From the Guidelines
A 33-year-old with a low Anti-Müllerian Hormone (AMH) level is at a higher risk for miscarriage and may face challenges with fertility, making it essential to consult a reproductive endocrinologist for personalized guidance and potential fertility preservation options.
Significance of Low AMH Levels
Low AMH levels in a 33-year-old indicate diminished ovarian reserve, which can be caused by various factors including premature ovarian insufficiency, genetic factors, autoimmune conditions, previous ovarian surgery, endometriosis, chemotherapy or radiation exposure, or simply being born with fewer eggs 1.
Impact on Fertility
The finding of a low AMH level is crucial because it may affect fertility, potentially making it more difficult to conceive naturally or through assisted reproductive technologies. According to a systematic review and meta-analysis published in 2021, women with low AMH levels have a higher risk of miscarriage, with an odds ratio (OR) of 1.35 [1.10–1.66] compared to women with medium or high AMH levels 1.
Recommendations
Given the potential implications of low AMH levels on fertility and miscarriage risk, it is recommended that a 33-year-old with a low AMH level consult with a reproductive endocrinologist. This specialist can provide a comprehensive fertility assessment, including additional hormone tests and an ultrasound to count antral follicles. They may also suggest considering fertility preservation options like egg freezing or discussing family planning timelines, as AMH levels continue to decline with age 1.
Considerations
While low AMH does not make pregnancy impossible, it does suggest that addressing fertility concerns sooner rather than later would be beneficial. Factors such as age, medical history, and personal preferences should be taken into account when making decisions about fertility preservation and family planning.
- Key considerations for individuals with low AMH levels include:
- Consulting a reproductive endocrinologist for personalized guidance
- Considering fertility preservation options like egg freezing
- Discussing family planning timelines and potential risks associated with delayed childbearing
- Understanding the potential impact of low AMH levels on fertility and miscarriage risk 1
From the Research
Significance of Low Anti-Müllerian Hormone (AMH) Levels
- A low AMH level in a 33-year-old woman may indicate diminished ovarian reserve, which can affect fertility 2.
- Research suggests that AMH levels begin to decrease at around 33 years of age in both women with and without type 1 diabetes mellitus 2.
- Women with low AMH levels may be at risk of premature ovarian insufficiency and may need to consider egg freezing or other fertility preservation options 3, 4.
- A study found that 19% of women aged 27-37 years had AMH levels below the 10th percentile for their age, and 3% had undetectable AMH levels 4.
- Another study found that women with low AMH levels were more likely to have a family history of premature ovarian failure and endometriosis 3.
Implications of Low AMH Levels
- Low AMH levels can indicate a reduced ovarian reserve, which can make it more difficult to conceive 3, 4.
- Women with low AMH levels may need to consider fertility treatment options, such as in vitro fertilization (IVF) or egg freezing 3, 4.
- AMH levels can be used as a marker of ovarian reserve, and can help clinicians identify women who may be at risk of premature ovarian insufficiency 5, 3, 4.
- A study found that women who underwent AMH testing were more likely to plan fertility preservation or attempt pregnancy earlier if they had low AMH levels 4.
Age-Related Normograms for AMH Levels
- Age-related normograms for AMH levels have been established, which can provide a reference guide for clinicians to consult with women who have infertility issues 6.
- These normograms show that AMH levels decrease with age, and can help identify women who may be at risk of premature ovarian insufficiency 6.
- A study found that there were significant differences in AMH levels among women aged 24-33 years, 34-38 years, and ≥39 years 6.