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.
The short answer is yes. The long answer is not in very case.
What are the treatable cases?
We have successfully treat cases where:
Women who are younger than mid 40’s and have very high FSH (menopausal range) and low Oestradiaol. It is important that these hormones are done on day 2, 3 and 4 of cycles. If your periods may be irregular or you may even miss some of your cycles but you have not stopped cycles completely. You will do better with our treatment if your FSH is going up and down a bit rather then keep going up.
Caroline is 41 coming up to 42. She has irregular periods. In March 2017, her FSH was 24, LH 12.6, Oestradial 77 and AMH<0.2. She has diagnosed as near menopausal and she was advised to go for donor eggs. She came to us and 3 months later, she retested her hormones. Her FSH is 7, LH 3.3, Oestradial 488 and AMH 1.8.
She e mailed us the post treatment results and said ’Comment? I do not believe this… in shock!’
Women who lost their cycles very early on i.e. in late teens of in their 20’s. You are still younger than 35.
Adele is 28. She lost her cycles at 18. She had 2 years of HRT straight after that and found it did not agree with her. She also tried 2 years of acupuncture to no avail. A few years ago, she developed arthritis with painful joints and bones. She came to us and by month 3, she was reporting period cycle symptoms such as cramps and pain although her periods have not come back yet. All her arthritis symptoms are now gone.
Women who have severe PCOS who may not have natural cycles as a result.
Miriam is 27. She has severe PCOS to the point of no natural cycles unless she uses contraceptives. We told her to come off the pills and at the end of her second month treatment with us, she had her first natural cycle.
She e mailed us to say ‘I had 3 days of bleeding, I can’t believe this.’
The endocrine system is a bit like the train network. Think of the glands as train stations. They produce hormones, which are the train signals. When the signals are right, the trains will run on time and to their destinations. This happy state of affairs will manifest itself in well-regulated menstrual cycles, healthy eggs and trouble free period cycles.
When the signals are wrong, the trains will not run on time, they may miss their destinations or in the extreme case, the trains will not run at all. The same is true with hormones, when the hormones are imbalanced, the period cycles are likely to be irregular, they are likely to have associated problems such as pain, PMS etc. In the extreme case, periods may stop entirely.
So what can be done? One way is to try to help by giving hormones. While externally administered hormones may regulate the period cycles or dealt with problems associated with periods, they may generate their own problems i.e. the unintended consequences of side effects. They are also telling your body to settle into a ‘I do not need to do anything’ mode which may not be a good idea. Last but not least, this approach tends to deal with the symptoms not the cause.
What we need is to address is the root causes of the problem – the glands. We need to make sure the body is healthy, the reproductive system is healthy and the glands are healthy. When they are in good health, the right level of hormones and their associated benefits are the results.
To go back to the analogy, signal problems seem best dealt with by finding out what went wrong in the train stations that were giving out the signals. When the stations function better, the signals they give out will be right again.
At TCM HealthCare, we help patients to improve their reproductive health by precisely that. Our treatment is tailored-made to each patient. We have built up an excellent track record. Consultants have seen our pre and post treatment results (for FSH, for AMH). Some patients are grateful to us and they write Google reviews and testimonials sharing their experience. For details on how we treat hormonal imbalance, please click here.
We hope to be of service to you too. Contact us to find out more.
I could only erect for 1 minute and could not ejaculate inside. After treatment, I can now maintain erection for more than 10 minutes and ejaculate inside.
Below are listed some recent reviews on research that show that Chinese medicine can help with balancing hormones, treating PCOS and dealing with anovulation:
Curr Opin Obstet Gynecol. 2008 Jun;20(3):211-5. doi: 10.1097/GCO.0b013e3282f88e22.
Traditional Chinese medicine and infertility.
Huang ST1, Chen AP.
PURPOSE OF REVIEW:
The present review gives an overview of the potential use of traditional Chinese medicine in the treatment of infertility, including an evidence-based evaluation of its efficacy and tolerance.
