AMH Test: Accuracy To Metaphysics

The wonderful season of Easter is approaching. So I felt it was appropriate to talk about eggs;

Female Reproductive Eggs

Everyone presumes that men can father children well into old age. But it’s very different for women. On average, between the age of 45-55 a woman undergoes a normal and natural process know as menopause. Essentially, menopause occurs due to the decline of a woman’s eggs in her ovaries.

What Are Eggs?

A female egg is an oocyte. This is a cell in the female human ovary that will undergo a process of cellular division know as meiosis. And so other terms for eggs are ovum or ova (plural).

What Is Meiosis?

Meiosis is a form of cell division exclusive to sexual reproduction. Meiosis reduces the chromosome number by half and creates four haploid cells. This way each are genetically unique from the parent cell that gave rise to them. I learnt way back when I was studying biology at the University of Melbourne. That is pretty incredible!

AMH

What Is The AMH Test?

If you are a woman trying to have a baby, an AMH Test is a relevant test to measure fertility. AMH stands for Anti-Müllerian Hormone. to measure the number of eggs you have left. There is controversy with this test as if you have a Low AMH result, this means that you have low Ovarian Reserve.

What is AMH?

Anti-Mullerian Hormone (AMH) is a hormone secreted by cells in developing egg sacs (follicles). The level of AMH in a woman’s blood can be an indicator of her Ovarian Reserve. AMH does not change during your menstrual cycle, so the blood sample can be taken at any time of the month.

What Is Ovarian Reserve?

AMH correlated with Ovarian Reserve. Ovarian Reserve describes the amount of eggs left in a woman’s ovaries.

How Much Does The AMH Test Cost?

It costs around AUD$75. There is no medicare rebate.

How Do You Take The AMH Test?

A simple blood sample during the first half of the menstrual cycle. It measures the levels of AMH (Anti-Müllerian Hormone) in your blood.

What Does The AMH Test Tell Me?

Results of the test are of AMH Levels. Whether they are Normal, Low or Raised.

An AMH test gives you some insight into the remaining quantity of eggs and number of fertile years you may have. It does not determine the quality of your eggs. To interpret your results you should compare your own level with other women of the same age.

Medical Opinion On The AMH Test

Dr Anne Clark deems the test ‘inaccurate and misleading’. The leading IVF Specialist of Fertility First, Sydney insists. She believes it is causing panic amongst women in their 30s and 40s.

”I have big concerns about its accuracy,” says Dr Clark. ”I’m seeing a lot of women turning up at my clinic in an incredibly distressed state and highly depressed. Because they’ve been told the test showed they had no chance of having a baby. It’s wrong and misleading.”

The Manchester Study on AMH

A recent British study, along with anecdotal evidence, had found discredited it. The study found that the Egg Timer Test was unreliable. It is becoming discredited worldwide. ‘

With thousands of women rushing to take the test, many companies have entered the market. Dr Kelton Tremellen said it was not always reliable. The Specialist of Repromed Clinic in Adelaide noted the following. ”[If it’s not done proper] one person’s blood is analysed and get two vastly different results,”. Compromised results can occur, for example, if a woman had been on the pill.

Furthermore, Dr Clark added that inaccurate readings also occurred when blood is stored incorrectly. Or if the hormone was not analysed immediately. She is unsure of the value of the test, and prefers to do an astral follicle count with an ultrasound. Dr Clark says research was increasingly discrediting. That it is devaluing the test as gauging a woman’s biological clock.

Similarly, recent study by Tadros et al (2006) stated that new automated Anti-Müllerian hormone assays are more reliable than the manual assay in patients with reduced antral follicle count. That is, that the AMH test is better for women with a reduced amount of follicles seen on an ultrasound.

Low AMH Women Were Just As Likely To Get Pregnant As Those With Normal Ovarian Reserve

Dr Anne Steiner, a professor of obstetrics and gynaecology at the University of North Carolina, Chapel Hill, said there is “huge interest” in such a fertility test. In 2017 she conducted a study analysing AMH and biomarkers. As expected, AMH levels decreased and FSH levels increased with age.

