Amg less than 1 is it possible to get pregnant. What days are the least likely to get pregnant

Every woman dreams of becoming a mother. Especially responsible couples are examined before conceiving a child. The most important thing to do is check your hormonal background... To do this, you should pass an analysis for hormones. These include anti-Müllerian hormone (AMH). But what to do when low AMH is noted in the analysis results? Is it possible to get pregnant in such a situation? The presented article will help you find answers to these questions.

Norma AMG

An AMG test helps to determine how many eggs are capable of turning into a baby. It shows how many follicles have matured in a woman's ovaries.

Before drawing conclusions about whether you have low AMH or normal, you need to familiarize yourself with the indicators of the norm. This hormone begins to increase from the moment puberty begins. Therefore, the ladies reproductive age this indicator reaches its maximum level and ranges from 1 to 2.5 ng / ml.

For a more accurate assessment of the hormone content, the analysis must be taken on the 5th day of the menstrual cycle. Deviations from the norm can be caused by various diseases... If you eliminate them, then at may be possible.

In the case when it comes to IVF, a slight increase in the hormone will only play into the hands of a woman. After all, this increases the likelihood of successful resolution of the procedure.

Reasons for the decrease in AMH

Enhancement AMH level can provoke one of the following conditions:

• normogonadotropic anovulatory infertility;
• abnormalities in the functioning of luteinizing hormone (LH) receptors;
• tumor processes in the ovaries;
• the presence of polycystic formations in the ovaries.

Low AMH is observed when:

• decrease (usually associated with aging of the body);
• menopause (not a pathology, since sooner or later it occurs in the life of every woman);
• overweight (obesity at childbearing age, that is, at 20-30 years old);
• ovarian dysfunction.

Possibility of pregnancy with reduced AMH

The presence of a reduced concentration of the hormone in a woman's body almost always indicates the presence of any pathology. Reproductive system disorders can be of a different nature: from the usual overweight and ending with tumor formations.

Despite the reasons that caused a decrease in the level of the hormone in the body, pregnancy with a low AMH becomes problematic. Since the content of this hormone cannot be artificially increased. The cause of the abnormality can be corrected, but an increase in the number of eggs is unlikely. It is possible to influence their quality and maturity.

Statistics indicate that for women with low AMH, only a procedure can be consolation artificial insemination... In addition, it often requires donor biological materials.

But there are also cases when the AMH decrease is corrected independently. This suggests that at the time of delivery of the analysis, its content was influenced by any negative factor, which distorted the research result.

Therefore, in each specific case, it is necessary to contact a specialist and develop a specific action plan.

AMG index for IVF

V modern world for couples wishing to conceive a child, but for some reason unable to do so naturally, there is an artificial insemination procedure. In medicine, it is called in vitro fertilization (IVF). This process is rather complicated and laborious.

Initially, you need to undergo an examination. The most indicative in this case will be the analysis for AMG. The anti-Müllerian hormone will show the reproductologist how many of a woman's eggs are suitable for fertilization. That is why there is a framework, that is, a certain indicator of this hormone is needed.

To carry out the artificial insemination procedure, the AMH index in a woman must be at least 0.8 ng / ml. Otherwise, the procedure will simply be impossible, because there is not the required number of eggs for fertilization. Even low AMH stimulation will be difficult.

However, too increased rate can be a hassle. In preparation for IVF, hormonal stimulation of follicular maturation is carried out. Due to the increased content of AMG in a woman's body, there is a risk of ovarian hyperstimulation.

Low AMH levels: is IVF possible?

Statistics indicate that IVF with low AMH is possible. But this is very difficult to accomplish. The hormone index does not affect whether the embryo will take root in a woman's body. But the very fact of fertilization can. Indeed, with a low AMH index, the number of eggs is very low, and their quality may be even worse. In addition, in this case, time is not on the side of future parents.

In principle, the procedure of artificial insemination with a low AMH is no different from the IVF procedure with a normal hormone level. But here the woman is forced to take more serious hormonal drugs. In addition, a longer period is required for the maturation of the eggs.

Typically, patients are prescribed hormonal drugs in a double dose. This, of course, sounds intimidating, but there is no reason to worry. A low hormone level will not lead to ovarian hyperstimulation or any other disease of the reproductive system.

Further actions of specialists depend on how the preparatory stage... If everything went well and the number of eggs that can be fertilized has increased, then the doctors take a follicle puncture, fertilize the egg and transfer the embryo into the mother's body. If the hormone indicator remains at a low level, then drug therapy subject to revision.

