and to determine the optimal cut-off value for predicting poor ovarian reserve and IVF outcomes 2, 4