Anti Mullerian Hormone AMH and FSH9 min read

Acupuncture and Chinese Herbs proven to lower FSH and improve ovarian production

Click here to see the many studies which show that acupuncture can lower FSH and improve ovarian production.

anti mullerian hormone amh and fsh

Low AMH and Ovarian Reserve

What is low anti mullerian hormone AMH or  low ovarian reserve (LOR ) -also called diminished ovarian reserve (DOR)?  How is this related to high FSH levels?  You may have heard these terms from your gynecologist or reproductive endocrinologist for the first time recently and the implications that they carry may have been shocking.  Lets take a look what is meant exactly by this diagnosis and what are the means of treating it according to western and Chinese medicine.

 “Low ovarian reserve” in Chinese medicine

In Chinese medicine we do not believe there is something that is an absolute reserve as such, an idea which you can see below is currently being proven in western medical studies. Ovarian production depends on the health and balance of the entire body and not only on some theoretical reserve. While it is undeniable that there is a loose correlation between age and the production of follicles and eggs, this correlation is, however,  in no way direct nor unchangeable.  

There are many processes in the body which can effect egg number and quality. Chinese medicine states that it is possible to improve ovarian production by improving the bodily processes which effect this production: hormone levels, stress levels, blood flow, oxidation and inflammation. This can take three to nine months because this is the amount of time necessary for a follicle to mature from it´s resting state until it is ready to ovulate.

 

Low Anti-Mullerian hormone AMH and Low ovarian reserve in western medicine

Low ovarian reserve means that a woman is not producing sufficient follicles and therefore eggs to get pregnant by natural means or have enough response to hormones to undergo an insemination or IVF cycle. In general this reserve decreases with age but this decline is different for each woman.

The problems with the concept of “low ovarian reserve”

Let´s take apart this term and look at each part separately in order to understand some of the problems inherent to this idea.

  • Low- There does not exist an exact minimum number of follicles at which the diagnosis of low ovarian reserve is indicated. So what exactly is “low”?  When your RE tells you that you have low ovarian reserve, in reality he is saying that you will have a poor response to western fertility treatments. There are, however, a number of studies which show that the tests used to measure “low ovarian reserve” are not even good at indicating how a couple will respond to hormonal treatments.  You can see one study here
  • Reserve- For many years western medical science assumed that women were born with between 200,000 and 400,000 eggs and went along using them up with each menstrual cycle until menopause. In the last few years a number of studies have found that this is not necessarily true. These studies have found stem and germ cells that are able to produce eggs in mice and humans. Doctors have also been surprised by the fact that many women who should be sterile after radiation treatment for cancer have become pregnant after bone marrow transplantation. The mechanism behind this is still unknown but somehow these women are able to produce new follicles and eggs.

See the studies here-     Human Study      Mouse study

Low Ovarian Reserve- Diagnosis

In western medicine low ovarian reserve is diagnosed in many ways:

  • Age – The only parameter of ovarian quality that is scientifically proven is age. For reproductive endocrinologists this is usually thought to mean low ovarian reserve as well. As we age, like most of our organs, the ovaries can have problems. In general women older than 35 often enter in this diagnosis and even more so those above the age of 40.
  • Ultrasound – this technique is used to count the number of antral follicles (those from which one will ovulate in the next cycle) In this subject as in many other there in no a consensus on what qualifies as low ovarian reserve.

No evidence for predictive quality of ovarian reserve testing

  • FSH (follicle stimulating hormone) levels – this test is done the 2nd -4th day of the menstrual cycle, shows us the strength of the message that the hypothalamus is sending to the ovaries to produce eggs. As the ovaries produce fewer eggs as time goes on this message gets stronger – FSH levels go up. So there is a reverse relationship between FSH levels and egg production. Here to it should be remembered that there is no consensus  (read Poor evidence for reliability of ovarian testing)  as to what number indicates low ovarian reserve but most clinics believe that a number higher than 9 is an indicator for low ovarian reserve.Problem of consensus in ovarian testing
  • AMH- (anti-müllerian hormone) – this hormone is produced by follicles 2-3 months before they become ready to ovulate. In this test we get some idea of how ovarian production will be in the next 2-3 months. Yet again there is no agreement in the fertility community as to which result for this test indicates low ovarian reserve.  ( read a Committee opinion on poor reliability of ovarian reserve testing )    Many clinics use a number of less than 0.8 as a sign of low ovarian reserve.