Recent studies demonstrated that traditional Chinese medicine could regulate the gonadotropin-releasing hormone to induce ovulation and improve the uterus blood flow and menstrual changes of endometrium. In addition, it also has impacts on patients with infertility resulting from polycystic ovarian syndrome, anxiety, stress and immunological disorders. Although study design with adequate sample size and appropriate control for the use of traditional Chinese medicine is not sufficient, the effective studies have already indicated the necessity to explore the possible mechanisms, that is, effective dose, side effect and toxicity of traditional Chinese medicine, in the treatment of infertility by means of prospective randomized control trial.
The growing popularity of traditional Chinese medicine used alone or in combination with Western medicine highlights the need to examine the pros and cons of both Western and traditional Chinese medicine approaches. Integrating the principle and knowledge from well characterized approaches and quality control of both traditional Chinese medicine and Western medical approaches should become a trend in existing clinical practice and serve as a better methodology for treating infertility.
PMID: 18460933 [PubMed – indexed for MEDLINE]
J Altern Complement Med. 2012 Dec;18(12):1087-100. doi: 10.1089/acm.2011.0371.
Chinese herbal medicine for infertility with anovulation: a systematic review.
Tan L1, Tong Y, Sze SC, Xu M, Shi Y, Song XY, Zhang TT.
The aim of this systematic review is to assess the effectiveness and safety of Chinese herbal medicine (CHM) in treatment of anovulation and infertility in women. Eight (8) databases were extensively retrieved. The Chinese electronic databases included VIP Information, CMCC, and CNKI. The English electronic databases included AMED, CINAHL, Cochrane Library, Embase, and MEDLINE(®). Randomized controlled trials using CHM as intervention were included in the study selection. The quality of studies was assessed by the Jadad scale and the criteria referred to Cochrane reviewers’ handbook. The efficacy of CHM treatment for infertility with anovulation was evaluated by meta-analysis. There were 692 articles retrieved according to the search strategy, and 1659 participants were involved in the 15 studies that satisfied the selection criteria. All the included trials were done in China. Meta-analysis indicated that CHM significantly increased the pregnancy rate (odds ratio [OR] 3.12, 95% confidence interval [CI] 2.50-3.88) and reduced the miscarriage rate (OR 0.2, 95% CI 0.10-0.41) compared to clomiphene. In addition, CHM also increased the ovulation rate (OR 1.55, 95% CI 1.06-2.25) and improved the cervical mucus score (OR 3.82, 95% CI 1.78-8.21) compared to clomiphene, while there were no significant difference between CHM and clomiphene combined with other medicine. CHM is effective in treating infertility with anovulation. Also, no significant adverse effects were identified for the use of CHM from the studies included in this review. However, owing to the low quality of the studies investigated, more randomized controlled trials are needed before evidence-based recommendation regarding the effectiveness and safety of CHM in the management of infertility with anovulation can be provided.
PMID: 23198826 [PubMed – indexed for MEDLINE]
Non obstructive azoospermia poses significant problems for conventional medicine. A few treatment options are available for clearly identified issues such as varicocele.
Varicocele is an abnormal tortuosity and dilation of veins of the pampiniform plexus within the spermatic cord. It is somewhat like a varicose vein of the scrotum. A varicocele could affect sperm by increasing testicular temperature. Varicoceles are found in about 40% of infertile men and 20% of all men in the general population. The large majority are fertile with normal sperm.
Urologists often diagnose and surgically repair varicoceles. However, correcting a varicocele (surgical procedure) often does not improve the semen quality enough to warrant a change of therapy required to result in pregnancy for the couple. Several studies have found that varicocele surgery can improve sperm counts or low motility but randomized and controlled trials do not consistently show improved pregnancy rates.
Sperm retrieval through biopsy of the testis is another solution offered by conventional medicine. In many instances, the only hope for building a biological family is to use sperm retrieved from the testis with assisted reproduction. However, in patients with non obstructive azoospermia, only about 50%-60% of men will have usable testicular sperm.
Once these solutions are exhausted or discounted, the patients are often at a lost as to what to do next.
At TCM HealthCare, we believe that non obstructive azoospermia is a functional disorder which can be amenable to treatment. Our clinical experience borne this out. We have extensive experience in treating non obstructive azoospermia and extremely low sperm count. Below is a patient who wrote about his experience with our treatment in 2015. More information can be found at the Testimonial page and the Treatment for Men page.