IVF protocols

The AMG index is crucial for the IVF procedure. Knowing this indicator, the fertility specialist chooses a more appropriate action plan and protocol.

IVF protocols for low AMH can be of two types: long and short.

Long-term protocols are enforced one week before the onset of menstruation. Over the next three weeks, ovarian stimulation is performed to increase the number of eggs available for fertilization. Then a puncture is taken a large number eggs (up to 20) and fertilization is performed. The artificially conceived three or five day old embryos are implanted in a woman. This protocol has possible complication- the risk of ovarian hyperstimulation.

A short protocol begins to be performed on the 2-3rd day of menstruation. Ovum stimulation is performed. For this, a puncture of the dominant follicles is done. However, in this case, complications are possible - the lack of high-quality eggs. In addition, the procedure is only suitable for women with good ovaries.

IVF without hormonal stimulation

With low AMH, fertilization is possible without exposing the woman to shock doses hormonal drugs... In this case, doctors monitor the woman's natural ovulation using an ultrasound scan. In this way, no more than 2 mature eggs are obtained in one cycle, which significantly reduces the chance of pregnancy.

This method, however, is also very difficult and has its pros and cons. The positive aspects include the fact that in this case you will not get twins or triplets, and you will not suffer from side effects hormone therapy. In addition, the cost of such fertilization is much lower.

The disadvantages include the fact that there is a high probability of missing the moment of egg maturation. Moreover, its quality will not be exactly what is needed for successful holding procedures.

Statistics

Low FSH, low AMH and other abnormalities are obstacles to fertilization. As statistics show, with IVF, only 20-60% end successfully. The likelihood of success depends on the woman's age, the quality of her egg and her hormonal status.

However, medicine does not stand still, and every year diagnostics and fertilization procedures are being improved. Thus, it becomes easier to give birth to a child from year to year.

High FSH and low AMH

Quite often, along with a low level of AMH, a high level of FSH is observed. FSH is a follicle-stimulating hormone that is responsible for the production of follicles in the ovaries. This situation is a rather serious obstacle to the IVF procedure.

Undoubtedly, statistics say that almost all IVF attempts end in pregnancy. But high FSH levels can prevent this from happening. In this case, it is recommended to complete the fertilization procedure using donor material.

And yet there is a chance to use your egg for this, but it is very small. This is only possible if the FSH level is slightly increased. But with a very high FSH, you should not waste precious time. Ovulation in a woman may never occur, which indicates the advisability of using a donor egg.

Anti-Müllerian hormone is a marker of a woman's ovarian reserve, in other words, the remaining number of eggs that can still be fertilized.

He himself does not affect the ability to conceive or bear a child. But its level in the body accurately predicts the chances of getting pregnant on their own and with the help of IVF. AMH is a kind of indicator of health and fertility.

Every woman is born with a fixed number of eggs. This indicator is laid as early as the 3rd month. intrauterine development.Before the start of the first menstruation, the girl's immature follicles are dormant..

With the first menstruation, the first follicle matures, releasing an egg, ready for fertilization. Each cycle the number of such eggs will decrease, and what remains will be the woman's ovarian reserve.

This dynamics is shown by the anti-Müllerian hormone. Today AMG is the most accurate analysis by which you can determine a woman's ability to conceive. as well as predict the onset of menopause.

In IVF, the AMH test makes it possible to assess the likelihood of fertilization of an egg after ovarian stimulation.

We offer you to watch a video about what AMG is:

Influence of AMH on the ability to conceive

Anti-Müllerian hormone is produced by the sex glands... V female body it is responsible for the production of follicles, and, therefore, for the ability to maturation of eggs.

If the chain is broken at the very beginning and follicles are not produced, then fertilization is impossible and the woman is not able to conceive naturally, as well as with the help of IVF and using her own eggs.

We suggest watching a video about the importance of AMG for conception:

When do I need to get tested?

Analysis for AMG is prescribed in the following cases:

• infertility;
• increased levels of follicle-stimulating hormone;
• unsuccessful IVF attempts;
• control of antiandrogen therapy.

And also a gynecologist can send a woman for analysis in the absence of pregnancy for a long time for no apparent reason.

AMG plays an important role at the stage of preparation for IVF. Based on its results, the fertility specialist can predict the response of the ovaries after stimulation.

The norm in women for conception

The norm of the anti-Muller hormone for successful conception child depends on age and individual characteristics women. It often happens that a woman in her 40s has an AGM higher than that of a twenty-year-old girl.

Normally, a woman of reproductive age has an anti-Müllerian hormone in the range of 1 to 2.5 ng / ml. Analysis data may vary slightly from laboratory to laboratory..