But after accounting for age. Amazingly, women with low Ovarian Reserve were just as likely to get pregnant as were those with normal Ovarian Reserve.

AMH Test “Erroneous Results”

The Manchester study on the efficacy of the AMH test found significant variations of up to 60 per cent. Head researcher Dr Oybek Rustamov said the study looked at the results of 5000 women. Between 2008 and 2011. Thus, he concluded the ”commercial AMH or Egg Timer Tests provide erroneous results” (Rustamov, 2011).

AMH: Inaccurate Egg Timer?

Always note with any blood or hormone test, that it is in fact a snapshot in time! Levels in your body change all the time so don’t think that the result is everything. Sometimes you can do a test and get three different results in a time period. Take it as a guide with a pinch of salt.

Do Eggs Age?

Yes of course they do. But being a young woman doesn’t gaurantee you have good eggs, and being an older woman doesn’t mean you have bad ones. Naturally like our body, eggs do age. They tend to decline in quality and quantity with age. Other factors contribute to this.

What Factors Can Speed Up Egg Ageing?

Well, there is the obvious! Stress, exposure to toxins from smoking, drinking too much, pollution and so on. Hormone imbalances can affect your egg health. Poor diet and unhealthy lifestyle choices and habits too. If an egg goes bad you cannot make it healthy again. This reminds us that maintaining a healthy lifestyle is paramount for good fertility.

An ageing egg leads to increased mitochondrial DNA damage. Then decreased oxidative phosphorylation and ATP production. Which affects the cell’s ability to survive and function.

Prolonged ovarian suppression can affect your Ovarian Reserve. If your ovarian function is suppressed long-term by physiological or pharmacological interventions. For example taking the oral contraceptive pill for a very long time. This may reduce AMH levels. Given long and profound pituitary gonadotropin suppression can lead to a reduced number of antral follicles (La Marca et. al., 2013, Kalio et al, 2013).

Can You Improve Your Egg Health?

You are born with a set number and constitution of eggs as a woman. By the time you are born as a female baby, all your primary eggs are present. That is about 400,000 primary eggs! The ovaries release these eggs as mature ones during the active reproductive years.

Four hundred thousand primary eggs is a big number! Yet note that only some egg cells will not mature for at least 40 years. Others degenerate and never mature. This is specific to each woman.

Primary eggs undergo oogenesis to become mature eggs. The main aspect that you can improve is oogenesis. Click here to learn more about foods for fertility and health.

What Is Oogenensis?

It is the growth process that matures a primary egg into a mature egg.

The primary eggs are dormant (sleeping) until it is time to release it from the ovaries. These eggs remain dormant until just before ovulation. Ovulation is the function of releasing a mature egg from the ovary.

Oogenesis occurs when the primary egg is ready to be prepared and released. It then undergoes the process of cell division (meiosis). This takes around 3 months. Spermatogenesis in men also takes around 3 months.

This is why Pre-Conception care in Chinese Medicine calls for both parties to prepare. How long? For three months before starting to try to conceive.

How Long Does An Egg Last For?

Would you believe only 12-24 hours! They are very fragile and precious, and this is why it is important to have good, healthy strong sperm. To fertilise the egg as soon as possible!

The Importance Of Pre-Conception Care

This lies in the understanding that your wellbeing affects the process of oogenesis.

For example, if you drink a lot of alcohol, smoke heavily, stress out a lot and eat junk food for three months. Three months before conceiving your baby that is! We can infer that your baby may be at risk to health problems and it may even be difficult to conceive at all.

Imagine if you are feeling good, are eating lots of good food and drinking filtered water? You feel balanced and manage your stress well. To feel motivated and present to be like this? To exercise often and sleep well.

