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Acupuncture and Fertility: AMH a Continuing Saga
I recently posted a blog entry about AMH (anti-mullerian hormone). To briefly recap my thoughts, AMH is potentially a good indicator of the client’s response to IVF but not the best indicator of potential conception. Many women with low AMH levels who are regularly ovulating are informed conception will not occur. This simply is not the truth.
In my monthly review of journal articles, I read:
The significance of serum anti-Müllerian hormone (AMH) levels in patients over age 40 in first IVF treatment
Yoko Tokura & Osamu Yoshino & Sayaka Ogura-Nose & Hiroshi Motoyama & Miyuki Harada & Yutaka Osuga & Yasushi Shimizu & Motohiro Ohara & Takeshi Yorimitsu & Osamu Nishii & Shiro Kozuma & Toshihiro Kawamura (J Assist Reprod Genet (2013) 30:821–825 DOI 10.1007/s10815-013-9991-3)
Researchers concluded AMH is a good indicator of the women’s ovarian response to IVF. Low AMH often lead to less follicles stimulated, higher doses of hormones and less chance of transfer compared to women with normal levels of AMH.
There was no clinical significance in the pregnancy rates between normal and low AMH levels. Women with normal AMH do have more eggs at retrieval and thus have additional chances to conceive. Yet most importantly, “the levels of AMH may indicate the quantity, i.e., the number of oocytes and embryos, but not the quality of them, and extremely low AMH levels do not seem to represent an appropriate marker for withholding fertility treatment.”
One of my clients asked if I observe issues with a women’s cycle who have a low AMH level. I do see some common glitches. Early ovulation, poor fertile cervical mucus and PMS, especially spotting and fatigue. From a Chinese view, low AMH indicates that the body’s ability to activate and signal ovarian growth is off. When the hormonal signaling is not solid, menstrual irregularities happen. When signaling is balanced, the menstrual cycle smoothly runs through its phases – period, ovulation and post ovulation – with minimal physical symptoms.
As I mentioned in the other article, please don’t let AMH define your reproductive health. Be aware there are other ways to help your reproductive journey. Yes, western medicine offers immediate solutions for conception, yet there are limits to its ability to adapt to your body. Some women will have a better outcome with other modalities (like acupuncture and Chinese herbs). Though the journey might be slower it can provide another option to having a baby.
The significance of serum anti-Müllerian hormone (AMH) levels in patients over age 40 in first IVF treatment
Yoko Tokura & Osamu Yoshino & Sayaka Ogura-Nose & Hiroshi Motoyama & Miyuki Harada & Yutaka Osuga & Yasushi Shimizu & Motohiro Ohara & Takeshi Yorimitsu & Osamu Nishii & Shiro Kozuma & Toshihiro Kawamura (J Assist Reprod Genet (2013) 30:821–825 DOI 10.1007/s10815-013-9991-3)
Discussion
It is reported that female age predicts over 80 % of IVF success [/fusion_builder_column][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][11].Additionally, in women aged 40 and older, ovarian reserve was the main prognostic factor of IVF success. Therefore, for older infertility patients, proper assessment of ovarian re- serve, including correct identification of poor responders, is essential. However, until recently a consensus regarding the definition of “poor response” had not been reached. In 2010, the European Society of Human Reproduction and Embryology (ESHRE) set criteria for the definition of poor ovarian response (POR) in IVF. According to the Bologna criteria, at least two of the following three features must be present: (i) Advanced maternal age (≥40 years) or any other risk factor for POR; (ii) A previous POR (≤3 oocytes with a conventional stimulation protocol); (iii) An abnormal ovarian reserve test result. Importantly, the criteria designated a serum AMH level of less than 0.5–1.1 ng/ml as an abnormal ovarian reserve test result [3]. Until now, these criteria have only been used to assess patients after completion of IVF treatment, and it remained to be elucidated whether these criteria could be useful to patients prior to initiation of IVF treatment. Moreover, the criteria have been established with data primarily from patients that were less than 40 years old. In this paper, we studied patients who undergo their first IVF cycles at the age of 40 and older, and investigated the significance of AMH levels in these women. Although the blood samples were taken before their first IVF cycle, the AMH data were not taken into consideration in determining gonadotropin dose. In the present study, there was a positive correlation between serum AMH and the number of oocytes retrieved. The ROC curve analysis for prediction of poor ovarian response, ≤3 retrieved oo- cytes, showed the optimum cut-off level of AMH was < 1.0 ng/mL, which is consistent with the ESHRE criteria indicating a serum AMH level of less than 0.5–1.1 ng/ml as an abnormal ovarian reserve test result [3]. Therefore, among the patients aged 40 and older at the time of their first IVF cycle, the ESHRE criteria proved their validity. Interestingly, there was a negative correlation between serum AMH levels and total dose of gonadotropins (P< 0.02). On the other hand, there was no correlation between the number of oocytes retrieved and total dose of gonadotro- pins.
These data suggest that the patients who exhibited lower AMH levels would need higher doses of gonadotropins. Therefore, patients with lower levels of serum AMH required additional stimulation to induce follicular development. When patients were divided into two groups, low and high group, according to cut-off level of AMH of 1.0 ng/ml, the low group had less chance of undergoing embryo transfer (63.3 %) than the high group (89.4 %, P<0.05). But as for pregnancy rate, 5 out of 30 patients in the low group (16.7 %) and 7 out of 19 patients in the high group (36.8 %) achieved pregnancy. There was a trend, but no statistically significance between two groups (P=0.1). When comparing AMH levels between the pregnant (N=12) and non-pregnant (N=37) groups, the pregnant group exhibited significantly higher AMH levels than the non-pregnant group (Fig. 3).Inaccor- dance with higher levels of AMH, the number of oocytes retrieved was significantly greater in the pregnant group (mean 5.4 range 2–9) than in the non-pregnant group (mean 3.4 range 0–9) (P<0.02, data not shown). Therefore, the more retrieved oocyte number would lead to a higher number of embryos to transfer, thus, increasing the chance of pregnancy. But lower levels of AMH did not indicate that there was no chance of pregnancy. In fact, among the 12 pregnant cases, 5 exhibited serum AMH levels of less than 0.4 ng/ml, which are classified as extremely low levels [14]. Collectively, the levels of AMH may indicate the quantity, i.e., the number of oocytes and embryos, but not the quality of them [5,7], and extremely low AMH levels do not seem to represent an appropriate marker for withholding fertility treatment. In summary, the present study suggested that serum AMH concentration in older patients might be helpful for the prediction of oocyte numbers which would be obtained in IVF. Moreover, the cut-off level of AMH was 1.0 ng/ml to obtain more than 4 oocytes. This cut-off level of AMH of 1.0 ng/ml might be useful to predict whether patients have a chance for embryo transfer, but had no power to predict achieving pregnancy. On the other hand, our data showed that patients over age 40 with extreme low levels of AMH still had a chance of pregnancy.[/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]