The lower the level of anti-Müllerian hormone, the lower the chance of getting pregnant.

At what level of AMH is pregnancy possible?

Indicators above or below the norm indicate malfunctioning of the ovaries and require the attention of a doctor. In rare cases, deviations in the parameters indicate an incorrect sampling or delivery of an analysis, so a woman can be sent for a retake.

If lowered

Decreased hormone levels indicate ovarian depletion... A deviation can be detected using laboratory analysis. It is possible to speak of a low content of AMG at values ​​from 0.2 to 1 ng / ml. This may indicate the following diseases:

• obesity;
• infertility;
• early puberty;
• the onset of menopause;
• decreased ovarian reserve;
• violation of the menstrual cycle.

Consider whether pregnancy is possible with low levels of anti-Müllerian hormone. The lower the AMH content in a woman's body, the less chances of conception. A value below 0.2 ng / ml is considered critical, at which a doctor can diagnose infertility.

The sooner it is possible to identify the disease that led to the decrease in the hormone, the more likely it is to return the ability to reproduce. If the anti-Müllerian hormone is low for a long time, then the question of how to get pregnant becomes relevant, and it will be more difficult to cure infertility.

If increased

Elevated AMH also indicates certain ovarian dysfunctions.... If it exceeds the norm by more than two times, it may be a symptom of the following diseases:

It should be noted that a high level of anti-Müllerian hormone can be a symptom of cancer.

Can the level be influenced?

Anti-Müllerian hormone is an indicator that indicates the remaining supply of eggs... An increase in its level will not lead to an early onset of conception, therefore, in the course of treatment, attention should be paid to the reasons that entailed a reduced concentration of AMH.

If, after the examination, infertility was diagnosed, doctors use various methods of influencing the ovaries. Their task is not to increase the level of anti-Müllerian hormone, but to achieve the formation of healthy cells for fertilization.

Studies have shown positive dynamics in patients after taking vitamin D3 and a dietary supplement DHEA.

An increase in the level of the hormone is observed in women in summer period due to the additional synthesis of vitamin D3.

Among the adherents traditional medicine there is an opinion that royal jelly and propolis have a beneficial effect on the possibility of conception... These products have a positive effect on the body, however, a specialist should select the treatment and prescribe drugs.

Abnormal anti-Müllerian hormone levels indicate wrong job reproductive system. A woman who has received disappointing test results in her hands should not despair - modern techniques IVF helps to get pregnant even with low AMH levels. Do not self-medicate. The faster qualified specialist will make the correct diagnosis and prescribe therapy, the more chances of giving birth to a healthy baby.

The anti-Müllerian hormone is one of the most important participants in human reproductive function... This substance is present in both male and female bodies. By monitoring the content of AMH in a woman's body, a specialist can draw conclusions about the patient's readiness for procreation and the overall state of her reproductive system. The substance has a serious effect on ovarian function by controlling the growth and maturation of follicles.

In women with a low level of anti-Müllerian hormone in the blood, insufficient ovarian activity is often diagnosed, which can become an obstacle on the way not only to natural fertilization, but even to IVF using their own eggs. With an increased content of AMH, various types of tumors can develop, which can also lead to infertility.

Further, you are invited to familiarize yourself with the basic information about AMH and its role in the human body, the procedure for taking an analysis for this hormone, information about normal performance and deviations from the established norm, as well as data on the possibility of pregnancy in the event of a low concentration of anti-Müllerian hormone.

Basic information about AMG

As noted, the anti-Müllerian hormone is present in the body of both sexes: in men, this substance is responsible for the formation of the genitals and the peak of its production is noted before the end of puberty, in women the hormone is produced in the ovaries from the very birth of the girl to the world until the moment the body enters menopause ...

A notable feature of AMG is that it is not under the control of gonadotropins and the menstrual cycle. By the concentration of the hormone in the woman's blood, her readiness for motherhood is determined. It has been established that the content of anti-Müllerian hormone does not depend on lifestyle, diet, and others. external factors. Of particular influence even age does not affect its concentration (with the exception of age-related menopause). For example, 40-year-old women often have much higher follicular reserves than 20-year-old young women.

In foreign practice, the concentration of the hormone begins to be monitored when the girl reaches the age of 12-14 years. It is during this period that the AMG content becomes high enough for its laboratory diagnosis.

Surveys are carried out regularly. After establishing the fact of a decrease in the AMH content in the body, the woman is offered to undergo the procedure of freezing her eggs. For this, cryopreservation methods are used.
Also, such procedures are often carried out before various kinds of operations affecting genitourinary system, chemotherapy and other types of treatment in which there is a possibility of suppression of the woman's reproductive function. With the help of frozen eggs, the patient in the future, if desired, will be able to become a mother, having undergone an artificial insemination procedure, usually IVF.

