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3-26-12 Finally Diagnosed

Mar 26, 2012 - 21 comments
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low AMH levels

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amh level

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low amh



Hello Ladies,

I just wanted to write a journal on the Anti-Mullerian Hormone and what it means. At this point, I have been diagnosed with having very low levels, which can mean poor ovarian reserve. I will know more about possible options to still conceive once I see my doctor on 4-6-12. Until then, here is a list of information below. Its a lot to read, but I just wanted to put it out there. I am sure my doctor didn't have me do this blood work before because I didn't fit the protocol being that I am considered "young". It is amazing what a simple blood test can determine. I can only help this helps someone else in my shoes find answers. Before this day I was never truly diagnosed. So now that I know why I have never been able to achieve pregnancy, whether with help or without the help from my RE, it has literally ripped my heart out of my chest. I also will not know my exact levels until 4-6-12. In the meantime I will never understand why I have had to go through 4 cycles of Clomid, one with IUI just to find out it would have never worked anyway. All because of what this simple blood test has determined.

* In healthy females AMH is either just detectable or undetectable in cord blood at birth and demonstrates a marked rise by three months of age; while still detectable it falls until four years of age before rising linearly until eight years of age remaining fairly constant from mid-childhood to early adulthood - it does not change significantly during puberty; from 25 years of age AMH declines to undetectable levels at menopause.[6] AMH is expressed by granulosa cells of the ovary during the reproductive years, and controls the formation of primary follicles by inhibiting excessive follicular recruitment by FSH. It, therefore, has a role in folliculogenesis,[7] and some authorities suggest it is a measure of certain aspects of ovarian function[8], useful in assessing conditions such as polycystic ovary syndrome and premature ovarian failure*

*AMH Test to Determine Fertility
AMH (Anti-Mullerian Hormone), also called MIS (Mullerian Inhibiting Substance) is produced directly by the ovarian follicles. Women with lower AMH have lower antral follicular counts and produce a lower number of oocytes. AMH level testing can also be very useful for young women who want to postpone childbearing , but want to check their fertility potential before doing so.

What is AMH ?

AMH stands for Anti-Mullerian Hormone. It is also called MIS (Mullerian Inhibiting Substance) . Since AMH is produced directly by the ovarian follicles, AMH levels correlate with the number of antral follicles in the ovaries . It has been documented that women with lower AMH have lower antral follicular counts and produce a lower number of oocytes compared with women with higher levels.

AMH Reference ranges

Interpretation:

AMH levels do not change significantly throughout the menstrual cycle and decrease with age. Healthy women, below 38 years old, with normal follicular status at day 3 of the menstrual cycle, have AMH levels of 2.0 - 6.8 ng/ml (14.28 - 48.55 pmol/L). High levels are found in patients with PCOD.
Ovarian Fertility Potential pmol/L ng/mL
Optimal Fertility 28.6 - 48.5 4.0 - 6.8
Satisfactory Fertility 15.7 - 28.6 2.2 - 4.0
Low Fertility 2.2 - 15.7 0.3 - 2.2
Very Low / undetectable 0.0 - 2.2 0.0 - 0.3
High Level > 48.5 > 6.8

AMH levels do not vary with the menstrual cycle and can be measured independently of the day of the menstrual cycle.

AMH can be used for

   1. Evaluating Fertility Potential and ovarian response in IVF - Serum AMH levels correlate with the number of early antral follicles. This makes is useful for prediciting your ovarian response in an IVF cycle. Women with low AMH levels are more likely to be poor ovarian responders.
   2. Measuring Ovarian Aging - Diminished ovarian reserve, is signaled by reduced baseline serum AMH concentrations. Women with poor ovarian reserve who have entered the oopause have low levels of AMH. However, this is a new test, and is still not easily available.

AMH versus FSH

The old standard for ovarian reserve testing was the Day 3 FSH level.

However, the FSH level is not as reliable as the AMH level for 3 reasons.

   1. The FSH level varies according to the cycle dates
   2. It depends upon the estradiol level ( a high estradiol level will artificially suppress a high abnormal FSH level into the normal range)
   3. It varies from cycle to cycle, so is not always reliable or dependable

An AMH level is a much better marker for ovarian reserve. It is much more stable than the FSH level and does not vary from cycle to cycle. Even better, it can be measured on any day of the cycle ! This is why most infertility specialists today use AMH to check ovarian reserve, rather than the old FSH level.

One confusing thing about AMH is that there are at least 2 scales out there and innumerable clinic definitions of what is "normal" - it depends on which assay they use and which study! One scale is ng/ml and one is pmol/l. The pmol/l scale runs from 0 to about 48; the ng/ml runs from about 0-10. On the ng/ml scale , less than 2 ng/ml is considered to be low.