It is important to remember that all of the numbers CAN be changed. Nothing is fixed in the body. I personally have treated many patients with high FSH, Low amh and low numbers of antral follicles who have gone on to get pregnant either by natural means or with the help of IVF.

 

In Chinese medicine the idea of a low ovarian reserve does not exist as such. When a patient with abnormal hormone levels or a low number of antral follicles comes to the clinic, we understand this as a problem of ovarian function that can be helped through treatment. There are of course limits to what Chinese medicine can do, and the change we make in older patients may not be enough to lead to a pregnancy.

Low ovarian reserve treatment

 Treatment with Chinese Medicine-

In our medicine we treat this diagnosis as a failure of proper function of the ovaries. Therefore the treatment consists in improving ovarian function. In Chinese medicine each case is different because we not only look at the problem but also at the patterns which are creating the problem.

The first priority in Chinese fertility treatment is to regulate the menstrual cycle in order to harmonize the normal hormonal changes which should be occurring during the cycle. The idea is to have menstrual cycles with the following characteristics.

  • Pain free menses without clots
  • Good quantity of menstrual blood
  • Follicular phase which lasts at least 12 days
  • Good ovulation shown by
    • Ovulation test strips
    • Rise in basal body temperature
    • The appearance of egg-white cervical mucous just prior to ovulation
  • Luteal phase with proper levels of progesterone shown by basal body temperature which remains high and that lasts at least 13 days

 

Once we have achieved good menstrual cycles the follicles maturing in the ovaries are exposed to the necessary hormones so that they can grow properly. With these changes we create better eggs.

The tools we use to attain this are:

  • Chinese herbs (click here to learn more about herbal treatment)
    • The herbal formulas used in the western diagnosis of low ovarian reserve have two central functions
      • They provide the basic ingredients necessary for the proper growth of follicles
      • They regulate and maintain correct menstrual cycles so that the ovaries are exposed to the normal balance of different hormones throughout the cycle producing eggs of the best quality and quantity possible.
    • Supplements- depending on the case we use a few supplements to decrease oxidative stress on the body and add any vitamins and minerals needed for peak fertility
    • Diet (link) – we use specific diets depending on the patterns of disharmony identified in each patient. You will be given a list of foods to eat more of, less of or eliminate completely from your diet. Bone broth is also highly recommended for patients who have been diagnosed with low ovarian reserve.
    • Lifestyle- a healthy lifestyle also helps the body and mind to be in balance. This is very important for good hormone production. It has been proven in many studies that stress causes hormonal imbalances. In modern life this is one of the most common problems among patients. The best thing you can do is to exercise in a moderate way to decrease stress levels. Yoga and mindfulness have been proven to be especially helpful in decreasing stress and anxiety.  See how these studies show the effect of these practices on stress levels:

How yoga reduces stress

Mindfulness proven to reduce stress

 Treatment with Western Medicine- At the moment there is no treatment in western medicine to improve low ovarian reserve as such. There are treatments which can help women with low ovarian reserve to conceive.

  • Donor Eggs-   For many fertility clinics the preferred option is egg donation. For many couples this idea can be very shocking at first and it may seem that doctors do not always appreciate the emotional and psychological impact that such an option carries with it.
  • In vitro fertilization (IVF) – another option is to attempt an IVF cycle and see what actual response the patient has to the hormonal stimulation. This can be done with a normal IVF or a modified in order to accumulate eggs. In this manner a series of hormonal stimulations and egg retrievals are done with the eggs retrieved in each frozen. When enough have been gathered they are unfrozen fertilized and transferred to the womb.