In accordance with the AMG indicators, the number of follicles in the female body is determined, which is an important milestone examinations during pregnancy planning. In accordance with the results of the analysis, it is established how many of the patient's eggs are ready for fertilization.

In adult women, hormone concentration values ​​equal to 1-2.5 ng / ml are considered normal. However, often, due to various kinds of circumstances, the content of a substance in the female body decreases or increases, for example, some ailments are even diagnosed in accordance with the level of AMH.

As a rule, blood for this hormone is donated on the 5th day of the cycle. If the research indicators exceed normal value, this may indicate the presence of neoplasms in the ovaries, delayed sexual development, etc. However, in some situations, an adequate increase in the content of anti-Müllerian hormone is only beneficial to the patient, increasing her chances of successful embryo implantation in case of artificial insemination.

In general, the list of pathologies that may be present in the female body when the AMH level deviates from the norm in both directions can be found in the following table.

Table. AMH deviations from the norm and comorbidities

Analysis for AMG in mandatory for women preparing to become a mother through an in vitro fertilization procedure. Also, experts recommend to undergo such a study in general to all patients planning a pregnancy.

Based on the real AMG indicators, the specialist can determine the ovarian reserve of the female body, i.e. roughly count the number of mature and healthy eggs. The fertilization program is selected according to the last value. Also, on the basis of the above results, the doctor determines the possibility of using the patient's own eggs for fertilization, or the need to use donor cells.

If the AMH content is too low, the quality of the eggs obtained from the patient often does not correspond to the norm. At high rates, stimulation of ovulation (one of the stages of in vitro fertilization) can lead to the appearance of ovarian hyperstimulation syndrome, which is a rather significant danger to the woman's body.

Patients who have scheduled an anti-Müllerian hormone test need to exclude excessive physical exercise and avoid stressful situations... On the eve of donating blood, you should refrain from eating, drinking and smoking (at least 1 hour). Patients who have undergone any kind acute diseases, or those taking any medications at the time of the test, it is imperative to notify the attending physician about this. For review deoxygenated blood... On average, it takes 2 days to complete the analysis for AMG.

Important! If the results of the study deviate from the norm, do not panic until you see your doctor. First of all, the obtained data should be studied by the specialist who issued the direction for analysis. In addition, there is often a need for examination by highly specialized specialists - a reproductologist and an endocrinologist. It should be understood that an accurate diagnosis of a specific patient can only be made by an experienced specialist, after a thorough examination.

Unfortunately, a low concentration of AMG in the overwhelming majority of cases indicates the presence of varying degrees of severity of pathologies of the female reproductive system - from obesity and puberty disorders to menopause, tumors, etc.

Anti-Müllerian hormone is a biologically active substance that regulates the growth and division of tissues, and in the female body it affects the number of follicles in the ovary.

When the AMH index decreases, then the onset of spontaneous pregnancy becomes unlikely.

In particular, with significant deviations in the functional reserve of the ovaries, the likelihood of successful in vitro fertilization also decreases.

A decrease in hormone concentrations is a reflection of the fact that gradually depletes its own resources.

When planning a pregnancy and previous unsuccessful attempts, the study of the concentrations of this hormone is one of the most necessary.

Also, a specialist, after receiving the results of the study, needs to determine the reason for the decrease and eliminate it in the near future.

Depending on the current physiological parameters of the patient and the reason for the decrease in AMH, the specialist will determine whether it is possible to become pregnant with a low anti-Müllerian hormone in a particular variant:

1. Basically, pregnancy with low AMH is not denied in cases where hormonal levels have not reached critically low levels. In this case, spontaneous pregnancy with low AMH is possible, but the likelihood of its occurrence in the natural cycle decreases. After undergoing individually selected hormonal correction and ovarian stimulation, the chances of pregnancy increase.
2. Also, the likelihood of getting pregnant with a low AMH is determined by an auxiliary study - analysis for. When the FSH values ​​do not go beyond 10-15 IU, then pregnancy may occur.
3. When AMH is low and FSH is high, the chances of conceiving are low, since modern reproductive technologies within conservative treatment cannot guarantee a high pregnancy success rate. The way out of the situation is the IVF Procedure.

For reference!

An increase in FSH concentrations is evidence that a woman's reproductive system is working out, and the functions of the ovaries begin to fade due to the approach of menopause.

