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Hi! new here: low AMH

5K views 46 replies 10 participants last post by  Padellina 
#1 ·
Hello everyone,

Firstly, to admin, thank you for approving me. I was a lurker for a couple of days before joining and realise what a valuable resource this site and forum is.

I was sterilised 8 years ago when I was 29 years old (Filshie clips). I have two children, ages 14 and 19, who were both conceived naturally. I have been with my current partner, who is 49 with no children of his own (no pregnancy scares in his history), for 5 years, and we recently decided we would like to try for a baby. I went to see a consultant regarding a reversal of sterilisation, as I thought it would all be quite straightforward, and we would be skipping over hills with a picnic basket and a small baby in tow in no time! Since my sterilisation, I have suffered really badly with painful periods and spotting, which I have had several tests for, all of which come back ok. No hormone disruption, no cysts etc. One consultant queried endometriosis, but I haven't been diagnosed, and no laparoscopy to confirm or deny.

The consultant we saw suggested that before I have the reversal, we first check my partner's sperm quality, my FSH and my AMH, to ascertain whether reversal or IVF is the best option (also considering our advancing years). I had my day 2 FSH earlier this month, which came back as 10.1 ui/L. My doctor said this was normal, but upon further Google research I see that it is not. My LH is 8.8 ui/L, which means nothing to me. I have tried Googling this (google is both my friend and my enemy), but I can't seem to find out if it is a good level or not, in comparison to FSH. At the beginning of 2014 (tests in reference to my periods), my FSH was 8.4, so quite a rapid decline.

Anyway, I also had an AMH test done, and the nurse called me to say it was really low at 0.6. She asked about my periods and said that potentially I may have endometriosis, which can play havoc with levels if it grows on ovaries. She suggested an antral follicle scan. My partner has yet to have his semen analysis, but the way things are going I suspect that will be awful too! After his analysis, the clinic said they will arrange a consultation with an IVF consultant to see our options. All looking a bit bleak, but what I really want to know is the following:

In worst case scenario (i.e. low AMH, rubbish scan results, low sperm count, endometriosis), is IVF still possible, or am I psychologically torturing us by even beginning this journey? Obviously, it could be that my partner's sperm is amazing, but even then my scan results would need to show something positive, wouldn't they?

I am so new it this, so please excuse the waffle and the ignorance. The lingo doesn't mean much to me yet.

 
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#2 ·
Hello

Welcome  :)

Sorry to hear about your diagnosis, I have low AMH (2) and stage 4 endo, it would be interesting to see what your AFC comes back as, your AMH is very low im afraid yes, your FSH is high but not mega high and FSH can fluctuate, the clinics do put a limit on your numbers to let you cycle, mine say AMH has to be over 2 and FSH under 10, I cycled with AMH of 2.2 and FSH 9 but my FSH went to 23 so we moved to donor eggs after that

Problem when your FSH is high is you don't respond to the meds and when your AMH is low they would need to aggressively stim you, I believe some clinics do natural cycles where the aim is to just get one egg but I don't know much about the success rates and requirements for that

I'm going to move your post to the low AMH board as the ladies there will be best places to advice you more



L xx
 
#4 ·
I just moved you there now  :)

Well there are ladies who have had a pregnancy with levels that low, but you would have to weigh up if you could afford to spend a lot of money on a small chance of success, you would have to find a clinic that would accept you though as mine said AMH over 2 and I know some clinics say it has to be 5 or above for a stimulated cycle anyway

Like I said I went for donor as it gave me a 60%-70% chance whereas I had a 5%-8% chance with my own eggs

Let the ladies here advise you more as they will know a little more on cycling with those levels x
 
#6 ·
Hi Rebelregrets,

I've got low AMH 1.5 and FSH tends to be approx 11-12, it varies each month and can fluctuate.  AMH doesn't really change.

The NHS wouldn't offer me IVF as I'm below their cut off in my area, they said go straight to donor, don't waste time with trying using your own eggs. However, it only takes one good quality egg and good sperm (ha. Listen to me, it only!!) And you have a miracle. 

So, I decided that I'm going to try with my own eggs first. We saw a few clinics and got their opinions and decided to give natural/modified IVF a crack.  Basically the theory being that drugs won't help low AMH patients produce more eggs and in fact the drugs might inhibit the egg quality.  At EC it could be only one they take. Low AMH people can and do get pregnant and have babies naturally. My very long winded point is  no one knows for sure, it's nature and I'd say if you want it, it's worth a go. If you don't try, the answer will always be no.

