Dealing with fertility issues is like swimming in alphanumeric soup: you get dropped into a whole world of Important Letters And Numbers That Mean Things, like AMH or DHEA, and it can make you feel like you’re drowning in an adult Sesame Street episode. If you’ve had fertility blood work done by a doctor, you’ve learned many new acronyms, some of which I discussed in a previous post (https://fertilityreset.wpengine.com/fertility-blood-work-good-bad-a-surprising-take-on-the-results/). AMH is one of those letter/number combos that gets mentioned a lot; and DHEA is often discussed in the same breath.
Depending on the results of your AMH test, your RE may be pushing hard for IVF. Or, you may have done research yourself (thanks, Dr. Google), and are worried about what you learned. And, you may have already discovered that DHEA is a miracle cure to increase AMH! Wow! Awesome! Order it now! Well….maybe. Like a lot of fertility “cures”, it depends.
The Upshot on DHEA and AMH: You Have to Know What You Are Doing
YES, it is possible to change your AMH, and increase the number of eggs you have. But you have to understand what AMH is, and there are additional blood tests you need to do to check for effectiveness before taking it. Furthermore, if you are NOT doing IVF, if you are TTC naturally, you may not need to worry about your AMH at all.
In order to understand what’s going on with AMH, we’re going to dive into biology, and yup, add some more letters to your fertility alpha-numeric soup. It’s important that you understand the how and why of AMH and DHEA so you can make a good decision about whether supplementing is a good idea.
If you don’t supplement correctly, you can actually screw up your fertility. I see this in my clinic all the time.
DHEA is NOT a panacea for fertility. It is a strong hormone, and you need to know how to use it correctly to get the best results.
Although this is long post, it’s worth your time, I promise.
What Is AMH? A Rough Measure of What’s in the Egg Development Pipeline
First, you need to understand what AMH is measuring. For that, you need a short lesson in the mechanics of egg development.
Women are born with all the eggs they will produce, known as proto-follicles. These proto-follicles generated and partially developed when you were growing in your mother’s womb, and then went into stasis. But when you hit puberty, development started back up, for a select group at a time.
Each month your body recruits a group of proto-follicles out of stasis. They are set on the developmental pathway to final maturation. For all women, this process takes 3 months. During that 90 days, your eggs are taking in nutrients, developing their energy, strong DNA and their ability to fertilize. Much of the chromosomal damage in an egg actually happens during this time.
FYI, supporting egg development is the foundation for the 90 day timeline for Fertility Reset Online programs, at www.fertilityresetonline.com.
What is the link to AMH? The developing follicles secrete a hormone during that 90 day process. The name of that hormone…? You guessed it, AMH (which stands for Anti Mullerian Hormone, in case you were wondering.) The more follicles in you have development, the higher the AMH. So AMH is a rough measure of how many follicles you have maturing.
Does AMH Matter? For TTCN, Not Really, Because Numbers Don’t Matter, Ovulation and Quality Does
Which brings us to the question, does AMH matter? The short answer is, it depends on how you are trying to get pregnant. If you are doing IVF, yes. If you are TTC naturally, not as much.
If you are TTCN, and ovulate regularly, AMH is mostly irrelevant. Why? Because AMH is a marker for how many follicles are in development, which doesn’t matter as long as you are ovulating every month. You ovulate only ONE egg a month. Of all the eggs that make it to day 75 of the development process, ONLY the strongest one is allowed to respond to FSH and develop enough to ovulate. The rest are actively suppressed by the body.
So, if you only have a few eggs, it doesn’t matter, as long as one actually ovulates. Quality, not quantity, matters for TTC naturally. (Future posts will talk about increasing egg quality).
If you aren’t ovulating regularly, then DHEA may be an option for you. But it depends on blood work results. If you are having TTCN issues, it is probably worth getting your DHEAs and testosterone levels checked (see below), to make sure your hormone levels are where they should be. But you don’t need to check AMH.
Does AMH Matter? For IVF, Yes, Because It’s a Numbers Game
If you are going to do IVF, AMH matters A LOT. Why is that? Because IVF is a numbers game. Read my post on Fertility Blood Work if you haven’t because I explain why in detail in that post.
The summary is this: IVF is a numbers game. Without any kind of intervention, statistically 5 out of 6 eggs from retrieval won’t make it to day 5 blastocyst stage. In order to increase the final number of embryos you get out of the process, the RE needs you to have as many eggs as possible going into retrieval. More in=more out. (The other way to improve the yield of good embryos is to increase the quality of each egg. More on that in future posts).
So a “Good” AMH Level is…What? It Depends (of course it does)
The level of “good” AMH, like many things in fertility, depends. For retrieval, higher AMH is better, to a point, because you want more eggs available for retrieval.