An AMH level can also be very useful for young women who want to postpone childbearing and want to check their fertility. Many women these days are postponing having a baby in order to pursue a career. The good news is that while usually fertility does not decline too much until the age of 32, for some women the decision to postpone childbearing can prove to be one they bitterly regret later on. Fertility does decline as a woman grows older, and the problem is that it is not possible to predict the rate of decline for an individual woman. Most women are lulled into a false sense of security if they have regular period, because they assume that if their periods are regular, this automatically means that their egg quality if enough for them to make babies !

Unfortunately, this is not always true - and for some women, while their egg quality is enough for them to produce enough hormones to get regular periods, it may not be enough to make a baby !

Suppose you are 32 and want to postpone childbearing for another year because you have a very good chance of getting a promotion ? Is it safe to do so ? Or will this be something you will kick yourself for later on when your IVF doctor says - I wish you had come to me earlier ? I'd suggest you get your AMH level tested. If you live in the US, you can get it done at www.mymedlab.com.

If it's low, you might want to re-think your priorities. If it's normal, then it's fine to postpone childbearing, but do get the test repeated every year. If it starts dropping, this is a sign you might want to pay attention to your biological clock before it is too late !

Please do remember that doctors do not treat numbers - we treat patients, so don't obsess over just one number is isolation.

The final proof of the pudding is in the eating - and your response to superovulation is the best way of assessing your ovarian reserve. If you grow eggs well, then you should not worry about your "numbers" ! *

Comments
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by JennyB0125, Mar 26, 2012
Oh Jess I am so sorry about this news, I am sending you tons of hugs & support!  I really wish there was something I could say to make you feel better, but I know there is nothing that will make you feel better until you can make a game plan. Just know I ma her to offer you support & listen to you vent.  I really hope you can work something out to make your dreams come true! Hugs!!!  

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by dscoqn, Mar 27, 2012
I would be interested to know what your AMH level actually is.  Mine came back in the 'low fertility range yet I have conceived numerous times naturally - my problem was they kept getting stuck in my tubes.  I just went through my first round of IVF and was worried about how I would respond to the meds given my bad AMH level yet I got 8 eggs and all fertilized.  I am currently pregnant from that IVF cycle.  When I got my AMH levels back the nurse who gave me the result said not to worry to much about it being in the 'low fertility' range as many women are in this range and still go on to have healthy babies.

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by dscoqn, Mar 27, 2012
I just found my result - it was  0.97 ng/ml

I cut this from your notes: On the ng/ml scale , less than 2 ng/ml is considered to be low.


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by plumber43, Mar 27, 2012
Honestly, I wonder about AMH, I am 45, I have an AMH of 5.6, I make many eggs, 18 on my 1st ivf, 6-8 with my iui's and 11 for my mini ivf and still no BFP. I mc at 9 weeks with an empty sac, I had about 5 make it to 5 day blast. We ended up with DE. I'm 16 weeks! I believe quality over quantity! Don't let AMH get you down! All you need is one good egg! There are suppliments I believe that help with quality!
Good luck Honey!
Melanie

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by beddajess, Mar 27, 2012
@ Jenn,

I just wanted to say thank you for being so understanding n so supportive of my feelings and what I am going through. It's honestly what helps me pull through... I am hoping to know our game plan in 2 weeks... Thank you again for being there for me Xoxo

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by beddajess, Mar 27, 2012
@ dscoqn,

Humm that's interesting to know. I tried emailing my doctor for the actual results but he has not got back to me with it. So he may just make me wait until my appointment. See my thing is, I have NEVER once became pregnant, miscarried or anything. So I believe that maybe things are worse than I know. Maybe my levels are undetectable. My other concern is, we cannot afford IVF at all. So if that is our only option, well, we are out of luck. As soon as I know my levels I will be sure to let you know! Hearing your story does give me a bit of hope. Thank you so much!

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by beddajess, Mar 27, 2012
@ plumber43,

Thank you so much for the encouragement! It means a lot. I am so happy it worked for you! Gives me hope! I guess I am just really concerned because so far treatment that should have worked has not helped me achieve pregnancy. I have never even miscarried. My concern right now is not only my eggs, considering I'm only 27 but the costs. We can't afford IVF. Sigh... I will update my journal when I know more. Thank you again for everything!

