What is AMH?
Anti Müllerian hormone (AMH) is produced in the ripening follicles (primary and preantral) in the ovaries.
The higher the number of cells that’s capable of turning into a mature egg, the higher the AMH is produced. AMH measures the quantity and not the quality of the eggs.
To check AMH level, a simple blood test at a clinic is needed. AMH level does not change during the menstrual cycle so it can be tested at any time.
It is normal for the number of ovarian follicles decreases in the aging process. As we age, AMH levels also decreases. Its highest levels are in the period between 23 and 25 years of age and lowest after menopause.
In the most productive period of women, the levels of the hormone are as follows:
- High levels (>3.0 ng/ML) – indicative of PCOS
- Normal levels (1.0-3.0 ng/mL)
- Low normal (0.7-0.9 ng/mL)
- Low (0.3-0.6 ng/mL)
- Very low (<0.3 ng/mL)
Can new eggs be made?
Conventional reproductive medicine have long believed that every woman is born with a limited number of cells that can ripen into mature eggs.
However, there are now emerging evidence to challenge this. Prof Evelyn Telfer at the University of Edinburgh, in a small study, involving cancer patients, showed that ovarian biopsies taken from young women who had been given a chemotherapy drug had a far higher density of eggs than healthy women of the same age.
So, IF ( a big if! ) new eggs can be made, AMH can be improved.
Although this finding is exciting, there’s a lot more research that needs to be done and we shouldn’t be too quick to pounce on any intervention yet. What we can do now, is to focus on the quality of the eggs.
Causes of low AMH
Low ovarian reserve still remains idiopathic (unknown cause).
Other possible causes are:
- Chromosomal and non-chromosomal anomalies
- Heavy smoking / drinking
- Obesity (BMI >25)
- Ovarian surgery (ovarian cysts)
- Pelvic infections (Chlamydia)
- Radiotherapy, chemotherapy
- Environmental toxins
- Stress (physical, emotional, environmental)
- Irregular, improper diet
How TCM can help
We all have the potential to heal. TCM is a natural way to give our body a little nudge and support where it’s needed. In this case, TCM regulates the hormones levels and improve the diminished ovarian reserve (DOR) by stimulating the blood flow in the ovaries so that they will have optimal nutrients to grow.
In TCM, there is exact treatment for DOR or low AMH. However, low AMH is classified as a symptom of delayed period, amenorrhoea (no period), irregular period or infertility, depending on what kind of symptoms are presented in an individual.
During TCM treatment, symptoms will be observed and treated according to syndrome differentiation. Once that is established, specific herbs and acupuncture therapy tailored to each individual will be determined.
For example, these are some of the different syndromes:
- Kidney Jing (essence) deficiency syndrome
- Blood deficiency syndrome
- Kidney deficiency and Liver stagnation syndrome
- Spleen and Kidney Yang syndrome
- Yin and blood deficiency syndrome
When it comes to women’s reproductive conditions, the Kidney, Liver and Spleen plays an important role. Among the 3 organs, the Kidney is the most important factor to consider. That’s because, Kidney is the “Root of life” and governs all growth and controls our reproductive system.
We are all born with a certain amount of a substance called the Kidney Jing or “essence”. Think of Kidney Jing as our DNA, the genetic combination determined by our parents. Since AMH level refers to the number of eggs we were born with, Kidney Jing is related to the AMH levels. The quality of our Jing is partly determined by your DNA but it can be depleted or preserved by lifestyle and diet. Similar to AMH, the Jing also decreases with age (it’s just a natural process). Kidney Jing is also closely related to the Kidney Yin and both Jing and Yin plays a vital role in reproductive health. Of course, Yin is never absolute; Yang also plays a part.
By observing the different symptoms presented, we can identify which organ to target and how much the Jing /Yin/ Yang has to be supported. By taking everything into account, we can work on a formula that works in harmony.
Other TCM methods
Moxibustion on acupuncture point CV 8 (Shen Qu “Spirit Gate”) located on the navel. Do it at home once daily, except during the menstrual period can help to boost the Yang and tonify the weakened body.
Another interesting method I read, is about a pharmacopuncture injection method, where herbs are injected by medical doctors to acupuncture points. In a Korean study, they injected of extracted solution of dried Cervi parvum cornu ( Lu Rong; deer’s antler ) and Hominis placenta (Zi He Che; human’s or sheep’s placenta), 0.1 mL of each, mainly at CV4, BL19, and BL22.
Lu Rong and Zi He Che combi tonifies the Kidney and Spleen Yang and also nourishes the essence. Both are animal products and used according to a TCM belief that “animal products have feeling 血肉有情“ and can directly nourish the uterus and meridians that are closely related to fertility.
Note: The deer is not killed in the process of harvesting deer antler. The antlers are simply cut during the summer, and regenerate over the next few months.
How acupuncture can help
As a part of the TCM treatment, acupuncture can help our body to function more efficiently.
Adding regular (ideally 2 times a week) acupuncture can also assist in the stimulation of egg quality.
