The short answer is no. Read on…
Conventional medical practice says that one of the most if not the most important hormones is AMH which indicates woman’s egg reserve. If this is low, the chances of her getting pregnant will be low. This may be the case with IVF technology where stimulating drugs are injected to retrieve eggs cycle by cycle. A high AMH implies a high egg reserve, which in turn implies more eggs can be retrieved. This increases the chances of more good quality eggs to be retrieved, which then means an IVF cycle is more likely to be successful. However, does the same rationale applies to a context different from ART (Assisted Reproductive Technology) i.e. natural pregnancy?
Does AMH level relate to probability of natural pregnancy?
Hagen et al. addressed this very question in a recent issue of the journal Fertility and Sterility (Low concentration of circulating anti-mullerian hormone is not predictive of reduced fecundability in young healthy women: a prospective cohort study 2012; 98:1602-8). They followed a total of 186 young Danish couples that intended to discontinue contraception to become pregnant until they conceived or for six menstrual cycles. They calculated the fecundability ratio (FR) (i.e., the monthly probability of conceiving) and time to pregnancy (TTP) was measured as the number of cycles from stopping birth control to pregnancy. They measured AMH levels and anticipated that those with low AMH levels would have a low FR and take longer to conceive. AMH levels were measured and were divided into 3 groups low (quintile 1), medium (quintile 2 -4) and high (quintile 5). The results are interesting.
59% of couples conceived during the study period. There was no difference in the FR in women with low or medium AMH levels (FR 0.81; 95% CI 0.44 – 1.40). In contrast women with high AMH levels had reduced FR (FR 0.62; 95% CI 0.39 – 0.99). High AMH levels are often seen in women with polycystic ovary syndrome (PCOS) and have irregular cycles. This decrease in FR was significant even when women with irregular menses were excluded from the analysis.
In IVF-related literature, a low AMH level is useful as a marker of follicle quantity than egg quality. This study demonstrates that in the context of natural conception in young women, where only one egg is involved, low AMH level also does not reflect egg quality.
Women with high AMH levels and regular cycles had lower chance of conception. These women may be similar to the group often termed ovulatory PCOS. They have other hormonal imbalances (elevated circulating levels of testosterone) that may be responsible for the lower FR.
They conclude that low AMH levels in young healthy women do not seem to be a predictor of reduced fecundability. This is consistent with high egg quality in these young women, despite a reduced ovarian reserve. Conversely, women with high AMH levels had a 40% reduction in the FR, and this persisted even after exclusion of women with irregular cycles.
In another study by Isabelle Streuli et al. published in 2014 in Reproductive BioMedicine 28, Issue 2, Pages 216–224, the researchers determined whether anti-Müllerian hormone (AMH) concentration influences the time necessary to conceive a live-born child – effective time to pregnancy (eTTP) – in a population of women who conceived naturally. This is an observational study of 87 women with a planned spontaneous pregnancy resulting in a live birth. eTTP was assessed retrospectively by a questionnaire and AMH was measured in a frozen serum sample from first trimester of pregnancy. eTTP was correlated with age (r = −0.24, P = 0.02), but not with AMH (r = −0.10) or body mass index (r = 0.05). With logistic regressions, the only variable that affected the probability of pregnancy within 3 or 6 months was age, irrespective of whether an AMH concentration limit of 1.0 ng/ml or 2.0 ng/ml was chosen. In conclusion, this study suggests that there is no relationship between AMH concentration and eTTP and therefore speaks against determining AMH in women who are not infertile for the purpose of predicting their chances of pregnancy.
A third study by Steiner et al. published in the American Journal of Medical Association in 2007 (JAMA. 2017;318(14):1367-1376) entitled ‘Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age’ posed the question: Is diminished ovarian reserve, as measured by low anti-müllerian hormone (AMH), associated with infertility among women of late reproductive age? In this time-to-pregnancy cohort study of women aged 30 to 44 years without a history of infertility, women with a low AMH value had an 84% predicted cumulative probability of conception by 12 cycles of pregnancy attempt compared with 75% in women with a normal AMH value, a nonsignificant difference. It concluded that among women attempting to conceive naturally, diminished ovarian reserve was not associated with infertility; women should be cautioned against using AMH levels to assess their current fertility.
The findings are concordant with previous reports describing AMH as a quantitative but not a qualitative marker of ovarian reserve and therefore does not reflect a woman’s natural ability to become pregnant.
All these studies of course do not refute the fact the AMH is important for ART (Artificial reproductive techniques) i.e egg freezing, IVF, ICSI etc. where the ovaries are stimulated with a view to obtain a high number of eggs which is the prerequisites for ART.
So does low AMH mean lower chances of natural pregnancy?
As the research findings above suggest, low AMH does not mean lower chances of natural pregnancy. Why so?
First, as Dr. Randine Lewis stated in her book The Infertility Cure, ‘In the perimenopausal period (defined as the period ten years or so before menstruation stops), there are still thousands of eggs remaining in the ovaries, ….. the DNA contained within our eggs becomes less table as we get older…. But contrary to what Western medicine would lead us to believe, a women’s eggs do not have an expired date. They respond to their surroundings just as the rest of our bodily systems do…. Ultimately, what makes our eggs less responsive is not age but hormonal fluctuations.’ This means that while advancing age is related to the hormone fluctuations, where hormonal fluctuations are slowed down or arrested within a certain time frame, natural pregnancy would be given a better chance to succeed even in older women with low AMH.
Second, it seems self evident that natural pregnancy requires a slightly different pathway for conception. The ovaries do not need to be stimulated to produce a high number of eggs. Rather, the natural process generally dictates that one dominant egg will come through in ovulation. This is all that is required in each cycle. When the egg is of good quality and the woman as well as the sperm on the man’s side are healthy, fertilisation, natural pregnancy and live birth will have a good chance to occur.
Commenting on the third study outlined above conducted by Dr. Steinner in an article published in New York Times (16 October 2017), Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine at Weill Cornell Medicine and NewYork-Presbyterian, declared the study “elegant.” As regards natural pregnancy, He said, “All it takes is one egg each cycle.” He added, “AMH is not a marker of whether you can or cannot become pregnant.”
Of course, natural pregnancy will take time. So does IVFs. We have worked out some clinical protocols to improve the health of eggs, the female reproductive system (by improving hormones all round) in general and sperms (by improving the quantity as well as quality of sperms) with a view to increase the chances of natural pregnancy. Much of these does not require a high or even a normal level of AMH. Neither would a low AMH impacts on this protocol or the success of it.
Last but not least, an exceptionally high AMH is associated with PCOS which impacts negatively on natural pregnancy and IVF alike. We have successfully treated many PCOS cases which see AMH decreases over time to lower or normal level, thereby increasing the chances of natural pregnancy and IVF success. Please check Google Review on right hand side of any treatment page.
For treatment programme to achieve hormonal imbalance, please click here.
For treatment programme to improve FSH, please click here.
For treatment programme to imp;rove AMH, please click here.
For treatment programme to improve egg quality, please click here.
For treatment programme to treat sperm issues, please click here.