For age it is more strict, age 43-44 years old is the age limit after which we don’t receive mostly the pregnancy from our own eggs. In most cases if we receive an embryo at such an age, the embryo is genetically abnormal so, we don’t recommend working with our own eggs after 43-44 years old. If we are talking about AMH, it is not so strict because even with very very low ovarian reserve sometimes we can see follicles, find eggs and work with those eggs. Also necessary to know that AMH level is quite variable and this variability is not only because of variability in the body but also it depends on laboratory part, pre-analytical part and machine and regions which are working with this biological material. It means that different machines may give different levels and that’s why AMH level per se. It is necessary to also see antral follicle count in several cycles because from cycle to cycle it may be different so, AMH is not so strict.
Of course it doesn’t mean that a woman with low ovarian reserve cannot be pregnant. It depends on the age group and it depends on underlying factors as well. So a woman with a low ovarian reserve that she has endometriosis, for example as well, it’s more difficult to conceive from another woman with low ovarian reserve and without endometriosis. So, it’s not one size fits all – it’s according to what we have to work with the age group and the underlying factors of course around it.
Depends on age. The fact that when your egg reserves are low, it means that you’ve got fewer eggs to be chromosomally normal but if you’re older with a lower reserve, those eggs that you’ve got left are likely to be chromosomally abnormal that will go on to fertilize, implant but miscarriage rates are much higher.
The answer is yes which is what we spoke about in a previous question, to do with the success rate. With low ovarian reserves, our success rates are low. So if we basically have a low AMH of 2.2 ng/ml, or lower, it means that the lower we get, the lower the success rate. There is a point, 1.2 ng/ml, in which things start to become grey, and of course, the more AMH we have, the better the result.
The truth is that an AMH level will not predict the chances of a natural conception. There have been some beautiful studies, some for an example from Germany in 2017 that have shown that it does not predict the chance of a natural conception. The story does change when we look at fertility treatments because the AMH or ovarian reserve may predict the number of eggs we are able to yield and therefore may affect the cumulative chances of pregnancy.
