Overtreating patients with low AMH levels

AMH is a relatively new blood test which is very useful in checking the ovarian reserve of women but results in over treating of patients by infertlity doctors.

AMH is a relatively new blood test which is very useful in checking the ovarian reserve of women. It allows us to estimate the quantity and quality of eggs left in your ovaries, so can get a better idea of how you will respond to superovulation. Basically, it allows us to check how young your ovaries are - and is much better than the older blood test of checking the FSH level, which was all what was available to us a few years ago.
However, like any other test, it has a lot of limitations. It provides useful information, but as with all biological systems, none of this is in black or white - these are all shades of grey. Like all tests, it needs to be interpreted by a skilled doctor, who uses his judgment to make sense of test result in the right clinical context.

Today, because the test is so easily available, many doctors do AMH level testing in order to counsel infertile women. While a normal AMH level is reassuring, many doctors do not seem to understand what to advise their patients when their AMH level is low. While low AMH levels do suggest poor ovarian reserve, this does not mean that these patients cannot get pregnant with their own eggs. However , there are some IVF specialists who reflexively advise their patients with low AMH levels to use donor eggs as their first treatment choice !

Both doctors and patients need to remember that doctors do not treat lab results - we treat patients. Sadly, it's so much easier to order lab tests and fix these rather than talk to the patient, that we tend to overtreat abnormal lab results such as low AMH levels.

Please remember that women with low AMH levels do get pregnant in their bedroom as well ! This is especially true for young women with low AMH levels - in these women, a low AMH level does not correlate as well with poor fertility as compared to low AMH levels in older women !

The trouble is that when infertile women find out they have a low AMH level, this is what they start obsessing about - much like the man with a low sperm count who is exclusively focused about his sperm counts!
Please remember that an AMH level is just one piece in a complex jigsaw puzzle ! If you do have a low AMH level, please do not panic. Remember that every problem has a solution - we just need to find the right one for you!

Here are some ground rules which may help.

  • Please don't jump to conclusions based on just one report. Please retest from another lab - remember that not all labs are reliable !
  • You need to collect additional evidence to confirm the diagnosis of poor ovarian reserve. One of the best ways of doing this is by checking your antral follicle count, using a vaginal ultrasound scan .
  • It's worth trying alternative medicines to try to improve your ovarian reserve. While these are untested and unproven, they are unlikely to cause any harm - and will give you peace of mind you did your best. You can use yourself as a personal guinea pig and run a clinical trial on yourself - this is a great way of becoming an expert patient !

It's important to remember that we do have solutions to this common and frustrating problem, and that a low AMH level does not mean that your dreams of having a baby will never be fulfilled !

It's a good idea to try IVF to see how your ovaries respond. Using donor eggs should always be Plan B !

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.