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by dscoqn, Mar 27, 2012
Oh that's a shame he can't give you your results by email - when is your appointment with him??  Also sometimes women don't realise that they have had a conception because they don't test early and then they get their period and think they just weren't pregnant - that's when a very early miscarriage (chemical pregnancy) can go under the radar.  I'm not saying this has necessarily happened to you but it does happen.  Do you test very early like around 10dpo??  I know what it's like not being able to afford IVF, the only reason I had it was because here in NZ women get two rounds for free funded by the government.  Otherwise we would never have had the money to do it.  I'm really sorry your result came back low, I know how I felt when I got my result - I bawled my eyes out thinking I was never going to have a baby.  The only thing that made me feel better was the nurse telling me it wasn't so bad - it gave me hope again.  I really hope your result comes back not as bad as you were anticipating and you can have that hope back.  Thinking of you xx

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by beddajess, Mar 27, 2012
@ dscoqn,

I agree! My appointment is scheduled on 4-6-12. I was suppose to have a medicated u/s this Friday, on my Momma's 4 year anniversary of her passing, so that we could check my follicles because we "were" going to do IUI again this cycle. But since we are limited on that and since my AMH results are so low, we decided to not do the IUI. And I have totally considered the chemical pregnancy, and I actually tested and it was negative this last cycle.

Wow thats amazing that they cover 2 rounds of IVF where you live. I wish I could move there for a while lol. California doesn't offer much at all. And thanks girl, that truly means a lot to me. I have been so heavy-hearted since we found out. I try to put on a smile at work, but it seems like my eyes fill with tears at the most random times. Only my co-worker n my boss know whats going on at work.

I honestly don't believe that my doctor will be telling me that its not bad, because he seems so sincere about my results, like its bad news. But I do hope n pray that we can at least have the option of IVF. We are looking into different things just in case. I hope I can get my hope back too!! Sigh

Thank you again so much for the support! xoxo

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by Kimberleigh2208, Mar 27, 2012
Jess, I am sorry to hear this news but, for me at least, it helped to know what the issues were so a plan could be determined.  I am glad to know you don't have to wait too long to figure out the next step and don't rule out IVF for the expense.  You never know what will happen in the future (and I don't mean you'll win the lottery or something crazy).  Even though my last job ended badly and the guys I worked for were jerks, working there presented me with health insurance that INCLUDED fertility treatments and that is how we conceived Morgan (as you know)!!!  So don't say you could never afford IVF and don't write off that another treatment may not work because you are too young and sweet to write off the possibility.  That's why we're all here for you Jess -- to keep you going when you think you're back is against the wall.  We love you and know that so many people on this site have overcome the odds so please don't give up and please always rely on us when you really need us!  

Sending big hugs your way,
Kimberleigh


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by beddajess, Mar 27, 2012
@ Kimberleigh,

You brought tears to my eyes, thank you, ahhhhh...

You are right, I am trying my hardest not to rule out IVF because of expense issue. I have always found a way to accomplish something my heart is set on. So I refuse to give up. Unfortunately, my job does not offer any help with IVF and everything else is at 50 % costs. I am hoping my doctor can do another test to determine the quality of my eggs. Because I would love to devise a better plan to achieve pregnancy. I have no idea what my doc will tell me when we see him but I am praying hard for some good news. In all honesty, I do feel a bit relieved in FINALLY being diagnosed after all of these years. I feel even more relieved that my feelings about it being something significant weren't false. It lets me know that I am not as crazy as others seem to think. I have always been told that I am so young n have so much time, and I just need to relax and blah blah blah. Well this test has confirmed that my chronological age is irrelevant and my biological age is a stake here. So God willing, I am praying for a miracle still.

I could not be more grateful than I am right now to know that I have so many wonderfully amazing MH sisters on here like yourself to help me through this. Because you are right, my back is against the wall. Others stories give me hope! I love you ladies too and I hope to be able to get through this so that I may be able to help someone else just like me!!


Sending hugs back!!

Jess xoxo

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by TTC2006, Mar 28, 2012
*hugs* Jess,

I hope that they Dr can give you some good news and that they are able to help you with a protocol that would work.  There is also a program called IINCID that helps people with funding for IVF treatment.  Maybe you can look into something like that in the future when you are ready if that does become your only option.

Still, I hope you get a miracle too, and don't need that step.





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by beddajess, Mar 28, 2012
@ TTC2006,

Thank you for the hugs my friend, they bring so much comfort!!

I hope they can come up with a protocol that will work too! My faith is really low right now because of the fact that I have to wait so long. And its so crazy you mentioned the IINCID thing because my bf sent me the link for that site today! How weird! I tried looking up the requirments on there and they are very strict and need a lot. So Idk. Because we are definitely doing some research because honestly I know we will have to be very aggressive with treatment.

I hope I don't need that step but I will try whatever I can in hopes I can come up with the funds.

I am hoping a miracle happens so that I can help encourage the next woman in need. I am steady praying for all of my MH sisters on here and that everyone achieves pregnancy!! I wouldn't wish this type of pain on anyone!!

