What's causing low AMH levels in Indian women?
Also read: What you should know about freezing your eggs
'We're seeing a clear downward trend in AMH levels even among women under 35," says Dr Rita Modi, senior IVF consultant at Motherhood Fertility & IVF, Kharghar, Navi Mumbai. 'And it's no longer restricted to urban India. The trend is equally concerning in smaller towns."
AMH, a hormone secreted by cells in developing ovarian follicles, is a critical indicator of a woman's egg supply. A drop in this value suggests a diminished ovarian reserve, reducing the chances of natural conception and often foreshadowing challenges with assisted reproductive techniques as well. Dr Angeli Misra, director of Lifeline Laboratory, Agilus Diagnostics in Delhi, confirms this trend with empirical data: 'The total number of AMH tests conducted pan-India in our centres annually is 4,700. There is definitely a noticeable rise in AMH tests being done in women under 35. This trend is mainly seen in metros and among young professionals who are starting their careers."
THE AGEING OVARY PARADOX
Paradoxically, this crisis comes at a time when India—still home to the world's largest population—is witnessing a declining total fertility rate (TFR). According to data from the National Family Health Survey, India's TFR dropped from 2.2 children per woman in 2015–16 to 2.0, slipping below the replacement level of 2.1. This reflects significant strides in maternal health and contraceptive awareness, but it also masks an emerging challenge: the premature biological ageing of Indian ovaries.
'Indian women typically hit menopause five years earlier than their Western counterparts," explains Dr Sonia Malik, chief clinical mentor at Nova IVF Fertility. 'It's not just social delay in motherhood—there's a deeper genetic and epigenetic acceleration in ovarian ageing that we're still trying to fully understand." Malik adds that environmental and lifestyle stressors—such as urban pollution, endocrine-disrupting chemicals in cosmetics and food packaging, and the rise of processed diets may be exacerbating the issue.
Also read: A practical guide to help you cut back on processed foods
According to Misra, the concern is far from anecdotal. 'The percentage of women showing lower AMH levels in our laboratory is as high as 38%, and those with very low ovarian reserve is about 26%. An increasing number of women under 35 are showing a low reserve, and these numbers are increasing every year. However, one must remember that we are mainly testing women who are being investigated for infertility, and not a normal cross-section."
EXTERNAL CAUSES
While age and genetics remain immutable drivers, external factors are proving equally detrimental. Air and water pollution, exposure to pesticides, and endocrine disruptors—present in plastics, cosmetics, and even produce—are widely believed to interfere with hormonal signalling and damage ovarian follicles.
In rural regions, infections such as genital tuberculosis, HIV, and other sexually transmitted infections are an added risk, often going undiagnosed and leading to pelvic inflammatory disease—a condition that can impair fertility by damaging the reproductive tract. 'Fertility health is increasingly under siege from both modern lifestyle choices and deep-rooted public health challenges," Modi notes.
Though often sidelined, psychological stress too is proving to be a silent saboteur. Chronic stress elevates cortisol—the body's stress hormone—which disrupts the delicate hormonal balance essential for ovulation. Malik points to the 'gut-brain-reproduction axis"—a triad that, when compromised by anxiety, poor sleep, and restrictive diets, can derail reproductive function. 'Many young women with intense work cultures or disordered eating habits end up with irregular cycles or unexplained infertility. These aren't just lifestyle issues they're medical ones," she emphasizes.
IS EARLY TESTING NECESSARY?
With fertility clinics becoming more mainstream and technologies like egg freezing gaining popularity, there's a growing call to integrate AMH assessments into preventive health check-ups much like regular screenings for thyroid, cholesterol, or diabetes. 'AMH testing can empower women to make proactive choices about their reproductive futures," says Modi. 'But it must be done with nuance and medical oversight. We don't want to create panic or rush women into interventions they may not need."
