AMH & HA
It is super exciting to find research that speaks directly to our HA clients, especially because the research on HA is not as robust as the research for other conditions like PCOS. Hopefully, this will improve as awareness of HA increases.
But first, let’s review what AMH is. AMH stands for anti-Mullerian hormone. Doctors will test AMH levels for insight into a women’s fertility and some will, unfortunately, use it as a predictor of women’s fertility.
Women with HA and who do not have PCOS, experience the “phenomenon” of low AMH caused by GnRH and FSH deficiency. These deficiencies lead to a decrease in the pool of growing follicles and a decrease in ovarian AMH production rather than a diminished ovarian reserve. Which makes sense! This means that low AMH due to HA can be reversed through the restoration of GnRH and FSH function. (It is important to note that little is known about the internal or external factors that influence serum AMH levels.)
Studies also show that AMH levels not only change through the menstrual cycle (similar to sex hormones), but younger women show the largest variations. AMH does reflect the pool of growing follicles at older ages (my thought is because sex hormones decrease as we head into menopause, so naturally we see less fluctuation in hormones) but in younger women, AMH does not correlate. Also, there is a huge difference between association and correlation.
Variations in AMH levels
AMH variations within a hormonal cycle can range from 28%- 163% (ummm excuse me WHAT?!?! 😲). Therefore a single AMH value is an inaccurate assessment. Yet medical professionals are using AMH levels to predict fertility and even pressure women into freezing their eggs or rushing into IVF. (Side Note: I am not against women freezing their eggs and going through IVF. I just believe that women should be informed about how their fertility is being assessed). Also, there is a difference between PREDICTING fertility and AMH levels being an ACCURATE indicator of poor fertility. I actually agree with the person who commented on my comment below 👇! .
While in HA you are in a state of poor fertility. TRUE! I mean hello… you are not ovulating or having a long enough luteal phase to get pregnant and or maintain a pregnancy. However, my point is that AMH levels can’t predict your future fertility. Especially in the context of HA, since HA is reversible. So we can expect low AMH levels taken during HA would also improve as well.
Time for a case study!
We had a client who came to us with primary amenorrhea (we discuss the different types of primary amenorrhea in the HHAP certification course) due to HA whose AMH levels started at .76 ng/mL (ekkk 👀) and is now at 3.69 ng/mL 🎉. Two months later she OVULATED! Yes, you read that right! Oh and her Dr highly encouraged her to freeze her eggs immediately if she ever wanted a chance to get pregnant and start a family. While this advice is not technically wrong, I do believe it is incomplete. Freezing her eggs was not her only option!
Like everything else, we must look at AMH levels in the context of the WHOLE person, her labs, lifestyle, and history of eating and exercise. I am not saying that we shouldn’t consider someone’s AMH levels but I would caution against making any type of decision solely based on an AMH value.
Power of words
As a practitioner, it is so important that we are mindful of what we “speak over” women. To tell a woman she is infertile and that can not get pregnant (when she has HA) is STRONG and it hits deep into the soul. And the truth is that it sticks with women for a long time and it takes a lot of work for her to believe that HA is reversible (which it totally is) and that she will be able to ovulate (which is also totally possible).
To hear more about this specific case study check out her episode HERE!
If you have any questions or comments send them over to Ashley@thehasociety.
References:
https://pubmed.ncbi.nlm.nih.gov/35787707/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486884/