How do you think this would affect your baby if you could enjoy this for three months before conception?

Chinese Medicine on Low Ovarian Reserve

In Chinese Medicine, low Ovarian Reserve relates to a deficiency of Jing or Essence. You inherit your Jing from your parents. You cannot make more Jing, you are born with your lifetime supply. However, you can live a healthy life so that you are less likely to tap in and diminish the amount of Jing you have left.

Jing is related to ageing. People who burn themselves out age quicker and use up all their Jing. People who nourish themselves and stay well preserve their Jing and look younger.

Metaphysical Aspects of Low AMH

Metaphysical Aspects can vary:

- I believe it is related to a feeling a lack in life.

- Low AMH relates to low egg numbers although it is not always accurate.

- The metaphysics of low AMH also entail not feeling enough.

- Feeling like you don’t have enough to give.

- Or that you are not good enough.

- Seeing it is inherited (relating to Jing), there may be trauma or rift with your mother or father
- It could be inherited thinking or ancestral trauma.

Pregenvy

Some women I see question how they can’t get pregnant? How can they not get pregnant when the unhealthy women around them are? Women who are overweight, living on a diet of soft drinks and MacDonalds! Drinking so much alcohol and not taking care of their bodies!

If you feel like you are very healthy and wonder why: you may need to dig deeper into yourself. Do you have emotional blocks or past traumas that stress you? Do you get depressed or anxious? Did your mother tell you that children were a burden? Or have you always known that getting pregnant would be difficult for you? These are aspects which affect the subconscious and psyche. A series of Holistic Coaching Consultations with Ilana can support you to break free.

AMH In The Acupuncture Clinic

Personally, I have seen many women in my Acupuncture clinic with an AMH of 0.1 to 1. They are usually the poor responders to IVF and may get one, two or no eggs on a collection. One thing I have noticed with many of these women is that they can conceive a healthy baby naturally. Much to their delight! This seems to happen when conditions are right. As in, they are healthy and well and their men are too.

These women may not get many eggs in an IVF harvest, but the AMH cannot depict egg quality. Egg quality not quantity is key. Having a balanced healthy diet, lifestyle and mindset can support your fertility.

References

Grande M, Borobio V, Bennasar M, et al. Role of ovarian reserve markers, antimüllerian hormone and antral follicle count, as aneuploidy markers in ongoing pregnancies and miscarriages. (2015) Fertil Steril. 103(5):1221-1227.

Kallio S, Puurunen J, Ruokonen A, Vaskivuo T, Piltonen T, Tapanainen JS. (2013). Antimüllerian hormone levels decrease in women using combined contraception independently of administration route. Fertil Steril. 99:1305–10. doi: 10.1016/j.fertnstert.2012.11.034

La Marca et. al. (2013). How Much Does AMH Vary In Normal Women? Int J Endocrinology. 2013; 959487. Published online 2013 Nov 19. doi: 10.1155/2013/959487

Anne Z. Steiner, MD, MPH¹; David Pritchard, MS²; Frank Z. Stanczyk, PhD³; et al (2017) Association between biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age. JAMA. 318(14):1367-1376. doi:10.1001/jama.2017.14588

Rustamov, Objek (2011). The reproducibility of serum anti-Mullerian hormone in subfertile women: within and between patient variability. Fertil Steril.:95(3)1185–7.

Tadros T, Tarasconi B, Nassar J, Benhaim JL, Taieb J, Fanchin R. (2016). New automated antimüllerian hormone assays are more reliable than the manual assay in patients with reduced antral follicle count. Fertil Steril. (2016) 106:1800–6.

doi: 10.1016/j.fertnstert.2016.08.045

Holistic Coaching Melbourne

At Femme Vital in Fairfield, Melbourne, expect the best health and life coaching to support your growth. Look forward to living life in an authentic and wonderful way.

Ilana is also a registered Acupuncturist and has achieved a Masters of Chinese Herbal Medicine.