Dr Nidhi Rajotia, unit head – obstetrics and gynaecology at Artemis Hospitals, Gurgaon agrees. 'It's totally understandable for women to feel a surge of panic when they discover their AMH levels are low. It is important to keep in mind that this doesn't automatically rule out the possibility of pregnancy." AMH, Rajotia points out, is just one part of the bigger picture when it comes to assessing a woman's ovarian reserve. 'It tells us about the number of eggs, not the quality. Fertility is affected by a range of factors, such as age, egg quality, overall health, and even the health of your partner's sperm. So, having a low AMH level doesn't mean that natural conception is impossible," she explains.
Also read: Planning pregnancy after 35? Here's what you should know
There is also increasing curiosity around when to get tested. 'Understanding when to check your AMH levels can really help you make informed choices about your fertility," Rajotia adds. 'While there aren't any clear symptoms of low AMH, women who experience irregular periods, have a family history of early menopause, or struggle with conceiving should think about getting tested. It is also helpful for those who are planning to delay pregnancy or are considering egg freezing." Misra reinforces this sentiment by saying that there is a lot of increase in the awareness regarding the utility of AMH.
'Most women are getting it done on medical advice for investigation into infertility. However, there is an increasing number of young women who are now, as a part of their life planning—both personally and professionally—getting the test done to know their ovarian reserve and plan their future pregnancy or egg freezing," she adds.
Both experts agree that fertility awareness should be part of school and college curriculums, not just restricted to biology textbooks but as part of practical health literacy. Rajotia puts it plainly: 'Education about AMH is incredibly important, not just for women dealing with fertility challenges, but for all women out there. Understanding AMH is key to becoming more aware of your reproductive health, allowing you to plan for the future with confidence."
GET YOUR BASICS RIGHT
Dr Parul Prakash, head, reproductive medicine (Unit I), Artemis Hospitals, Gurgaon answers basic questions on the anti-Müllerian hormone (AMH).
What is AMH?
AMH is produced by small follicles in the ovaries. A blood test measures AMH levels to assess the number of eggs remaining. Because AMH remains stable throughout the menstrual cycle, it is considered a reliable fertility marker.
Is it normal for AMH to decline with age?
Yes. AMH peaks in the mid-20s and gradually declines. By 35, the average AMH is 1.5 ng/mL (nanograms per milliliter), and by 40, it dips to around 1.0 ng/mL. Levels below 1.0 suggest a diminished reserve but don't automatically imply infertility.
Why do Indian women's ovaries age faster?
Studies suggest Indian women experience menopause nearly six years earlier than their Western counterparts. Factors may include genetics, environmental stressors, and lifestyle habits.
Can lifestyle changes help?
While we can't reverse aging, lifestyle adjustments—balanced diet, exercise, stress management, and reducing toxin exposure—can support reproductive health.
Tanisha Saxena is a Delhi-based independent journalist. She writes stories that are on the intersection of art, culture and lifestyle.
Also read: Magnesium mania: Understanding the hype behind the wellness trend
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Hindustan Times
an hour ago
- Hindustan Times
What is fibremaxxing? Know all about this wellness trend that improves your hormonal health, metabolism
Fibremaxxing is one of the wellness trends making rounds on social media. It spotlights fibre, which is commonly associated with better digestion. But fibremaxxing looks at it through a much wider lens, positioning fibre as a tool for improving overall welbeing, from enhancing metabolism to mental wellness. Swap wheat flour for ragi flour to make rotis and parathas, and increase fibre intake.(PC: adobe stock) Asad Hussain, founder and CEO of Odds Fitness, shared with HT Lifestyle that fibremaxxing involves a complete biological optimisation, demonstrating the health benefits of fibre, which go beyond the mainstream understanding of fibre benefits, like better digestion and better bowel movements. ALSO READ: Make your fibre intake more diverse: 12 foods that aren't green vegetables Describing what is fibremaxxing, Asad elaborated, 'Fibremaxing is the practice of deliberately increasing your daily fibre intake not just for digestion, but for overall biological optimisation. It goes beyond counting grams of roughage. The diverse fibre sources, timing, pairing with pre- and probiotics, and using fibre as a performance tool for everything from mental clarity to metabolic health.' Protein has dominated the diets of fitness enthusiasts and continues to do so, with people closely tracking their intake every day. But fibremaxxing manages to challenge this monopoly, reminding that other nutrients, like fibre, also deserve the spotlight because of the robust benefits. 