Low AMH, Infertility And Ayurveda!

What is AMH?

• Anti mullerian hormone (AMH) is a product of granulosa cells of small antral and preantral follicles in woman. AMH is only present in the ovary until menopause.

• AMH envelop each egg and provide them energy.

• Serum AMH is a marker for quantitative aspect of ovarian reserve.

• Ovarian reserve is the term used to determine the capacity of the ovary to provide egg cells that are capable of fertilization and resulting in a healthy and successful pregnancy.

• As women age, the number of follicles or eggs available for reproduction gradually  decline and AMH level also decline with age.

Causes of Low AMH:

Low AMH levels suggests that Ovarian reserve of women is rapidly declining and they must immediately seek infertility treatment; if they are trying to get pregnant.

Causes:

• Hormonal imbalance

• Autoimmune

• Idiopathic

• Environmental causes 

• Genetic factor 

• Age

• Endometriosis

• Stress

High levels of AMH can be seen in PCOD.

How to diagnose low AMH?

Normal levels of Serum AMH:

• Normal 1-3

• Below normal 0.7-0.9

• Low 0.3-0.6

• Very Low <0.3

Low AMH can be diagnosed by doing blood test serum AMH.

Declining levels of AMH are the marker of poor ovarian reserve and premature ovarian failure if occurs in young women. Poor ovarian reserve is a condition of low fertility characterised by low numbers of remaining eggs in ovaries or impaired egg development or recruitment, in short; decreased quality and quantity of eggs in ovaries.

AMH levels in the blood serum can be drawn at any point in menstrual cycle and generally do not vary cycle to cycle.

Other markers to diagnose poor ovarian reserve are:

• High levels of serum FSH done on D2 or D3 of cycle (First day of proper flow is counted as day 1. Spotting is not considered as start of period). High FSH strongly predicts poor response for fertility treatment.

• Antral follicle count (AFC):

Transvaginal sonography can be done to determine AFC. It is measured on Day 2 or Day 3 of period.

                     AFC                         Significance

• • <4                            Poor reserve

  • 4 to 7                      Low count

  • 8 to 12                   Slightly reduced reserve

  • >12                         Normal

The AFC count in Indian Woman is significantly different from western literature. A cut off value of 10 may be used.

Why Low AMH causes infertility?

• Low AMH is not exactly the cause of infertility but an indicator of state of depleted ovarian reserve.

• The woman with advanced age and depleted ovarian reserve responds very poorly to the fertility treatment and even stimulation for IVF treatment. So, in these cases oocytes donation is suggested. As the quality of eggs are also not good; the chances of healthy pregnancy are also lower.

• Ayurvedic treatment gives a new hope in younger women with depleted ovarian reserve.

Ayurvedic management to improve AMH

As Ayurveda has the holistic approach, one has to modify dietary habits and lifestyle to gain maximum result of treatment.

Take healthy diet and modify lifestyle

• Reduce intake of sweetened and processed packaged food

• Avoid salty spicy fried junk food

• Avoid alcohol, tobacco, smoking and caffeine

• Avoid the combination of foods which are incompatible. For example, milk with food, curd with fish, milk with fruits etc.

• Take organic fresh local seasonal fruits and vegetables.

• Eat dry fruits for example black resins with seeds, almonds, walnuts etc.

• Take at least 10 ml desi cow ghee in your diet.

• Keep yourself hydrated.

• Exercise daily to reach a healthy weight.

• Take proper sleep.

• Do Yogasana, pranayama, meditation regularly and avoid stress.

• Follow daily and seasonal regimens explained in Ayurveda according to your body constitution. Know further details about this from nearest Vaidya.

Ayurvedic Medicines:

There are many herbs, bhasmas and medicinal preparation which increase quality and quantity of eggs and also give nutrition to reproductive system when taken under proper guidance. For example, Shatavari, Manjishtha, Amalaki, Guduchi, Gokshur, Yashtimadhu, Vidarikanda, Vacha, Brahmi, Abhrakbhasma, Suvarnamakshik bhasma etc

Panchakarma

• Basti acts on vata predominantly. It increases strength of reproductive organs. Uttarbasti is an intrauterine instillation of sterile medicated oil or ghee. Vamana and Virechana detox the whole body and improve digestive fire for proper nourishment of reproductive hormones and organs and hence, help to increase the quality and quantity of eggs.

• Yoniprakshalana (Irrigation of vulva and vagina with warm decoction) and Pichudharan (Insertion of a sterile tampoon soaked in medicated ghee or oil in posterior fornix of vagina) are also helpful 

• According to Ayurveda; A Cheerful mind forms the basis of pregnancy; so relaxing panchakarma procedures like massage, steam, head massage, Shirodhara are done to reduce stress and its impact on infertility treatments.