Ep.167: Pregnancy is possible with low AMH levels with restorative reproductive physician Dr. Codruta Pandaleche

The first thing many doctors do when a couple is struggling to get pregnant is run some lab work. AMH is a common lab run that suggests your "egg count" and is often interpreted as your future ability to get pregnant successfully. Dr. Codruta Pandaleche, a restorative reproductive physician previously working with THE leading RRM clinic in the world (NeoFertility in Ireland), shares why AMH is NOT a predictor of fertility. If your doctor is telling you you need to pursue IVF because of low AMH levels, listen to this episode first and share it with your friends! AMH is NOT a predictor of your fertility. 

NOTE: This episode is appropriate for all audiences. 

Guest Biography:

A native of Romania, Dr. Codruta Pandaleche has been a practicing physician for 16 years and most recently in the specialty of restorative reproductive medicine at NeoFertility in Ireland. She is now the medical director at Saol Nua Clinic and specializes in women who want to conceive with low AMH and those who experience recurrent miscarriages. 

Helpful links:

• Ep. 69: AMH - Can it tell you if you're infertile?
• Saol Nua Clinic
• https://pubmed.ncbi.nlm.nih.gov/35147056/

Transcript

Caitlin (00:01)
Welcome back to the Woven Well Podcast. If you have ever struggled to conceive a pregnancy, then you likely had your AMH level tested at some point. Some consider this to be the most significant indicator of a woman's fertility, but is it? Is pregnancy impossible for women with a low AMH, or is there anything that they can do about it? Well, I've invited a guest expert to answer these questions for us and give us some much needed education on AMH.

Today we're talking with Dr. Codruta Pandaleche who is a physician specializing in restorative reproductive medicine. She's in Ireland, she's been there the last 18 years, and she previously worked at the Neo Fertility Clinic with Dr. Phil Boyle, and she's now opening her own practice in a few weeks. She focuses on preconception and conception and brings over 16 years of clinical medical experience.

She has a special interest in low AMH and recurrent pregnancy loss, and I cannot wait for her to share. Dr. Codruta welcome to the show.

Dr Codruta Pandalache (01:04)
Hi Caitlin and to all the listeners and lovely to meet you all. It's an honor to be invited to the lovely podcast and I hope that I will be able to clarify a few things regarding to AMH and fertility.

Caitlin (01:20)
I no doubt that you will. I'm excited to go through so much with you. So let's start off by hearing what does AMH actually tell us what would be considered a low AMH level.

Dr Codruta Pandalache (01:34)
Yeah, first of all, I think it's very important to know what is AMH because everyone is just panicking regarding AMH and low AMH. So an AMH test measures level of anti-mullerian hormone, which corresponds to your egg count. Although it's connected to your egg count, it won't predict your fertility. An AMH test is basically a simple blood test that you can have with your doctor, with your healthcare provider.

AMH level corresponds to the number of eggs you have or your ovarian reserve. When it comes to low or high, a little definition, higher AMH levels mean more eggs and higher ovarian reserves and the lower AMH levels mean fewer eggs and a lower ovarian reserve. But again, it will never predict your fertility. And one note to keep in mind that even if your AMH levels are in the typical range,

other factors may influence your ability to conceive. When it comes to range, really varies depending where you are in the world.

Providers usually measure AMH levels in nanograms per milliliters. In Europe, we measure it in picomoles and that will make the values being slightly different.

Caitlin (02:44)
you

Dr Codruta Pandalache (02:53)
example of a lowest value for a female, age 35 to 39, this is what we see in practice in general, would be 1.05 picomoles and the highest would be 53.5. So what do we consider a low AMH? If anyone would see themselves on the lower end of their range, so I consider a low AMH of 1.

Caitlin (03:03)
Wow.

Dr Codruta Pandalache (03:22)
or 1.7 or even 2, but we have worked successfully with couples who have AMH below the 1.

So let's say

low would be 1 nanogram per milliliter.

Caitlin (03:37)
Okay, and I bet a lot of people listening are already surprised by what you're saying because you are giving very low numbers, but then saying it is not a predictor of your fertility. So that's not what they're hearing when they go to work with a reproductive endocrinologist at an IVF clinic. They're not told that information.

It seems like AMH is a direct predictor because it seems like, that's how many eggs are left and it must not be a lot. So maybe break that down for us, the differences there in those two approaches.

Dr Codruta Pandalache (04:06)
Yes.

So first of all, everyone has to be aware that AMH levels naturally will decline with age. Okay. So it is normal to see a lower ovarian reserve in your 30s, 40s or 50s, obviously. What we can see in the practice is premature ovarian insufficiency.

which is slightly different and it will put you under a low AMH risk group before you age, before you're 30. Okay? How we see things differently, you're right. From the IVF point of view or your other healthcare providers, you have low AMH and you panic because you think that you don't have any more eggs. From the restorative reproductive medicine point of view,

We look at the AMH as a value, not as a fertility predictor. And I tell all of my patients, we only need one egg every month. We don't need two, we don't need 30, we don't need 10. So this is where we come in differently and we approach it differently. And for us, a low AMH, it's definitely not a problem of conception. You only need one egg.

