Strange blood work results.. TTC

Hi Dr- I am in my late 30's .. took bcp for several years and have been off since Sept. I am doing this on my own as my clock has been ticking. In Oct, FSH came back as 10, my Estroidal, luteal phase, etc came back as 'normal'  (dont know the nbrs off hand) and I brought these to an RE for a consult,  not wasting any time. RE wasnt too concerned either. I am seeing both my gyn and RE and they are faxing each other and I am paying out of pocket for RE.  And my gyn is doing what he can that insurance allows. So, ovulation was infrequent-ovulated without any help in Oct but Nov and Dec-nothing but a big fast cyst that delayed menses . RE gave me shot of progesterone, period came, and now we're starting again. RE wrote me Femara-produced some big follicles and positive OPKS but no pregnancy.  My Progesterone this past cycle was 7.2  (on day 24) again gyn seems to think it was normal, even on Femara.  I had CD3 blood work redone and my results are really wierd. And ultra sound is showing cysts on both ovaries since I have constant pain, especially when taking Femara and my gyn is doing my laproscopy  Mar 22. Well, FSH went from 10 to 1.6 in four months-  yes 1.6 and AMH is low. RE's nurse practitioner said cysts may have interferred with the blood work but time is of essence here.  The nurse pactitioner says my FSH and low AMH do not coincide with each other and of course, we're going to redo the blood work in April. And she says we need to be aggressive, and start with injectables when I am given the go ahead. I do not have the funds for IVF right now and it *****.  What is your opinion as to what can be causing the super low FSH of 1.6?  Can the cysts cause these results? I am taking lots of supplements including a small dose of DHEA (12 to 25 mg) a day as that is all I can tolerate. Not sure if the small amount is going to do anything. RE said he was ok with it. Please comment and sorry for the long post. Lots of issues going on here. Thank you

[Elaine Brown, MD]

Hi!
Taking Femara in the previous cycle will interfere with the CD3 values.  Unfortunately, the highest FSH is the most prognostic value, so your number of 10 will be the one that gives you the most information. As you know, 10 is a borderline number when it comes to IVF.
A low AMH will "push you off the fence" on the wrong side, and actually, it DOES correlate with your more accurate FSH value.
If you were my patient, I would have to advise you to consider donor eggs.  ESPECIALLY since you are developing cysts in response to ovarian stimulation.
If that is not an option for you, you should seek out a specialist in "older women" who
are difficult to stimulate.
Sorry to give you an anwer that you don't want to hear, but I feel it is important to be realistic, especially when you are paying the bill.

Good luck!
Dr B