Why does the hormone go down

The need for an analysis for AMH can arise in situations where pregnancy does not occur for a long time, but for obvious reasons when initial examination the physician was not found.

After receiving the results of the study for the hormone, the doctor needs to determine the root cause that provoked hormonal disorder.

The reasons for the fall of AMH can be different, but the main factors provoking such a negative for women's health phenomenon, are as follows:

• ovarian failure;
• early menopause;
• decrease in ovarian reserve;
• critical high rates body weight (obesity grade 2+);
• early development genitals.

With a low anti-Müllerian hormone, you can get pregnant, but self-conception occurs extremely rarely, since AMG is only an indicator indicating the number of physiologically capable oocytes.

It is possible to stimulate such an indicator medically, but it all depends on the response of the ovaries to stimulation, since the number of capable eggs does not increase and, in fact, the ovarian reserve remains unchanged. It is possible to qualitatively increase AMG only after eliminating the causes that led to a decrease in healthy eggs.

How to increase AMG

At the current stage of development medical science there are no recognized effective methods for increasing ovarian reserve and the number of eggs. It is possible to achieve a temporary slowdown in the process of lowering AMH if you wish to become pregnant due to hormone replacement therapy.

Treatment involves the use of pharmacological agents that suspend the functioning of the ovaries for the required period, thus it becomes possible to achieve stabilization of the indicators.

This technique is used in relation to patients who have been found to have problems with a decrease in the reserve and a decrease in anti-Müllerian hormone in the absence of pregnancy and the presence of her desire in the future.

The key condition for such therapy is its timely start.

For reference!

Medical studies have concluded that it is possible to increase the AMH value with the use of Vit. D3 and dehydroepiandrosterone. This method is used for values ​​up to 0.5 ng / ml.

Increased anti-Müllerian hormone during pregnancy planning

With a slight decrease in anti-Müllerian hormone, pregnancy can occur - the probability of conception increases in relation to the value of the reduced indicator.

But overestimated concentrations of anti-Müllerian hormone are not positive, as they may indicate various pathologies reproductive system, often - tumor processes, birth defects and disorders of LH receptors.

Biologically active substance a woman rarely has difficulties with conception and, if necessary, IVF has a high chance of successful completion of the procedure.

The main danger of overestimated AMH values ​​lies in hyperstimulation - in the ovaries, big number follicles, and the glands enlarge.

When the procedure is not performed, which increases the duration of the protocol.

How to lower AMG

The need to lower the anti-Müllerian hormone values ​​is formed when the digital values ​​of the indicator reach 7 or more units. This is often the case with PCOS when ovulation is not occurring.

It is possible to stabilize and bring the value of AMH to physiologically correct only due to the restoration of ovulation.

To achieve this, use and conservative methods, and surgical route solving the problem.

Upon completion of the course of therapy and with strict adherence to medical prescriptions, the ovulatory ability is restored within 1 month.

Significance of AMG results and its role in IVF

AMG indicators reflect the state of the ovarian reserve. A woman who is healthy about 300 thousand. oocytes, and with each subsequent year their number decreases.

Ovarian resource is a designation of the number of follicles present in them and provides an opportunity to predict ovarian stimulation during the IVF procedure.

With a sufficient RR index, a woman, even with critically low levels of anti-Müllerian hormone, has a chance to become pregnant when using artificial insemination methods.

IVF with low levels of anti-Müllerian hormone

For the successful completion of IVF, it is required that the values ​​of the biologically active substance are at a minimum level of 0.8 ng / ml.

With lower substance indices, the onset of pregnancy is in doubt even during the IVF process, since the number of mature eggs ready for fertilization is extremely small.

However, a low anti-Müllerian hormone index does not affect the engraftment of the transplanted embryo.

The critically low values ​​of the biologically active substance indicate the presence of significant difficulties, however, pregnancy is possible.

With insufficient concentrations of AMG, the procedure is performed in the same way as with normal parameters of the substance. The indicator influences the choice of the best variant of the IVF protocol.

The stages of its implementation are identical at any concentration of AMG. With an underestimated value, biologically active connection long protocol and standard are applied.

Long protocol it is used for weak ovarian response, when 3-7 follicles mature.

Previously, it is required to undergo a long - up to 45 days, and powerful hormone therapy, the purpose of which is to stimulate the intensive production of eggs and accelerate the process of egg maturation.

The standard protocol is used when the response is moderate - when 10 follicles or more mature. If the result of stimulation is successful, the reproductologist performs the following manipulations:

• ovarian puncture;
• fertilization of the egg;
• Egg division is monitored for 3-5 days;
• the eggs are planted in the uterine cavity.

