14 Apr Fertility and Hormones
Fertility and Anti Mullerian Hormones (AMH)
Recently the test to assess ovarian reserve has become more sophisticated, using the Anti Mullerian Hormone blood test.
Most medical practitioners still use the three day Follicular-Stimulating Hormone (FSH) test, determining levels on day three of the cycle; this is an inexact test as FSH levels fluctuate in the blood over the course of a day, this is only a measure of FSH at the time you are drawing blood, so it would only be accurate if you had several blood tests of the course of the day to get an average reading.
It is now well established that The AMH test is a more useful biochemical test. AMH is a protein produced by immature follicular cells, before they are able to be seen by ultrasound. Production decreases and stops as follicles reach 8mm, therefore levels are fairly constant and be done on any day of the cycle.
Blood levels of AMH have been used to measure the remaining reserve of growing follicles in women, as it is only produced by small ovarian follicles. With increasing age this reserve diminishes.
AMH levels do not reflect egg quality, this is where natural medicine steps in to optimise the viability of egg reserves, if levels are low we can always improve on quality.
The measurement gives us an insight into women reaching menopause and also polycystic ovarian disease, a condition which is becoming increasingly more common. This has become a standard test for In Vitro Fertilisation (IVF), as having more eggs at retrieval provides a greater number of eggs to fertilise and develop into embryos.
Unfortunately, the disadvantage of the AMH test is that there are inconsistencies in the interpretation of levels, as it is a new test, the levels considered as normal are not yet clarified and agreed on by the experts and not all Labs use the same assays for testing.
Polycystic Ovarian Syndrome (PCOS)
Although PCOS is the most common female endocrine disorder in the United States, and increasing in Australia Its cause remains unclear, more recent research points to a genetic component. This is why “syndrome” is most commonly used in conventional medicine to describe PCOS as there are varied signs and symptoms within the condition.
Polycystic Ovarian Syndrome is characterised by multiple cystic growths on the ovaries. This develops when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, either through the release of excessive luteinising hormone (LH) by the pituitary gland or through high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus.
Insulin resistance is a common finding among both normal weight and overweight PCOS patients. Their elevated insulin levels contribute to, or cause the abnormalities seen in the hypothalamic-pituitary-ovarian axis that lead to PCOS. Specifically, hyperinsulinaemia causes a number of endocrinological changes associated with PCOS, 20-25% of normally menstruating women have PCOS, These women may have reduced fertility and an increased risk of miscarriage.
Risk Factors that can contribute to the incidence of PCOS include:
- Insulin resistance
- Obesity- family history of PCOS
- Nutritional deficiencies
- High glycaemic load diet
- Sedentary lifestyle
Symptoms & Signs of PCOS:
- Irregular menstrual cycles –Infertility
- Elevated serum (blood) levels of androgens (male hormones)
- Central obesity – “apple-shaped” obesity centred around the lower half of the torso
- Male-pattern baldness
- Oily skin
- Periods of PMS-like symptoms
- Sleep apnoea
- Multiple cysts on the ovaries
- Chronic pelvic pain
- Blood sugar fluctuations
This is a complex multifactorial condition, with individuals suffering different symptoms within the same syndrome.
Natural medicine works on a holistic level to:
- Improve insulin resistance
- Ensure regular menstrual bleeding
- Reduce stress
- Reducing high androgen levels
- Improve ovulation and fertility
- Improve diet and Lifestyle
- Weight loss, restricted fat intake
- Aerobic exercise which promotes the number of insulin receptors and make them more functionally competent.
Saliva Testing at NatMed
Saliva testing has been used in clinical research, for more than 30 years. Saliva testing has been available to practitioners for over a decade, Over years of clinical practice, it has been shown that saliva testing is the most accurate measurement of the body’s availability of the hormones Cortisol, DHEA, Estrogen, Progesterone, and Testosterone. Saliva testing is much more specific and correctly identifies the level of hormones at the cellular level, in contrast to a serum (blood) test, which measures the level of hormones circulating in the bloodstream.