In general, you want AMH measuring between 1-4. Less than one, and the number of eggs available for retrieval is low, leading to a less successful outcome. More than four, and the quality is likely to be low, because your body can’t give all those eggs the full complement of nutrients and hormonal inputs they need to be healthy. (In fact, an AMH over 4 is a potential warning sign of PCOS.)
DHEA: The Male Hormone for Females and Eggs?!?
Which brings us to DHEA. DHEA is a type of androgen, a male hormone: the one you most likely know is testosterone. It might surprise you to learn that women have small amounts of testosterone too! Testosterone gives us our sex drive. And, it is the androgen DHEA that is responsible for stimulating proto-follicles into development.
This job is critical: you need adequate amounts of DHEA to make sure that you have an egg that can ovulate every month if you are TTCN. If you are doing IVF, then you want a high number of eggs available for retrieval.
You want a good number of eggs developing, so you have a lot available for retrieval. DHEA can increase the number of eggs you have developing. DHEA can do that, sometimes.
The Link Between AMH and DHEA
Low DHEA often results in low AMH. However, the reverse is not true: low AMH is not always the result of low DHEA. You need blood work to determine whether supplementing with DHEA will help.
Why Not Just Take DHEA and See?
Why not just take DHEA and see? Because if you are expecting DHEA to improve your AMH, and it doesn’t, it will be yet another disappointment. You don’t need false hope. You need facts, and a plan to improve your fertility that will help. Not another dead end and dashed dream.
Furthermore, DHEA, if taken inappropriately, will DECREASE your fertility and weaken egg quality. Do not take it without knowing what you are doing. If you have PCOS, DHEA IS A DISASTER. You already have too much testosterone, adding DHEA will shut your fertility down.
Testing: AMH, DHEAs, and Free/Total Testosterone
Two organs in the body produce DHEA: your adrenals, and your ovaries. Your adrenals produce most of it, the ovaries not as much. Whether you will respond to DHEA and get an increase in AMH depends on which organ is having trouble. That’s where blood work helps.
To figure out if supplementing with DHEA will help, you need to get three blood tests: AMH, DHEAs, and free and total Testosterone. Here’s why:
AMH to see how many follicles are in the pipeline, and if you need to think about DHEA…..
DHEAs to see if your levels are low, and….
Testosterone free and total, to see whether it’s the ovaries or adrenals that are the issue.
Understanding the Test Results
Low AMH: not many eggs in development. The question is supplement with DHEA or not? TBD by the following results:
Low Testosterone, low DHEAS: adrenal insufficiency. DHEA will very likely help, because the ovaries need more DHEA from the adrenals. The DHEA supplement supplies that.
DHEAs high/normal, low Testosterone: Ovarian issue. DHEA will not help, or will be only marginally effective because the ovaries are getting enough DHEA, they just aren’t responsive.
If your test results support taking DHEA, then you want to dose correctly.
You want micronized DHEA, 25 mg 3xday. For DHEA to be effective for IVF, you need to take it for a minimum of 8 weeks before cycle. The strongest effect is 4-5 months after you start taking it; then the effect plateaus. But keep taking it until you are done with your retrievals!
Effective, Safe Source for DHEA
There are a lot of supplements out there. Unfortunately, many of the commercially available brands do not actually have the guaranteed level of the substance they advertise. Designs for Health is a nutraceutical company that has strict manufacturing protocols and testing standards. I recommend DFH products to my patients because I know they are getting the correct therapeutic does.
I sell an effective, safe, and guaranteed therapeutic dose DHEA in my online store. https://fertilityreset.wpengine.com/shop/
Get Tested Again in 6 Weeks
To make sure the dosing is effective, get your free and total testosterone and DHEAs tested again in 6 weeks. You want your testosterone at the midpoint or slightly higher of the lab range.
If your DHEAS and testosterone levels have not increased in 6 weeks, you may need to add or switch to direct testosterone supplement. Taking testosterone requires the knowledge and cooperation of your RE or OBGYN, since effective testosterone is available by prescription only.
DO NOT use testosterone creams. They will not give you a consistent or reliable dose, and that can cause issues. At best, it’s a low dose and does nothing. At worst, the dose is too high and will shut down your fertility completely.
In a Nutshell
–TTC Naturally: AMH doesn’t matter. DHEA levels might. Get tested. If your DHEA and testosterone levels are low, supplement as indicated
–IVF Success: AMH matters a lot. Get AMH, DHEA, free/total testosterone tested. If AMH is 1-4, and testosterone normal, don’t supplement. If AMH and testosterone are low, supplement as indicated. If AMH low and testosterone normal, supplementing won’t help.
–Blindly following generic recommendations in regards to fertility leaves you open to potentially throwing off your fertility further. Make sure you know what is going on before supplementing. Working with a fertility expert and educating yourself will always improve your situation.
With much love,
P.S. If you are interested in taking either my TTC Naturally or IVF Success my Fertility Reset courses, go here: www.fertilityresetonline.com
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