In case of successful completion of the procedure, the patient is transferred from the register of the reproductologist to the register of the obstetrician-gynecologist.

The use of stimulation with a critically low AMH does not give an effect and can lead to a rapid depletion of RR. Difficulties occur in the stimulation phase due to the small number of eggs and in the fertilization phase - due to their insufficient quality, the division and formation of the embryo does not occur.

When the response of the ovaries is poor - no more than 3 follicles, further procedures are recommended to be performed according to the cryoprotocol.

Eggs or embryos are frozen so that they can be reused without re-going through the stimulation stage. Also, there are options for IVF with a donor egg.

How to take AMG

It is performed at the beginning of the ovulatory cycle, approximately 3-5 days. The material for the study is venous blood.

After taking it, it is centrifuged and then in the apparatus and in the sample obtained, the concentration of the hormone is determined.

The cost of such a study is quite high - 1100-2800 rubles, depending on the region and the chosen medical institution.

Often for precise definition the indicator requires a study in several stages - in total, the duration of the procedure is 2-5 days.

When to get tested

An analysis to identify the values ​​of anti-Müllerian hormone is a necessity for such indications:

• infertility unknown etiology;
• suspicion of tumor processes of the granulosa cell type in the ovary;
• later sexual development;
• suspected or diagnosed PCOS;
• undergoing antiandrogen therapy and evaluating the effectiveness;
• preparatory stage of the IVF procedure.

Often, the AMH value does not change throughout the entire ovulatory cycle. But, to increase the reliability of the study, it is required to pass it at the start of the cycle.

The study of the concentration of AMG assumes that the patient must comply with certain rules:

1. The material should be taken on an empty stomach, the last meal should be at least 10-12 hours before the estimated time of analysis.
2. For 2 days, stop taking hormonal and other types of drugs, if it is impossible to cancel, provide comprehensive information about the pharmacological agents, dosages and the scheme of their administration to the laboratory assistant.
3. In the 3 days preceding the analysis, it is required to abandon intense physical activity, as well as, if possible, avoid stressful situations.
4. The last smoke break before blood sampling is allowed 1 hour before the analysis, but not later.
5. Alcohol-containing products should be excluded 3 days before the study

The woman receives the results of the research in her hands, or they are transferred to the attending physician after 1-2 days from the moment of the analysis.

The norm of the level of the hormone in the body of a healthy person

To obtain the most reliable information, it is required to undergo an analysis for AMG in several stages, and the result of the study is as follows:

• 0-0.8 ng / ml - critical low value AMG;
• 8-1 ng / ml - AMG is lowered;
• 1-2.5 ng / ml - physiological norm;
• 5-7 ng / ml and more - AMH is increased.

Anti-Müllerian hormone concentrations are virtually unaffected by lifestyle or eating habits women.

Also, the indicator of a biologically active substance is not affected by the age of the patient, except for the period of the onset of menopause.

With any fluctuations in the anti-Müllerian hormone in any direction from the norm, with a high degree of probability, it is possible to assume the presence of pathological processes in the woman's reproductive system.

Diagnosis of infertility includes many studies, but one of the main ones is the analysis of hormones in a woman. Levels of endocrine hormones, which regulate the functioning of the reproductive system, are routinely determined. If such a study does not give results, an anti-Müllerian hormone test is additionally prescribed.

Anti-Müllerian hormone (AMH) is present in the body of both sexes. The hormone is produced by the gonads from birth, but only during puberty does it reach its maximum.

In men, AMH levels are high during periods of growth and puberty, since the hormone is involved in the development of the genitals. With a critical decrease in AMH levels, a man may be unable to conceive a child. After puberty, levels decrease, but the hormone continues to be produced until the end of life.

The importance of the hormone for women is different. The concentration of AMH remains in the blood from birth to menopause. In the female body, anti-Müllerian hormone is produced by the granulosa tissue of the ovaries. Accordingly, the more cells are involved in the process, the higher the hormone will be. With the onset of menopause.

How the number of eggs is determined

Experts call the anti-Müllerian hormone an “oocyte counter” because its level reflects the number of capable oocytes. The number of germ cells capable of fertilization is laid in the girl's body even at the stage of intrauterine development.

During puberty, there are up to 300 thousand of them, if the girl does not have serious pathologies. This number of cells is called the ovarian reserve. Each menstrual cycle in a healthy woman, it is marked by the maturation of the germ cells, from which the most efficient and high-quality cells stand out.

The process of maturation of sex cells in the body of a sexually mature woman does not stop during pregnancy and the use of contraceptives. By itself, the anti-Müllerian hormone does not play an important role in the fertilization process, but its diagnostic potential is enormous.