Caitlin (05:14)
Yes.

.

Dr Codruta Pandalache (05:30)
every month in order to be able to have a healthy pregnancy. the other clinics will say, well, you need a higher AMH. Why is that? Because they want to over-stimulate the ovary to be able to collect 10 or 12 or 14 follicles, eggs, in order to give you a better chance of having maybe five or four or three embryos at the end of that cycle.

But we don't do that. We use one egg at a time and we will want to make sure that that egg is a very good quality egg rather than quantity. I want to make sure that people know that a higher AMH level isn't always a good thing. You know, we will see higher than the usual in people with, for example, PCOS, Polycystic Ovarian Syndrome. Okay. So

Caitlin (06:11)
Yes.

Hmm.

Dr Codruta Pandalache (06:28)
Yeah, no, if you have a high AMH, it's not necessarily a good thing. So this is where we come in differently. And that's why you will hear us, restorative reproductive doctors saying that AMH is not a problem. And then you will hear other clinics saying AMH is a problem. And usually this comes with a big bang where you're told that you need donor eggs because you don't have sufficient eggs.

And this I think is heartbreaking for every couple that they are going through infertility to hear. So yeah, this is why we are different.

Caitlin (07:01)
Yes.

Absolutely. So that's encouraging, I would imagine, for anyone listening. So are there ways then that restorative reproductive medicine works to increase the AMH? Is that possible to do? And have you seen any success in your patients?

Dr Codruta Pandalache (07:22)
Yes,

answer to both questions is

When we look at the egg quality, we know that the egg quality is influenced by mitochondrial health, which is the cellular health, oxidative stress, nutritional status, the emotional well-being, genetics, general health in general. The environmental factors are important.

and obviously hormonal balance. So all those factors will play an important role in egg quality.

are hoping that with every single treatment that we are going to give to the patient who has low AMH, we will improve not only the value of the AMH into the next maybe three to four months, but we will improve the egg quality. So we are

giving each patient a very individualized treatment plan. There's no two patients who will respond the same to the same treatment. So with restorative fertility medicine, we create a very individualized plan and we usually see very good outcomes. Either they get pregnant, which is exactly what we want, or I had patients where they just wanted the repeat AMH.

in three months and I was pleasantly surprised to see not only once but multiple times an increase in their blood tests. So I had somebody who came in and said actually I'm not pregnant yet but I'm so happy my AMH is now 7.2 from 1.6 or 1.5 and I was like oh my god that's a win it's a win in itself because that means that we're doing things the right way and so this is

Caitlin (09:05)
Yes.

Dr Codruta Pandalache (09:13)
This is how we work with people when it comes to low AMH and yes we do see not only an increase in their AMH but also we see the pregnancies coming in. Yeah a nice story. I actually it's even on my Instagram page I posted it not long ago. Beautiful story a couple who came to see me in the clinic in NeoFertility They were both 34 years old.

Caitlin (09:25)
Yeah.

Dr Codruta Pandalache (09:40)
trying to conceive since 2021, so about three years of trying to conceive, never pregnant and never miscarried. The lady had endometriosis which was removed in 2023 and a low AMH of 0.9. 0.9. They were advised IVF with donor eggs because this is what they're doing when you have low AMH. We've identified

Caitlin (09:55)
Wow.

Dr Codruta Pandalache (10:07)
that she's ovulating but with low hormones and that tells me as a provider that the ovulation event is not

They both had higher than normal BMI which to be honest it's an international problem at the moment, it's a global problem and we actually identify a male factor and so the DFI was high so there were a few things going on in the same time so the AMH was really not a problem.

from my point of view. The good news is that they were pregnant after their first treated cycle, which is absolutely beautiful. We performed a scan at seven weeks in ultrasound and then we performed a second ultrasound at nine weeks. The seven weeks in one day ultrasound was measuring perfectly normal. The blood results were absolutely balanced and everything...

Caitlin (10:44)
Yes, wonderful.

Dr Codruta Pandalache (11:02)
was perfect with that couple. They gave birth to a lovely baby girl. We did implement a lot of things in the month and a half before they've conceived. Lifestyle nutrition advice, very important. It's all starting with being healthy in general. I have a saying and I love this. A healthy woman will be a fertile woman and a healthy man will be a fertile man. So

get yourself to a point where you say, am healthy, you will be fertile. So we've supplemented both female and male accordingly with their blood results and their needs. And then on the first medicated cycle with follicle stimulation and luteal phase support they've conceived. Yeah, I was absolutely, absolutely grateful to see that result coming in so quickly after their struggle. And like,

Caitlin (11:37)
you

Yes.

Dr Codruta Pandalache (12:00)
You know, they came and they said, no, everyone said we're not going to have a baby. And now they have their little baby girl. And actually, actually, they got in touch with us for a second baby. Just not long ago. I know, I know. And it's so beautiful to see, you know, people, people really getting to know that low AMH, it's not a problem. It is not a fertility diagnosis. I know it's a big

Caitlin (12:08)
Hmm, that's it.