'For years, protein has held the nutritional spotlight. It's been glorified in everything from shakes to cereals, championed as the nutrient of fitness, strength, and satiety. Fibre is the unsung hero of longevity and internal balance. It fuels gut microbes, supports healthy cholesterol levels, slows glucose absorption, and feeds the ecosystem that keeps your body in check. In the bio-optimisation world, that makes fibre a game-changer," Asad unpacked how fibre is also gaining a more prominent importance in diets. Benefits of high-fibre diet: Improved hormonal balance, metabolism and immunity When you include a high-fibre diet, you build a strong immune system, reducing risk of falling sick. (PC: Freepik) A high-fibre diet benefits three major functions of the body that are integral to health. Asad listed the benefits, which include hormonal health, metabolism, and the immune system: 1. Balances hormones: Soluble fibre helps remove excess estrogen and improves insulin sensitivity. These are the two key factors in hormonal health, especially for women. 2. Boosts metabolism: Certain fermentable fibres support the growth of gut bacteria that produce short-chain fatty acids (like butyrate.) This plays a role in energy regulation and fat metabolism. 3. Strengthens immunity: Since nearly 70% of immune cells are located in the gut lining, a fibre-rich diet that supports gut health may indirectly enhance immune resilience. How can fibremaxxing be done with Indian foods? Roasted chana contains fibre. (PC: Freepik) One of the misconceptions is that fibremaxxing requires premium, exotic foods. Asad debunked this notion and shared that Indian foods can also easily fit into a fibremaxxing lifestyle. Clarifying the misconception, Asad described, 'One of the biggest myths is that fibremaxxing requires exotic ingredients or imported powders. The truth is, Indian diets are beautifully equipped for this trend; we just need to bring intentionality back to the plate.' Here are some of the ways, as outlined by Asad, one can maximise fibre intake with Indian foods: Embrace millets like bajra, ragi, and jowar instead of always defaulting to rice or wheat. Rotate your dals, each lentil variety brings its own fibre profile. Don't just stick to moong. Add prebiotic power with raw salads made from beetroot, carrots, cucumber, and onions before your meals. Smart snacking with roasted chana, trail mixes with seeds, or fruit topped with flax and chia. Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
Economic Times
3 hours ago
- Economic Times
Employee joins Indian startup after decades of working with US firms, almost dies: ‘Damaged heart, uncertain future'
Synopsis A professional's harrowing experience at an Indian startup reveals the devastating impact of a toxic work environment. Enduring gaslighting, impossible demands, and constant availability led to severe stress and a heart attack. He now urges others to prioritize well-being over financial gain, emphasizing that no job is worth sacrificing one's health and life. iStock A Story of Burnout, Breakdown, and the Fight to Rebuild A professional recently shared a harrowing experience on the "Indian Workplace" subreddit, shedding light on the deeply damaging effects of a toxic job environment. After spending nearly twenty years with multinational companies across the US and Europe, he had grown accustomed to work cultures that valued transparency, boundaries, and employee well-being. However, after being laid off unexpectedly, he found himself forced to accept an opportunity at an Indian startup—despite early signs that it was far from the second week of joining, the red flags were unmistakable. Revenue figures were being manipulated, the leadership team operated with unchecked egos, and employees were expected to be available nearly around the clock—from late morning to the early hours of the next day. As days turned into weeks, he became immersed in a cycle of gaslighting, favoritism, and impossible client demands, all while facing zero regard for boundaries or dignity. Despite knowing he should walk away, the fear of joblessness during a volatile hiring climate kept him chained to the role. The daily stress began to erode not just his emotional health but also his sense of identity and ethical compass. Depression quietly set in, while the pressure and psychological abuse from leadership he could no longer withstand the atmosphere and chose to resign—even though he had no other job secured. But the toll had already been taken. Just weeks after quitting, he suffered a massive heart attack. Two emergency stents were inserted to save his life, and doctors warned that a delay of just half an hour could have been back home, unemployed and recovering with a weakened heart, he reflects on whether the monthly pay he earned was worth the irreversible damage. His answer: absolutely not. He admitted that while he once believed he had no alternative, lying in a hospital bed brought clarity. There's always a choice—we just often fail to recognize it until the consequences become physical."Now I'm home—jobless, with a damaged heart and an uncertain future. Was that monthly salary worth permanently destroying my health? Hell no..." he urged others working in similarly suffocating environments not to sacrifice their well-being for financial comfort. No paycheck is worth permanent health damage. Survival should never come at the cost of one's physical or mental integrity. While he learned this truth the hard way, he hoped others would heed the warning post struck a chord with Reddit users. Many responded with compassion, echoing similar experiences. One commenter shared how her husband—only 31 years old—suffered two heart attacks and needed three stents due to intense stress in the hotel industry. She had to leave her own job to care for reminded the original poster that while joblessness is daunting, it is still a better fate than losing one's life. Encouragement flowed in—praising him for choosing himself over a paycheck and wishing him strength for the road ahead. Some even advised moving to quieter towns for peace and healthier many, this story served as a powerful reminder: work can wait, but health cannot.