The extended Efort test can be used to determine the concentration of AMH in a woman's blood and assess her ovarian reserve. When the Efort test is prescribed:

• absence of pregnancy during normal sexual life without the use of contraception;
• infertility for unclear reasons;
• history of unsuccessful IVF;
• late puberty;
• determination of the results of antiandrogenic treatment;
• polycystic ovary syndrome;
• suspected ovarian tumor;
• increased levels of follicle-stimulating hormone.

Modern medicine makes it possible to predict the premature depletion of egg cells and plan a pregnancy so that it can be in time. For the study, it is necessary to collect anamnesis and determine the indicators of FSH, LH and AMH.

The number of follicles is counted using ultrasound. Additionally, candidate genes for premature ovarian failure are being investigated. Young girls who are at risk of early ovarian failure should implement their reproductive plans and family planning on time.

Exists additional measure protection: social and biological preservation of fertility, that is, cryopreservation of oocytes. This method is recommended for those women who postpone the birth of children due to temporary medical contraindications.

However, in women with elevated FSH, low AMH, ovarian volume up to 3 ml and the number of antral follicles up to one, it is not always possible to obtain oocytes for storage. Such patients are advised to use donor material.

Preparation for analysis

In order for the test results to be informative and accurate, it is necessary to follow all the instructions for preparing for the study. To determine the level of AMH, venous blood is needed. The Efort test is carried out strictly on the third or fifth day of the cycle.

A few days before the test, it is necessary to minimize physical and psycho-emotional stress. One hour before the analysis, one must not eat or smoke. Donating blood is postponed if shortly before that the woman suffered acute infection or other serious illness.

Anti-Müllerian hormone rate

Only a doctor can correctly interpret the results of any analysis, since many different factors can affect the data obtained. The hormone index is almost independent of external factors such as diet and lifestyle. Age also does not matter. Some women over 40 have significantly higher AMH levels than girls of reproductive age.

AMG standards:

• for a woman: 1-2.5 ng / ml;
• for a man: 0.49-5.98 ng / ml.

When the level deviates from the norm in a woman of reproductive age, it is important to check first reproductive system for pathologies and disorders. The anti-Müllerian hormone reflects the functionality of the ovaries, therefore, the state of other organs and the concentration of other hormones, as a rule, do not affect the results of the study. When detecting deviations from the norm, violations must be looked for precisely in the ovaries and the processes that regulate their work.

Lowered anti-Müllerian hormone

A reduced indicator is considered to be less than 1 ng / ml in women of reproductive age. Before puberty and after menopause, low AMH levels are considered normal because primary follicular activity is absent at this age.

A low concentration of AMH in a woman of reproductive age indicates a small number of primary follicles ready for fertilization, as well as ovarian depletion. Both of these reasons lead to the same result - difficulty in conceiving naturally and minimal response to drug stimulation.

Atimüllerian hormone affects the growth and differentiation of tissues. Differentiation is the formation of a cell genotype. In a woman with a normal hormonal background, differentiation, maturation and release of one egg fall out for one cycle. In the presence of violations, anovulatory, irregular and other disruptions in the menstrual cycle appear.

The AMH indicator is only an indicator of the number of capable oocytes, but the reasons for their reduction are completely different. With a decrease in AMH levels, it is necessary to find and treat the cause, not the effect. This is the only way to correct consequences such as infertility and early climate change.

Reasons for the decrease in AMH:

• menopause;
• dysgenesis of the gonads (incomplete development of the glands);
• early puberty;
• obesity and other metabolic disorders;
• hypogonadotropic hypogonadism.

A decrease in AMH levels after age 30 may be a signal of early menopause. Decrease is due different factors, therefore, a woman will need to consult not only a gynecologist, but also an endocrinologist and reproductologist. Usually, changes in the concentration of AMH are detected precisely during preparation for fertilization or when clarifying the reasons why conception fails.

Natural conception with low AMH

The issue of natural conception with low AMH remains controversial. Critical is considered to be less than 0.2 ng / ml, low - up to 1 ng / ml. At a very low level AMG chances minimum for self-conception.

With a low concentration of the hormone, it is necessary to additionally pass an FSH test. If the level of follicle-stimulating hormone is within the normal range, the chances of natural conception persist.

A serious problem is the combination of low AMH and high FSH. A decrease in the level of AMH in women over 40 indicates that the reserve of eggs is running out, and there is no way to force the body to produce additional ones.

If the reason for the decrease in AMH was menopause, but the woman still wants to get pregnant, a replacement may be required. hormone therapy... This will help delay menopause and increase the chances of natural conception.

