Every woman is born with a fixed number of eggs. This is known as her ovarian reserve. As a woman grows older, her ovarian reserve decreases. Anti-mullerian hormone (AMH) and follicle stimulating hormone (FSH) are 2 female reproductive hormones which indicate a woman’s ovarian reserve, and her fertility.
In this article we will demystify the terms AMH and FSH and find out what these hormones do from a Western Medical perspective – and why they matter when you are trying to conceive. We will also explain how Traditional Chinese Medicine (TCM) can help to naturally balance the levels of these hormones within you and in so doing, improve your fertility.
What is AMH?
AMH stands for Anti-Mullerian Hormone. AMH is produced directly by the ovaries and the levels of AMH correlate with the number of follicles in the ovaries. Women with lower AMH produce a lower number of eggs compared with women with higher levels and your levels of AMH levels provide information about your fertility. Levels of AMH will naturally decline with age and high levels can sometimes indicate Polycystic Ovarian Syndrome (PCOS)
What is FSH?
Follicle stimulating hormone (FSH) is released by the pituitary gland into the bloodstream. FSH is essential to the correct functioning of women’s ovaries and men’s testes. In women, this hormone stimulates the growth of follicles in the ovary before the release of an egg from one follicle at ovulation. It also increase Oestradiol production which leads to thickening of the uterus.
Levels of AMH, FSH and Lutenising hormone (LH)
AMH levels naturally decrease as we age with age as the ovarian reserve is depleted – as women approach their 40s it is normal for them to have lower AMH readings. Satisfactory AMH levels are above 21.98. If your AMH levels are below this there are treatment options available to you including supplementation with DHEA. TCM has also been shown to help improve AMH levels naturally.(1)
Levels of FSH rise during the follicular phase of the menstrual cycle, which begins from the first day of menses until ovulation. It correlates with the number of follicles you have. As the number of follicles drops, the level of FSH increases. As women approach menopause they will tend to have higher levels of FSH. High FSH levels can also indicate impaired ovarian reserve or premature ageing of the ovaries meaning that you have relatively few eggs left in the ovaries or the eggs are impaired in some way.
Elevated levels of LH can be an indication of infertility and it can indicate decreased sex steroid production from the ovaries, as experienced in premature ovarian failure. Many women experience Polycystic ovary syndrome (PCOS) which is associated with high levels of LH and reduced fertility. In this condition, an imbalance between LH and FSH can result in an inappropriate production of testosterone.
A lack of LH in women means that ovulation does not occur and menstrual periods may not occur regularly.
Chinese Medicine For Low Ovarian Reserve
Evidence supports the use of TCM treatment to optimise ovarian function. TCM considers Low ovarian reserve to be due to Kidney Deficiency and Blood Stasis. Kidney Deficiency in these patients will often express as dysfunction in the Meridians that relate to the Liver, Heart, and Spleen. TCM treatment will focus on supporting the Kidney energy and Vital Essence. In addition the Blood will be Tonified which will result in regulated menstrual cycle.
Chinese Medicine For Low AMH Levels
As we age our Vital Reserves – our Jing reserves become depleted. Overwork, poor diet and excessive exercising can all exacerbate this problem, resulting in Yang Deficiency, Blood Deficiency and Qi Deficiency. According to TCM low AMH levels indicate a deficiency in Kidney Yin energy, which is normally needed to make good, fertile eggs. TCM treatment would focus on nourishing Kidney Yin to optimise fertility, and promote energy and blood flow to the uterus.
Can Chinese Medicine really help with Ovarian Reserve and Egg Quality?
Yes! Women’s eggs do not have an expiration date and their quality responds to their surroundings. They become less responsive when hormones fluctuate. By providing enough nutrients and improving the flow of Blood and Qi to your ovaries poor ovarian reserve can improve – and the quality of the egg can improve. (2)
Optimising your AMH and FSH Levels with through the interpretation of TCM diagnostic patterns
1.Liver Qi Stagnation or Liver and Kidney Yin Deficiency
This pathology is manifested in a variety of ways including:
- A menstrual cycle that is shorter than 25 days
- Irregular painful periods with clotting
- Regular constipation
- Stress or elevated anxiety levels
- Pre menstrual syndrome (PMS)
- Poor quality sleep
- Dry skin
These symptoms may be experienced individually or together and can be accompanied by the following common signs of menopause: Hot flashes, night sweating and frequent headache. Many women experience these symptoms not due to menopause but as a result of hyperthyroidism or high levels of cortisol and an impaired immune system. They may also be caused by high levels of stress.
Chinese Medicine treatment is geared towards smoothing the Liver Qi, calming down Excess Heat and unblocking the energy channels in order to ease the flow of energy throughout the body. By stimulating the body’s innate ability to heal this will help to rebalance ovary or uterine function. Helpful herbal supplements include Liver Detoxing Remedy and Yin maintenance.
2.Spleen and Kidney Yang Deficiency
This pattern is accompanied by the following symptoms:
- Delayed or absent periods that may have an extremely light flow or be of a shortened duration.