Indian Express
3 hours ago
- Indian Express
Rujuta Diwekar's dating tip can change your gut health game for life: ‘Ask if your potential partner knows how to set curd'
The benefits of incorporating curd in Indian diet have been hailed for centuries now. According to Kanikka Malhotra, consultant dietician and certified diabetes educator, regular consumption of curd after lunch can significantly alter gut microbiota composition due to its probiotic content. In simple terms, improved digestion and immunity. Yay! 'These live cultures enhance beneficial bacterial populations, improving microbial diversity and suppressing harmful bacteria like Enterobacteriaceae and Staphylococcus,' Malhotra said, adding that the lactic acid bacteria in curd strengthen gut barrier function, reduce inflammation, and promote short-chain fatty acid production, which supports colon health. In a recent interview, celebrity nutritionist Rujuta Diwekar reiterated on the importance of knowing how to set curd, and how that can give one a peek into their partner's soft skills. 'The dating advice I give girls is that, 'Get married in a house where the guy knows how to set curd. We have progressed enough to know how to do everything else in life. The guy should know how much to heat the milk to be able to set the curd, or else the milk will curdle and go bad. And if it's not hot enough, the curd will not set.'' 'Ask this on your first date only, forget whether he is a mountain or a beach person, coffee person or chai person, ask if your potential partner knows how to set curd,' she quipped. Experts believe a well-set curd is way healthier than one that isn't. 'Curd is formed through the fermentation of milk by lactic acid bacteria. During proper fermentation, these bacteria produce lactic acid, which coagulates the milk proteins, forming a gel-like structure. A well-set curd is more likely to contain viable probiotic cultures, which are essential for gut health,' said Malhotra. In contrast, poorly fermented or runny curd might lack a sufficient live bacterial count due to contamination or inappropriate incubation conditions. Dt. KS Aujla, clinical nutritionist at Unity Critical Care Hospital, Jalandhar, shared a quick recipe to help you set curd at home: 1. Whole milk 2. A spoonful of curd (as a starter) 3. A clean container – preferably an earthen clay pot or a stainless-steel bowl Since curd is made through fermentation, temperature and time play an important role, she noted. 1. Boil the milk until it comes to a good boil (around 80°C). This helps eliminate any unwanted germs. 2. Let the milk cool down until it feels warm to the touch (not hot), ideally between 35–40°C. 3. Add a spoonful of curd (starter) to the warm milk. Mix gently but thoroughly. This starter contains the good bacteria that help ferment the milk. 4. Leave the container undisturbed in a warm place for 6–8 hours. During this time, the bacteria multiply and convert milk sugar (lactose) into lactic acid, which thickens the milk and gives curd its taste. 5. In the summer, keep it away from direct sunlight or heat. In winter, wrap it in a cloth or place it in a warm corner to keep it warm. 6. Once set, refrigerate it to stop further fermentation and enjoy your homemade, gut-friendly curd!
