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Tan Xiaojun
·Senior reproductive medicine expert
·Postdoctoral fellow at Peking University
·PhD candidate at Xiangya School of Medicine, Central South
University
·Master’s tutor at Central South University
· Master's degree candidate in reproductive
medicine at the University of South China
· Professional training at Huazhong University
of Science and Technology and Tongji
Hospital Reproductive Center
Expertise:
diagnosis and treatment of infertility, first/second/third generation IVF (including
egg/sperm donation), microsperm retrieval, embryo freezing and resuscitation, artificial
insemination (including husband's sperm and sperm donation), paternity testing, chromosomal
disease
diagnosis, high-throughput gene sequencing, endometrial receptivity gene testing and other
clinical
technology applications. Many of these technologies are at the leading level both domestically
and
internationally.
Do you still adhere to the reality of natural pregnancy when AMH is lower than 1? The low pregnancy probability of AMH, the decline of ovarian reserve function, IVF process, reproductive medicine evaluation, China for pregnant elderly, how to prepare for pregnancy when AMH is low.
Do you still insist on the reality of natural pregnancy when AMH is lower than 1? Five medical facts help rational judgment
Do you still insist on the reality of natural pregnancy when AMH is lower than 1? This paper analyzes the medical science from the aspects of ovarian reserve, pregnancy probability, suitable population and assisted reproductive process, so as to help pregnant people objectively understand the low fertility possibility and realistic choice of AMH.
1. What is AMH below 1? Important medical indicators of ovarian reserve
AMH (anti-Miao Lei hormone) is one of the important indexes for clinical evaluation of ovarian reserve function. This index is secreted by small follicles in the ovary and is usually used to reflect the number of collectable follicles in the ovary of women.
The general reference range is as follows (slightly different in different laboratories):
< 0.5 ng/ml ovarian reserve is seriously decreased.
Medical research shows that AMH level is related to the number of eggs, but it does not directly determine the quality of eggs. This means:
AMH is low → the number of available follicles decreases.
But it is still possible to expel eggs of acceptable quality.
According to the review of Human Reproduction Update, AMH level can predict ovarian response, but it cannot predict the probability of natural pregnancy alone.
Expert tips
Low AMH is not the same as "unable to get pregnant". Natural pregnancy is still possible, but it usually needs to be comprehensively evaluated in combination with age, ovulation, tubal patency and male semen quality.
Second, what are the common conditions of people with AMH below 1?
Clinically, people with AMH below 1 are not of a single type, and can usually be divided into the following categories:
Common characteristics of crowd types
Older pregnant women over 35 years old are more common.
Shortening or disorder of menstrual cycle in people at risk of premature ovarian failure
Decreased ovarian reserve after surgery, such as ovarian cyst surgery
Genetic or physical factors have less natural follicular reserve.
According to the data of "Technical Specification for Assisted Reproductive in China", the increase of female age will lead to the gradual decline of AMH, and the decline rate will obviously accelerate after the age of 35.
Clinical data show that:
The average AMH of 30-year-old women is about 2.5–3.5 ng/ml.
The average AMH of 40-year-old women is about 0.5–1.0 ng/ml.
Therefore, whether intervention is necessary for low AMH depends not only on the value, but on the combination of age and pregnancy time.
Third, can you get pregnant naturally with low AMH? How to treat it from a medical point of view?
From a medical point of view, natural pregnancy needs to meet the following basic conditions:
Normal ovarian ovulation
Tubal patency
The uterine environment is suitable for embryo implantation.
The man's sperm quality is normal
AMH mainly affects the number of follicles, but does not directly affect ovulation function.
Therefore, there is a clinical situation:
AMH is very low, but it still ovulates regularly and becomes pregnant naturally.
Some research data show that:
People with AMH below 1
The probability of natural pregnancy in each cycle may still be in the range of 5-10% (depending on age)
Source:
Practice Committee of the American Society for Reproductive Medicine (ASRM)
But it should be noted that:
The time window is usually shorter.
For example:
The reality of natural pregnancy when age AMH is low
There is still a certain probability of being younger than 35 years old.
The probability of pregnancy at the age of 35-38 decreased significantly.
The probability of natural pregnancy over 40 years old is low.
4. If assisted reproduction is selected, what are the common technical paths?
When natural pregnancy preparation is still unsuccessful for a certain period of time, some people will consider assisted reproductive technology.
Common technologies include:
1. Ovulation monitoring and ovulation induction
Suitable for:
Ovulation but fewer follicles
Try to improve the chances of ovulation
Common ways:
B-ultrasound monitoring follicle
Moderate drug for promoting excretion
2. Artificial insemination (IUI)
Suitable for:
Mild infertility
Tubal patency
The principle is to send the treated sperm directly into the uterine cavity to improve the probability of sperm-egg encounter.
3. In vitro fertilization (IVF)
When the ovarian reserve drops significantly, some people will choose in vitro fertilization.
The main steps include:
Ovulation promotion
Take egg
Laboratory fertilization
embryo culture
embryo transplantation
According to many clinical studies, people with low AMH may get fewer eggs in the test tube cycle, but there are still successful cases.
Expert tips
Low AMH does not mean that the success rate of test tubes must be low. Embryo quality, age and uterine environment also have important influence on the final result.
Five, AMH less than 1 FAQ
Q1: Does low AMH mean poor egg quality?
Not exactly.
AMH mainly reflects the number of eggs, and the quality of eggs is more affected by age. Young women may get better quality eggs even if their AMH is low.
Q2: Can it be conditioned if AMH is low?
At present, there is no clear medical evidence that a certain method can significantly improve the level of AMH.
However, some lifestyle adjustments may contribute to the overall reproductive health, such as:
Regular schedule
Maintain a reasonable weight
Avoid smoking and drinking.
Reduce high pressure state
Q3: Should the birth plan be evaluated as soon as possible if AMH is low?
Most reproductive medicine guidelines suggest:
If the following conditions are met, an early assessment can be considered:
Over 35 years old with low AMH
Pregnant for more than 6–12 months without pregnancy.
The menstrual cycle changed obviously.
Early assessment can help to understand the trend of ovarian function, so as to make a more reasonable pregnancy plan.
Six, natural pregnancy and assisted reproduction process comparison.
In order to help understand the time and steps of different paths, a simple comparison is as follows:
Time characteristics of main steps of pregnancy preparation method
Natural pregnancy and ovulation monitoring → having sex for a long time.
Artificial insemination promotes ovulation → sperm treatment → injection cycle is about 1 month.
IVF ovulation promotion → egg retrieval → embryo culture → transplantation cycle is about 1-2 months.
Different paths are suitable for different groups of people, so they usually need to be evaluated by reproductive medicine before making a decision.
Seven, summary: AMH is lower than 1, is it realistic to insist on natural pregnancy?
From a medical point of view, several important conclusions can be drawn:
1. The low AMH mainly reflects the decrease in the number of eggs, and does not completely determine the pregnancy ability.
2. Age is an important factor affecting the probability of natural pregnancy.
3. Young women with low AMH may still get pregnant naturally, but the time window is usually short.
4. If pregnancy has not been successful for a long time, reproductive evaluation is a common medical advice.
5. Natural pregnancy preparation and assisted reproduction are not antagonistic choices, but fertility strategies at different stages.
For fertility consultation in Kyrgyzstan, please contact your dedicated consultant
/Fertility Consultation /
Dr.Chan
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