- Regulates the menstrual cycles (make sure it comes every 26-32 days)
- Improves the blood circulation (make sure blood is not stuck)
- Increases the blood supply to the ovaries, so they get optimum nutrients, oxygen and larger hormonal stimulation
- Balances Yin and Yang (for example: Yin = estrogen, Yang = progesterone)
- Tonifies deficiencies or reduces excess conditions in the organs
- Regulate the autonomic nervous system to help you relax (calm the Shen and help release stress)
These treatment takes time and patience to achieve results. For most cases, regulating a period cycle takes at least 3 months. Longer if it is a complicated case. As period only comes once a month (or less for some) and blood is renewed every 90 days, we need to monitor for a few months to see the effect.
Here are some of the acupuncture points that help increase AMH. Note that everyone has different body types hence the points combination used must be determined by your TCM physician.
- Zusanli, Guanyuan, Sanyinjiao, Qihai: For boosting Qi (vital energy).
- Diji, Zigong: To target the ovaries.
- Shenshu, Ganshu, Pishu acupoints: For Kidney, Liver and Spleen respectively.
- Yinlingquan and Fenglong acupoints: For phlegm stagnation.
- Hegu, Xuehai and Taichong acupoints: For Qi stagnation and blood stasis.
- Mingmen and Yaoyangkuan acupoints: For cold stagnation.
Any lifestyle advice to increase AMH?
A large body of literature suggests that pregnancy rate and implantation rate are significantly lower in women with vitamin D deficiency. The exact mechanism is still unclear but evidence suggests that they are presumably multifactorial, involving the regulation of the hypothalamus-pituitary axis (or HPA is a complex system involving the brain that controls hormone secretions), ovarian folliculogenesis (creation of eggs), and uterine implantation.
And another interesting fact is that vitamin D receptor is expressed in most reproductive organs, including endometrium, myometrium, ovarian, cervical, and breast tissues. Directly linked to the reproductive system!
It’s time to sun bath! Avoid noon and early afternoons as the UV can be too strong for your skin.
For supplements, the recommended dosage is 400- 800 IU, or 10-20 micrograms per day.
The flesh of fatty fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best sources. Small amounts of vitamin D are found in beef liver, cheese, and egg yolks. Some mushrooms provides Vitamin D but may be insufficient.
Food List for Vitamin D
Source: National Institute of Health, Office of Dietary Supplements
|Food||IUs per serving*||Percent DV**|
|Cod liver oil, 1 tablespoon||1,360||340|
|Swordfish, cooked, 3 ounces||566||142|
|Salmon (sockeye), cooked, 3 ounces||447||112|
|Tuna fish, canned in water, drained, 3 ounces||154||39|
|Orange juice fortified with vitamin D, 1 cup (check product labels, as amount of added vitamin D varies)||137||34|
|Milk, nonfat, reduced fat, and whole, vitamin D-fortified, 1 cup||115-124||29-31|
|Yogurt, fortified with 20% of the DV for vitamin D, 6 ounces (more heavily fortified yogurts provide more of the DV)||80||20|
|Margarine, fortified, 1 tablespoon||60||15|
|Sardines, canned in oil, drained, 2 sardines||46||12|
|Liver, beef, cooked, 3 ounces||42||11|
|Egg, 1 large (vitamin D is found in yolk)||41||10|
|Ready-to-eat cereal, fortified with 10% of the DV for vitamin D, 0.75-1 cup (more heavily fortified cereals might provide more of the DV)||40||10|
|Cheese, Swiss, 1 ounce||6||2|
Food for the Kidney
Think black: Kidney is associated with the colour black. TCM believes that black coloured food like black fungus, black beans, black sesame can help to tonify the Kidney,
Think salty: Kidney is associated with the taste – salty. With that, I mean naturally salty. Think seafood such as oysters, shellfish, kelp, seaweed.
Chicken or duck eggs : Jing is essence. Egg contains the essence and nutrients to turn into a whole chick!
Seeds & Nuts: black sesame, chia seeds, flaxseeds, pumpkin seeds, sunflower seeds, cashews, walnuts and almonds. They contain fertilized germ cell and also the nutrients for a new potential plant.
Beans: Kidneys are shaped like beans. Beans are also new potential for a new plant (growth!) and they’re high in protein too.
Royal jelly: Queen bee’s food made from pollen. It’s a super Jing strengthening food for overall well-being as well. Royal jelly can be expensive, bee pollen is a more affordable option.
Bone Broth: Kidney is in-charge of the bones and marrows too. Drinking bone broth soups can nourish your body with minerals and collagen.
Red meat: Some good quality, organic (if you can find), grass-fed red meat. Wild caught red flesh fish is great for nourishing the blood.
Chicken liver: A great blood nourishing food and provides lots of vitamin B too.
High iron plants: The body absorbs plant-based iron less efficiently. But if you’re vegetarian, add dark green vegetables such as spinach, kangkong, sweet potato leaves, seaweed and mircro-algae (spirulina, chlorella) to nourish blood and Jing.
If you’d like to discuss on your period, contact me for consultation in Singapore here.