- Periods may be accompanied with painful cramping, fatigue, bloating, cold hands and feet and disturbed sleep due to an excessive need to urinate at night.
These symptoms are characteristic of an under-active thyroid, adrenal fatigue, or any number of unexplained factors. Spleen and Kidney Yang Deficiency are sometimes the result of long term overwork, a diet lacking in sufficient quantities of protein, genetic factors or can come about after being ill.
3. Kidney Jing and Blood Deficiency
These patterns of disharmony within the body can result in the following symptoms:
- Delayed, absent or scant periods
- Dizziness or low energy levels
- Poor concentration and impaired memory
- Diminished sleep quality
- Pale face
- General heaviness about the body
This pattern could be the result of iron deficiency or anaemia, thalassemia or genetic factors. In addition a diet lacking in protein, or being on long term medication can cause these Deficiencies.
Chinese Medicine treatment principles here would focus on Stimulating the Kidneys addressing activity levels and nourishing Blood and Jing. Natural herbal supplements that support these functions include: Tao Hong Si Wu Tang and Blood Maintenance
There is a wealth of research to demonstrate that Chinese Medicine can support female fertility and balance levels of AMH and FSH. There are a number of possible mechanisms for this including:
Acupuncture to Improve Ovarian Reserve
Acupuncture, a kind of traditional Chinese medicine, is becoming increasingly popular for its ability to improve reproductive results. It has been shown to help women with decreased ovarian reserve (DOR) or premature ovarian insufficiency (POI) improve their ovarian reserve.
A study carried out in 2020 to determine the effectiveness of acupuncture showed that acupuncture significantly lowered serum levels of FSH and LH, raised serum levels of AMH, in patients with decreased ovarian reserve. Acupuncture was also found to regulate the menstrual cycle and to improve perimenopausal symptoms.
Cupping to Improve Ovarian Reserve
Cupping involves placing cups on the skin to create suction. The suction may facilitate healing with blood flow and the movement of energy or Qi in the body. Cupping helps balance Yin and Yang, or the negative and positive, within the body. Restoring balance between these two extremes is thought to help with the body’s resistance to pathogens as well as its ability to increase blood flow and reduce pain. It increases blood circulation to the area where the cups are placed which may relieve muscle tension, improve overall blood flow and promote cell repair.
Natural Treatment To Improve Ovarian Reserve
Effective Herbal Treatments
There are a number of safe and natural herbal remedies that are effective in improving AMH and FSH levels, improving ovulation and egg quality and regulating the menstrual cycle.
1. To regulate and improve menstrual cycle
Anemarrhena Rhizome or Zhi Mu is a popular and high grade botanical extract. It is used in cases of Yin Deficiency – which is often characterised by short menses or scant periods. In addition it has effective natural antibacterial and antiviral properties that are helpful at clearing inflammatory and infectious conditions. This herb can be used daily as a Yin tonic to hydrate the body, reduce skin dryness, body temperature, intense thirst, dry cough and to expel phlegm.
2. To improve ovulation and egg quality
Schisandra Berry or Wu Wei Zi is a multi-function adaptogenic herb often known as a Super Berry! This Berry is helpful at improving both ovulation and the quality of eggs. In addition it affects testosterone levels and promotes endurance and enhances vitality. This pure extract contains significant protective antioxidants and dopamine.
3. High FSH levels, fatigue and irregular periods
Astragalus or Huang Qi has been used for centuries in traditional Chinese medicine. This powerful herb is effective at regulating the menstrual cycle. It can be added to your daily routine to strengthen the immune system, increase stamina, strength, and vitality. It is a natural antioxidant that protects the cells from external influences and enhances the immune system.
4. Fatigue, irregular periods with frequent desire to urinate at night
Mugwort or Ai Ye has warming properties. This powerful herb is valuable to support many aspects of women’s health, especially conditions relating to “cold uterus” which has a negative effect on fertility. It boosts Yang energy and alleviates symptoms including heavy bleeding, cramping pain, blood clotting, helping fibroid, endometriosis and cysts.
Diet and Lifestyle advice to improve ovarian reserve
1. Vitamin D
Research demonstrates that women with low vitamin D levels tend to have lower AMH levels than women with healthy vitamin D levels. Some foods, like salmon and eggs, contain a small amount of vitamin D, but most of our vitamin D comes from the sun. On average we need 10 minutes of direct sunlight or 30 minutes outdoors on a cloudy day to meet our vitamin D requirements.
2. Managing our weight
It is important to maintain a health weight and to ensure that your diet is full of fresh food and plenty of cooked vegetables. Being overweight has a negative effect on AMH levels.
3. Regular exercise
A recent study (3) investigated the impact of a 45 minute walk three times per week for 12 weeks, and saw some great results!
For more information about how Acupuncture and Chinese Herbal Medicine could help to support you on your health and fertility journey and to book your free consultation.
* These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease. We can’t guarantee the treatment result, as the symptoms of conditions are unpredictable and vary greatly from person to person. The treatment length and recovery time also varies for individual. Please visit our clinics website: GinSen where a specialists will discuss your care and provide a consultation, and the treatment will be designed to meet your individual needs.