‘My partner and I had being trying to conceive for a number of yeears without success.
My health was not always great and I often felt tired and was dragging myself through life.
My sperm test results revealed a virtually non existent count (less than 100) and the doctor doing the test results analysis said ‘I had as much chance of conceiving with my partner as winning the lottery.’ Going to my GP I was told that there was nothing conventional medicine could do about it. They could only offer help on the woman’s side. There was nothing they could do for a man.
Looking desperately for an alternative I found TCM Healthcare on the internet and spoke to Prof. Au who said he thought they could help. He then arranged an appointment for me with Professor Y Li at TCM HealthCare’s Clinic in Harley Street, an expert trained in Chinese Medicine and Fertility in Beijing.
In the initial consultation the Professor asked questions and listened to my answers and explanation of my medical symptoms. He also took my pulses and looked at my tongue. His manner was always friendly and sympathetic and it was obvious he really wanted to help. He stressed Chinese medicine treats the whole body and said I should see improvements generally in my overall health along with the improvements in fertility.
I was prescribed herbs to be boiled with water which would make a hot drink to be taken twice per day. Although not the most tastefull drink I figured that it was doing me good and soon got quite used to my daily routine of drinking it morning and night.
I had folow up appointments each month during which he would reassess my condition and would then refine the herbs I was to take for the following month.
I noticed I started to have more energy and generally started feeling better all round.
After about 4 months I decided to have a second test and was genuinely shocked to see my count had increased to 20 Million. A subsequent test two months later revealed it had improved to 70 Million
After seven months my partner announced she was pregnant. Today my partner had her 11 week scan and all is well.
Thanks to all those at TCM Healthcare.’
James from London
Conventional medicine believes that PCOS cannot be cured. At TCM HealthCare, we have some experience in curing PCOS which has been confirmed by patients that have gone through treatment with us and have a scan subsequently.
Lori sent us this message in 2016:
‘I first saw Professor Li following an early miscarriage after our first IVF treatment in 2015. He listened carefully to our situation and my ongoing symptoms, and identified a number of deficiencies that are involved in my inability to get pregnant. Following six months of treatment, I am happy to report that many of my troublesome symptoms have either disappeared or improved dramatically. We are planning a second IVF treatment shortly and feeling optimistic. Many thanks to Professors Li and Au – they are kind, supportive and professional.’
‘Some good news though–I had a scan last week and my ovaries are no longer polycystic! This means they can start me on a higher dose of FSH and hopefully collect more eggs this time. Fingers crossed.’
Lori from London 2016
Due to the success of our work, we have also been invited to write an article about our work on PCOS and fertility b the PCOS Charity Verity. A copy of the article can be sent to you on request. We have also reproduced ‘A patient’s journey’ in the article below:
Educational consultant Yvonne Archer had been diagnosed with PCOS. She became pregnant three times between 1997 and 1999 but lost each baby between six and nine weeks. She was referred to an assisted conception unit in December 1999. Scanning showed a normal uterus and her tests were negative. Clomi-phene did not work, and while ovulation induction went well, she still did not conceive.
In early 2000 her consultant suggested she had reached the point where IVF would be necessary. Meanwhile, Yvonne had been experimenting with aroma-therapy, TCM general medicine and acupuncture with no success.
In May 2000 Yvonne went to TCM HealthCare’s fertility clinic, where she was diagnosed with kidney and liver deficiency and put on herbal medication for five months. Again, nothing happened. While her body was back in balance, our doctor explained that pregnancy was not automatic and her body needed time.
In February 2001, Yvonne rang to say she was pregnant, and was keen to see the TCM specialist to ensure that this time she could carry the baby to full term. After a consultation in March 2001 she was prescribed 12 days of herbal medicine. No further medication was necessary. She gave birth to a healthy daughter in October 2001.
My FSH result was 25 before. It is now 13.9! (Two failed cycles of IVF and further treatment for a few months later in 2017), I am 6 weeks pregnant!
I could not believe my AMH test result, It has gone up more than 3 times. I am very pleased with the treatment.