If my own eggs don't play ball, I'll move to DE like Lilly83.  I agree with Lilly83, have the AFC scan.  My little overies are currently only producing around 2/3 follies per month - between them, not each, sadly.

Good luck with the decision making and investigations if you go for it.

XxxX
 
#7 ·
Thank you so much for your advice. I will definitely go for it, absolutely, without a doubt. My hopes are quite low, so i suppose anything higher than nothing is a bonus! I haven't thought about DE yet; I think if this doesn't work we will foster instead. It's all dependant on partner's sperm quality and my AFC, I suppose. I won't know until mid-August which seems like such a long time to wait! Every month that goes by, I feel like my follicles are drying up a little more. We don't qualify for NHS IVF as I already have two children from a previous relationship, so we will hit the credit card. Only enough for one cycle though  :( xx
 
#8 ·
Hi, Rebel, your FSH is not bad for your age, which makes me think that your very low AMH is an indicator that you won't get many eggs per cycle, not that you are near menopause, esp. if you still menstruate regularly. Definitely a good idea to have an AFC scan done, but don't give up hope if your AFC is disappointingly low (e.g., 3 counting both ovaries, which is what mine usually is).

There are basically two approaches for very low AMH: aggressive stims, as Lilly mentioned, which would usually be 300 iu or more of injectable FSH (e.g., Gonal-F, Menopur) per day, probably on short protocol (long protocol would most likely way oversuppress your ovaries); or natural or mild IVF, which is pretty much the opposite. Aggressive stims are trying to jump-start your body into producing a lot more eggs per cycle than normal. However, for many of us low-AMH ladies, we are never going to get more than 2 to 4 eggs per cycle no matter what. Natural IVF is what it sounds like: you have a natural cycle, and the doctors attempt to retrieve eggs from any follicle(s) you produce. This often yields excellent egg quality, but you are at much higher risk of getting no eggs collected; for that reason, it can be prohibitively expensive unless you go abroad. Mild IVF often involves a combination of low-dose injectable FSH plus an oral drug to induce super-ovulation (Clomid or Femara), although some clinics just use low-dose injectable FSH on its own. Mild IVF is most like a natural cycle, except giving your ovaries a little extra "juice" to help them mature more than one follicle at a time.

If you do cycle with high-dose stims and get poor results, don't assume it's game over. I actually got more eggs on my mild IVF cycle (75 iu/day Menopur plus Femara) than I ever did on high-dose stims. But still talking about tiny numbers: my massive haul of eggs on the mild cycle from which I am now 20 weeks pregnant was a grand total of four. ;D If you end up looking at mild or natural IVF, don't be afraid to look at clinics abroad; I know the travel sounds daunting, but it's easier to organise than you'd think, and you can save quite a lot of money without compromising on quality of care.

Here are a couple of links that may be helpful:

Low AMH / High FSH Cycle Buddies (lurk and see what other ladies' treatment experiences are like) http://www.fertilityfriends.co.uk/forum/index.php?topic=331263.0

Natural, mini, mild IVF chat thread
http://www.fertilityfriends.co.uk/forum/index.php?topic=331471.0

Wishing you lots of luck on your journey! ^reiki^
 
#10 ·
Yup, and I'm an old duffer, too. At 37, and with a history of 2 successful pregnancies, you have a reasonable shot at any eggs you do produce still being of decent quality. :)
 
#11 ·
P.S. If your DH has a poor semen analysis result, look into a high-quality supplement like Fertilisan-M. Supplementation, avoiding alcohol, quitting smoking, getting exercise (keeping those testes nice and cool, of course), and keeping weight under control can all really help. Making sure he's properly hydrated before giving a sample will help with volume issues too.
 
#12 ·
Partner is quite looking forward to his contribution to the cause...! I'll pass the tips on. Neither of us drink and I gave up smoking five months ago. He is still smoking but looking to cut down. I'm conscious of sounding like an obsessive when we chat about it, but if we are throwing all this money at it we may as well do it properly!
 