The ability to conceive depends on the number of oocytes, the number of genetic and chromosomal mutations, the degree of sensitivity of the endometrium of the uterus, the presence of gynecological and other pathologies.

In vitro fertilization with low AMH

Low AMH determines the chances of a natural pregnancy. If this indicator is not combined with others alarms, IVF allows you to achieve the maturation of eggs and successful conception even with minimal stimulation. Therefore, a low AMH index does not become a contraindication to in vitro fertilization.

In contrast, IVF will be the most likely method of conception when anti-Müllerian hormone levels are low. The Japanese IVF protocol is recommended when combining low AMH and high FSH (from 15 IU / L). The minimum stimulation is divided at intervals to obtain 1–2 viable eggs in each cycle. The resulting cells are frozen and transferred to the uterus at a favorable time.

The IVF duct in the natural cycle is used in cases where a woman's ovarian reserve is depleted for one reason or another. Stimulation of ovulation is carried out minimally or not at all. Over the course of several cycles, doctors try to get at least one egg, which is fertilized and transferred to the uterine cavity.

The short IVF protocol with ovarian stimulation is indicated with a slight decrease in AMH, which does not accurately indicate an oocyte deficiency. It is necessary to take into account the level of FSH, the age of the patient, the results of previous protocols and stimulations. If all these indicators are normal, the chances of conception are high, therefore, a short protocol is carried out.

Preparation for IVF with low AMH levels may include the use of transdermal testosterone, androgens, estrogens, DHEP, hCG, LH, L-arginine, corticosteroids, aromatosis. Herbal medicine and hirudotherapy are recommended.

When to use donor eggs

A third of women of older reproductive age cannot get pregnant even through IVF. Required to use donor eggs... Artificial ovarian stimulation is most often ineffective with low AMH in combination with other disorders. On the contrary, additional stimulation can deplete egg reserves more.

Indications for oocyte donation:

• increased FSH;
• lowered anti-Müllerian hormone;
• insufficient ovarian volume (less than 3 ml);
• the absence of antral follicles or the presence of only one.

If a woman does not want to use donor material, the most promising IVF protocol is used, although stimulation in such patients is most often ineffective. In this case the best option will listen to the recommendations of his reproductive specialist.

Increased AMH levels

A woman's AMH level is considered elevated when it exceeds 2.5 ng / ml. It should be borne in mind that in preparation for IVF, this figure should be slightly exceeded. The increase will tell you that the stimulation is working and the chances of successful fertilization are high. Reasons for an increase in AMH levels:

• tumor;
• polycystic ovary disease;
• delayed sexual development;
• defects in luteinizing hormone receptors.

All the reasons for the increase in AMH levels can be divided into two groups. The first includes conditions in which the follicles mature normally, but the eggs do not go beyond the glands. This can be observed with polycystic ovary, when the follicle grows and develops, but is unable to overcome the cystic surface.

The second group includes an increase in the concentration of AMG against the background of the growth of granulosa tissue of the ovaries. The most obvious reason is the tumor transformation of the sex glands. When identifying increased AMH first of all, an ultrasound of the ovaries is prescribed. After detecting tumors or polycystic disease, it is necessary to undergo long-term treatment and re-take the test. The results are likely to improve significantly.

Therapy with elevated AMH

Treatment of the causes of an increase in AMH is carried out taking into account the age of the woman and the goals that need to be achieved in this way. Therapy for polycystic ovary syndrome includes the normalization of body weight, nutritional correction, adequate physical activity, rest and work regimen.

A woman should normalize hormones and carbohydrate metabolism. After that, it is possible to stimulate ovulation or to surgically ensure the release of the egg outside the ovaries. The tactics of treatment for hyperplastic processes in the ovaries are agreed with the oncologist. In case of detection malignant neoplasms the question of conception is postponed until complete recovery.

How to increase AMG

An increase in AMH values ​​does not lead to an increase in the chances of natural conception. Stimulation of hormone production with drugs does not change the number of capable eggs, and, therefore, does not solve the problem of infertility. In this case, the treatment consists in identifying and eliminating the causes of the decrease in the hormone.

Often, artificial stimulation is ineffective, since a decrease in AMH indicates a premature menopause. Such patients are advised to pay attention to assisted reproductive technologies. Even if the results of the analysis for AMG deviate from the norm, one should not panic ahead of time.

Decreased or elevated anti-Müllerian hormone is not an indicator of absolute infertility and the inability to conceive a child on your own. It is necessary to take into account many other factors and only after that make a decision on artificial stimulation and in vitro fertilization.