⁓

Yes.

Hmm.

Dr Codruta Pandalache (12:30)
know for the majority of the world. As I was discussing with you and with every other person that I'm talking about, restorative fertility medicine is not well known yet. And it's just beautiful because you do work with the individual and for their needs, for their personalized needs. So, yeah.

Caitlin (12:52)
Yes. Making

it so individualized and honoring the human being that's sitting in front of you as unique and unrepeatable. No one else will be exactly the same as that unique woman. And so honoring her by truly treating her specific concerns and

seeing what she needs, not just giving the same treatment to every couple that walks in the door. It makes such a difference and we completely agree with you, you know, here on the podcast, we completely agree with you about overall health and how that greatly influences because we often try to separate all the different systems of the body, but we are one person and so all of our systems work together. You know, the

Dr Codruta Pandalache (13:22)
Yeah. Yes.

Caitlin (13:44)
digestive system is going to affect the reproductive system. The adrenal health is going to affect the reproductive system. And then also we are mind, body, spirit. And so we want to make sure that we're healthy in all of those ways. And, because it's not just based on one value like AMH, it is the whole person and the whole health, not to say that there aren't things that we can do to improve the AMH level.

Dr Codruta Pandalache (13:50)
Yes. Yes.

Yes. No.

Caitlin (14:13)
it's within the context of improving our overall health as well. So we've talked about ways before we started recording some ways that you could possibly increase the AMH level. What recommendations would you have for a listener who maybe knows that their AMH level is low and they want to do something to address that?

Dr Codruta Pandalache (14:18)
Yes.

Yes. So first of all, they should either investigate possible causes of low AMH. You know, that can definitely be done. And if you know that you have maybe autoimmune diseases, I see this a lot. People that have autoimmune conditions can present with low AMH. Okay.

Try to identify the cause and if you can fix it, that's going to help as well. But in general, supplements, and I know that there so many supplements out there, but now talking about supplements and AMH, it was a very good study that was published by PubMed. It's actually, anyone can look it up, in related to micronutrients and increasing AMH.

Basically, the study's objective was to evaluate the effect of the micronutrient supplementation on female AMH. A total of 244 women were included in the study. In Austria, they were all treated with an oral micronutrient preparation consisting of a mix of supplements. So, omega-3 fatty acids, coenzyme Q10,

vitamin E, folic acid and selenium were used to treat those 244 women for three months, daily for three months. And the data is really good because this micronutrient supplementation has a positive effect on serum AMH levels, so on their results. Also on endometrial thickness,

ovulation frequency and luteal phase duration. So it's really risk free if you're thinking that every single nutrient that was micronutrient that was used are basically supplements over the counter. Okay. So I would say to someone who wants to improve their egg quality, to maybe discuss with their healthcare provider in order to get the right advice when it comes to supplements, but

Caitlin (16:37)
you

Dr Codruta Pandalache (16:56)
I think

every single person that lives in this world should be on a very good supplement of Omega 3 that contains DHEA and EPA. Not all supplements with Omega 3 contain those two very good things. EPA DHEA. Also trying to conceive you want to be taking folate, folic acid as everyone knows it, a good supplement of folate

and also an antioxidant like coenzyme Q10. I personally love coQ10, but there's another one that I really like. It's called alpha lipoic acid. So they're all supplements and they all work together to bring the quality of the egg to its best. But obviously

Caitlin (17:27)
.

Dr Codruta Pandalache (17:45)
not only supplementing things will help, you want to look at the bigger picture as we both said, restorative fertility medicine looks at the whole picture and we're trying to identify all the factors that are there working against you to get pregnant.

Caitlin (18:04)
Absolutely. Well, and I find it very encouraging to hear about those supplements. Like you mentioned, they're over the counter, so anyone has access to them. And while you do want to make sure with your doctor that you're taking them in healthy levels and at the right dosages, it is something very practical, very approachable that anyone can begin doing once they refer their speak with their physician about it. So that's really encouraging.

Dr Codruta Pandalache (18:11)
Yes.

Exactly.

Yes. Yes.

Caitlin (18:33)
My goodness, I appreciate so much you being on the show, sharing your experience and your knowledge and providing a lot of hope and encouragement to couples.

Dr Codruta Pandalache (18:42)
I really hope that everyone who listens to this little episode will find it interesting and they will get some sort of information. And again, I'm so thankful for being here with you today.

Caitlin (18:55)
Thank you for being here and we'll make sure to have a link both to the study that you mentioned and to your new clinic so anyone in Ireland listening can know where to find you. ⁓

Dr Codruta Pandalache (19:01)
Yes. Thank you so

much, Caitlin. Thanks again.

Caitlin (19:09)
Listeners, we are so glad that you're here, that you're listening. I hope this has been a very helpful episode. If you prefer video content, you like to watch your podcast instead of listen, make sure to check out our YouTube channel at Woven Fertility. But otherwise, you can find us here or there every week as we continue to talk about all things natural fertility. As always, thanks for listening as we continue to explore together what it means to be woven well.

Dr Codruta Pandalache (19:36)
you