What to do if anti-Mullerian hormone is low

As people's awareness of healthy fertility continues to increase, many couples will go through a period of pregnancy preparation before preparing to have a child. The most important thing in pregnancy preparation is to go to the hospital for a check-up to understand whether your body has the conditions for pregnancy. When getting the test results, most people will be exposed to anti-Mullerian hormone. Low anti-Mullerian hormone will hinder pregnancy. How should it be alleviated at this time?

What is anti-Mullerian hormone?

Anti-Mullerian hormone is produced in the testicles and ovaries of all mammals. It can cause the Mullerian duct to degenerate, so it is named Mullerian inhibitory substance. The more small antral follicles there are in the ovaries, the higher the AMH concentration; conversely, as the follicles are gradually consumed with age and various factors, the AMH concentration will also decrease. When approaching menopause, AMH gradually approaches zero and can be used as a marker to predict ovarian reserve.

What does it mean to check AMH?

①Evaluate ovarian reserve function: Ovarian reserve includes the quality and quantity of primordial follicles. As women age, their reproductive capacity gradually declines, and once the primordial follicles are exhausted, follicles cannot be recruited, leading to menopause.

②Evaluation of premature ovarian failure: Early ovarian dysfunction does not cause menstrual irregularity, and the subsequent perimenopause may last for 3-10 years. Studies have shown that serum AMH concentration can distinguish between early (i.e. regular menstrual cycles, increased FSH concentration in the follicular phase) and transitional ovarian dysfunction (irregular menstruation, increased FSH concentration in the follicular phase). AMH can provide an accurate assessment of follicular reserve in young women with hypergonadotropin secretion, especially those who have elevated FSH but do not meet the clinical diagnostic criteria for premature ovarian failure.

③ Polycystic ovary syndrome (PCOS): PCOS is the reproductive endocrine disorder with the highest incidence in the population, but the current diagnostic threshold of ≥12 follicles in one ovary is questionable. This is mainly due to improvements in imaging technology that can identify more follicles, which has artificially led to an increase in the incidence of polycystic ovary morphology in the general population, especially young women.

The serum AMH level of PCOS patients before ovulation increases significantly with the increase of AMH concentration in follicular fluid, thereby inhibiting follicle growth. The increase in AMH has nothing to do with ovulation and is mainly caused by an increase in small antral follicles. Therefore, in PCOS patients, serum AMH levels are negatively correlated with ovarian reserve function and ovulation induction effects, that is, the higher the AMH level, the worse the ovarian reserve function and ovulation induction effects.

④ Predicting ovarian responsiveness in assisted reproductive technology: AMH levels can predict ovarian responsiveness and identify women at risk of ovarian hyperstimulation syndrome. The dosage of ovulation-inducing drugs can be determined based on the AMH value.

⑤ Predicting the age of menopause: AMH levels are closely related to the age of menopause. With increasing age, AMH levels gradually decrease. Serum AMH levels gradually decrease in the 5 years before menopause and can predict the age of menopause.

⑥ Assist in diagnosing abnormal sex development: AMH can assist in diagnosing whether the child has developmental disorders such as abnormal gonadal development, precocious puberty, and cryptorchidism. If the serum AMH level is very low or undetectable, it is highly suggestive of the absence of testicular tissue. The serum AMH level in patients with cryptorchidism was significantly lower than that in patients with monotestis.

Normal value and significance of anti-Mullerian hormone

2-7 ng/ml, normal value

0.7-2ng/ml, indicating low ovarian response

<0.086ng/ml, indicating menopause

>7ng/ml indicates polycystic ovary syndrome, ovarian hyperstimulation syndrome, ovarian granulosa cell tumor

AMH is not only of great significance but also more convenient and stable to detect than sex hormones.

What to do if anti-Mullerian hormone is low?

1. Hormone replacement therapy (HRT): The classic treatment method at home and abroad is hormone replacement therapy. It is generally believed that on the one hand, it can improve the development of secondary sexual characteristics in adolescent patients with ovarian insufficiency and alleviate menopausal symptoms caused by estrogen deficiency; on the other hand, it can reduce the occurrence of long-term complications such as osteoporosis and cardiovascular diseases. It includes estrogen alone therapy and estrogen-progestin sequential therapy.

2. Ovulation induction therapy: For women who want to have children, exogenous gonadotropin drugs can be given on the basis of hormone replacement therapy to interfere with the growth, maturation and discharge of eggs, so as to achieve the purpose of making women pregnant.

3. Psychological treatment: There is a close connection between psychological factors and infertility caused by ovarian insufficiency. The two both promote and restrict each other. Patients with ovarian insufficiency are prone to mental health problems, such as anxiety, depression, insomnia, and a significant decrease in sexual satisfaction. These psychological crises in turn affect the fertility and treatment outcomes of patients with ovarian insufficiency. Therefore, it is crucial to maintain an optimistic attitude towards life and improve the quality of life.