#13 ·
Smoking is a big contributor to infertility, both male and female. Has he considered vaping to help cut down, if patches and gum aren't doing it for him? It's not the nicotine that really hammers the sperm, it's the other compounds in smoke. I mention vaping only because it's the thing that finally enabled my SIL and FIL to quit,  and they were both super-addicted.
 
#14 ·
I can see you have had some great advice, thanks ladies

Just wanted to echo the smoking issue, my DP had a low count and quality when he had been quit 3 months, 9 months later it was much much improved, also smoking can affect fertilisation and there will be a lot resting on it with what might be 1 or 2 eggs xx
 
#16 ·
Many people smoke and get pregnant easy but I think when the odds are against you anyway you need to do everything you can or risk kicking yourself for a long long time xx
 
#18 ·
Hi all,

This thread hasn't been active for a while, but I am new and have low AMH, so was wondering if there have been any updates for you ladies with low AMH?

Mine is 4.4 pmol/L = 0.6 ng/ml, very low!
Hubby has low sperm count and low motility, been referred for ICSI, but feeling quite low about our chances.
Don't think they've tested my FSH levels, should that be done as a matter of course?

DH is on wellman, I'm on DHEA, and looking for suggestions for other options to improve our chances. Any advice welcome

Thanks
Natalie xx
 
#19 ·
Mine is 0.6 too! I was given a 10-15% chance of success, and every single step we got through was a huge relief. It was like hurdles. My consultant put me on short flare protocol (combo of 300 Menopur and 300 Gonal F) and I got my BFP last week. Just holding out for viability scan now. So all is not lost; don't give up hope.
 
#20 ·
With regards to tips; I just tried to keep healthy. I didn't take any supplements other than Pregnacare (plus OH took zinc). Stopped caffeine, stopped vaping and I don't drink, so that wasn't a problem. Diet stayed the same, other than I drank a little more milk than usual. xx
 
#21 ·
Hi Rebel,

Thank you for your reply and a huge congrats on your BFP, I'll keep my fingers crossed for your scan!

That is so comforting to hear a similar scenario 😊👍

Currently I'm only taking DHEA, but was looking to include at least vitamin D into that. I might just get the pregnacare as you say, all bases covered then!

My DH is on well man tablets at the advice of the clinic so hoping that is sufficient for his problems. Trying to also convince him to improve his diet, too much sugar and caffeine in my opinion, but potentially being a little too obsessive! Haha

Thanks for your support

Good luck with your scan

Natalie xx
 
#22 ·
I was tempted to encourage (nag) my OH too, but he gave up smoking so that was a big enough deal, I think. I felt the temptation to do EVERYTHING I read about, but in the end decided it was best to just go with what my clinic says. You just don't know though, do you? If this hadn't worked, I might be all, "If only I had eaten ground armadillo, I might have had a chance", or something similar. Anyway, thank you for your good wishes and I send you all the best for your journey. X
 
#23 ·
PS. Just for info - my first antral follicle count showed 5 one side and 4 the other. I started stims and at the first scan they could only find two each side. At the next scan there were about 7 each side, so just goes to show that even that isn't set in stone: they hide! I eventually got 8 eggs, two of which fertilised and went back in. Good luck! Xx

Passion4baking said:
Hi Rebel,

Thank you for your reply and a huge congrats on your BFP, I'll keep my fingers crossed for your scan!

That is so comforting to hear a similar scenario 😊👍

Currently I'm only taking DHEA, but was looking to include at least vitamin D into that. I might just get the pregnacare as you say, all bases covered then!

My DH is on well man tablets at the advice of the clinic so hoping that is sufficient for his problems. Trying to also convince him to improve his diet, too much sugar and caffeine in my opinion, but potentially being a little too obsessive! Haha

Thanks for your support

Good luck with your scan

Natalie xx
 
#24 ·
Haha that made me laugh!

Where can you buy ground armadillo anyway? 😜👍

Wow that is a massive change in your follicle count, I was panicking because I have 3 one side and 4 the other. Fingers crossed I see the same increase as you did!

Your story is just what I needed, thank you so much xx
 
#26 ·
Passion I would definitely take the Pregnacare Conception - it's NHS guidance that all TTC women should be taking 400ug of folic acid a day, and aiming to get the minimum Vitamin D which I can't remember off the top of my head. You can get the folic acid+vitamin D tablets on their own very cheaply at Boots, but the Pregnacare has everything in it that you need for well-rounded TTC, so covers them all off in one go...
 
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