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by stacey10, Mar 28, 2012
low amh while a concern at your age is no barrier to concieving, as the eggs that you do have will still be healthy, I have had a very low amh result and when you add that to may age 45 then you really start having problems :) my re told me that its a much better option to have a low amh result in a youner person than in an older one for the exact reasons I mentioned above, your eggs will still be young and healthy,  if your looking for info on eggs etc a really good site that I came across when doing my "looking" lol is w   w   w   .    natural-fertility-info  .   com have separated it so it wont get xxx out lol

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by beddajess, Mar 28, 2012
@ Stacey10,

Thank you so much for the info on the website! I will look into it. I have an appointment on 4-6-12 to discuss my results. As of right now I do not even know my results by numbers. I just know its disappointingly low. I have read that there are other tests that can be done to tell the actual quality. I have responded well to Clomid but have never achieved pregnancy. So there might be a possibly that my eggs are not good. I am going to demand more tests to be done to determine this.

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by stacey10, Mar 29, 2012
there are heaps  of other things you can try if you want to try naturally, I really dont think it will be egg quality considering your age which is a good thing :) in a healthy young person activley tryng to get pregnant, 75% of fertalised eggs do not implant, I also cannot reccomend this website enough, there are fantastic tips on hpow to prepare your body for pregnancy, a fertility diet, how to improve egg quality etc ... this is what I take everyday....
I start the day off with natural museli, with chia seeds,coconut oil and bee pollen, then I take coq10, fish oil, royal jelly and evening primrose ( for c/m from c/d1 until ovulation) I also have vital greens and maca as well, all of these are for egg health, and are aslo good for whole body helth especially royal jelly and maca which are considered superfoods :) so dont give up theres still alot you can do naturally if you want too :)

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by stacey10, Mar 29, 2012
Oh and I dont know how I forgot to mention acupuncture, that can work a treat as well :)

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by AshersC, Mar 29, 2012
Hey lady I just read your journal and I am in tears.  :(  I cannot imagine how terrible you must feel.  I don't want you to lose hope...Not yet.  When do you get to find out from the dr. where to go next?  I know how frustrated you must be that you have spent all this money on treatments that wouldn't have worked anyways had they given you that blood test early on.  :(  I am PRAYING that you can still resume treatment and not have to do IVF for financial reasons because I know it is expensive.  Please keep us updated, I am very worried about you.  :(  I have a Drs. Appt. for April 4th I am seeing a new doctor.  He is a specialist that works in Billings Mt but the clinic he works with is based in Seattle.  Oh well, its gana be pricey but maybe I will get some REAL answers!!!!  PRAYING FOR YOU!  <3, Ash

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by beddajess, Mar 29, 2012
@ Stacy10,

Thank you so much for all of the great information!! I bookmarked the website ;-) I also will be looking into some of the supplements as well as acupuncture! =) You seem knowledgeable and your input is much appreciated! Thanks again my friend!

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by beddajess, Mar 29, 2012
@ Ash,

I cannot thank you enough for sharing your tears with me, it means so much to me, more than words can say! *big hugs*

I promise not to lose hope just yet. I think I am just even more emotional because we were already preparing for our 2nd cycle of IUI and then we get hit with this news and have to cancel the cycle and I honestly do not know when we will be able to do something again because of Steve's work schedule. He stays on base for a few weeks at a time. That is one of the major reasons I am bummed. It all seemed so right but honestly, with low AMH it explains A LOT as to why we haven't achieved pregnancy.

I hope n pray we don't have to do IVF because I honestly do not see how we can. It seems impossible. I mean we will never stop trying naturally but this all just s*cks ya know? I promise to keep everyone updated!

I am so so anxious for your appointment on the 4th, 2 days before mine. Ya gotta keep me updated as well ok? I am praying that this specialist can get you some real answers. Remember to remain strong and ask as many questions as you can k. Write them all down if you need to.

I am always thinking of you and praying for you my dear friend!! Always...

Lovingly,
Jess your friend xoxo

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by Jessmarie842, Mar 30, 2012
I'm so sorry to hear about your low AMH but don't loose hope. I can imagine how devastating it can be to have that news but know that it doesn't mean anything.  I know a  friend that was told that her odds of conceiving with her own eggs was nearly impossible but she started doing chinese accupuncture and taking herbs and about six months later was able to conceive naturally. I don't like needles but I enjoy accupuncture.  I'm going to start accupuncture for fertility myself. There are many alternatives that can help. The website that a couple of the gals mentioned (natural-fertility-info) has great info and is a very supportive community too. They also have a fertility diet page because a healthy diet is essential when it comes to improving egg quality.  I will keep you in my prayers! Sending positive energy your way!

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