I’ve had many patients over the years come to me wanting help with their fertility issues. Most of them come with having had prior testing. One such test is what is named the “egg reserve” test. A woman’s “egg reserve” is said to be able to be measured by testing their Anti Mullerian Hormone (AMH) levels in their blood.
And I am here today to tell you that AMH is NOT, and I repeat NOT, a measure of egg reserve!!!!
Let me repeat that again. AMH is NOT, and I repeat NOT, a measure of egg reserve!!!!
One question you should be asking is, “How can a blood test measure my egg reserve….?”
Just think about it. Think.
Does that seem logical to you?
When physicians want to know what’s happening with your ovaries they normally refer you to have an ultrasound….., right? Right….?
So how can a simple blood test accurately measure the amount of eggs you have in “reserve”? Short answer, IT CAN’T.
It is not an egg count and it does not measure how many eggs you have left. This is not what the test does, and it is lazy of the medical establishment to describe it like this.
And here’s a fun fact: Males also produce AMH. In males, AMH is produced by the Sertoli cells, found in the semineferous tubules located in the testes.
So another question you might like to ask is, “If men also produce AMH, how can it possibly measure the amount of eggs I have left in reserve?”
It has been incorrectly termed the egg reserve test in a convenient “dumbing” down of what this test actually measures. GPs and specialists call it the egg reserve test all the time, even IVF clinics on their websites will describe it as an egg reserve test. But it doesn’t measure reserve.
Teja and I were invited to an IVF Australia laboratory tour, and we got to ask one of the top fertility specialists in the Hills District area who was walking us through the lab this very question, so we could hear it from the “horses mouth”.
“No.” He said. “AMH is not a measure of egg reserve.”
AMH is a measure of follicle recruitment.
IVF clinics love this test because it is a good predictor of how well a woman will respond to follicle stimulation drugs (FSH injections) during a IVF cycle..
AMH levels are measured at a reference range from 0-90. If a woman has “low” AMH levels then she can theoretically be given the maximum dosage of FSH drugs in order to stimulate follicle growth, with little worry that she will hyperstimulate.
Women with “high” AMH levels are not necessarily “more fertile”. Women with PCOS for example, will have high AMH levels, but they are not more fertile. PCOS women are not “more fertile” because they rarely ovulate.
Women with high AMH levels will be given lower dosages of FSH stimulation during an IVF cycle. Their risk of Ovarian Hyperstimulation Syndrome (OHSS) is high and therefore they need to be monitored closely during an IVF cycle.
AMH levels naturally decrease as women age.
If you are one of those women who have been told you have a “low ovarian reserve”, please DON’T FREAK OUT. If your AMH is 5 it does NOT mean you have 5 eggs left. This is not how you should interpret the results. It just means, should you choose to do IVF, they will start you on high/maximum FSH dosages from the beginning of your treatment.
IVF treatment is about numbers. They want lots of eggs collected because they know not all of them will fertilise, and of the ones that do, not all of them will progress well. So you may get 10 eggs, 6 of which will fertilise, however only 3 may make it to blastocyst stage (the stage they like to transfer or freeze).
In Traditional Chinese Medicine we are about quality. We want your children’s children to inherit good fertility. Their fertility is influenced by you and your health now. So we don’t focus on the AMH number. We focus on overall health. Your overall health drives your egg health. So in our clinic it does matter what you eat. It does matter how much and when you sleep. It matters how much water you drink ad how nutrient dense your food is. It matters that you stop drinking alcohol and stop smoking cigarettes, vapes and weed. It also matters that your partner is invested too and also willing to make these same necessary changes that will encourage good sperm health.
It matters because your egg is a microcosmic reflection of everything you put into your body.
Yes there are other people who are fortunate to not do all the “right” things, and yes they are blessed with children. And yes, it’s not fair. What you don’t see, however, is the health struggles those children face growing up, and the fact that the fertility that was so generously bestowed before them, stops now with them.
When we know better, we do better.
We want good health for our children.
If we are privileged enough to have the time to put into our pre-conception health, future generations benefit.
In our consults we go through how these choices affect your fertility. We offer acupuncture and Chinese herbal medicine to enhance overall health as well as fertility but only if the patient is a willing participant in their own health journey.
You shouldn’t dig a well when you’re already thirsty.