AMH questions (and other random thoughts)

[midwest07]

Hi all, I have been wanting to jump in here (or maybe back on the main board but not sure if that is ok since we are TTC #2.)

Brief history - We have a 19 month old DD that was the result of a successful IVF process in late 2014/early 2015. It was our first cycle, we ended up with 3 5-day embryos. All tested normal. We did an FET with the best one and I got pregnant and had DD in late 2015. We recently did an FET with our 2nd best embryo and it did not work. We have a 3rd embryo, but our doctor says it's not a very good one and their protocol now for freezing, it wouldn't have made it. She is not saying not to try it, but between the clinic fee and meds, an FET is around $3000, so the doctor suggests considering putting that to IVF again.

I am almost 36, so was 33/34 during IVF and being pregnant.
I recall having 15 eggs retrieved and 11 fertilized, and I wasn't on super high med doses. I also did a few medicated IUIs and responded well. Our general diagnosis is unexplained, I ovulate late and have a short LP.

I was not quite ready to jump back into IVF, so we asked about any other options to try on our own for a few months. She said we could try Femara and TI, at least try something while we decide. She also said we needed to retest my AMH.

I got the results late Friday and plan to talk to the clinic today. It was 0.81. I have no idea what it was back in 2014. 

Can anyone just guide me through that AMH number? Is it important what the number is now only, or where it was a few years ago? Like say it was 0.95 in 2014 and we had a successful IVF, maybe that isn't so bad? It makes me nervous that we need to be making a decision and moving to IVF right away and should not be waiting even a few months and it seems more obvious no way we could get pregnant on our own. I am finding lots of conflicting info online about what is a really bad number and what is borderline. I also started on some supplements and a few diet changes.

Since those here have had success, I would appreciate hearing from anyone with similar numbers or stories or anecdotes or whatever. thank you!

[shauni27]

I didn't want to read without posting, but I do not specifically have an answer for you. I know when I started IF treatments in 2014 they did not test AMH unless your other numbers were low. Mine were not. So I was diagnosed as unexplained. Then in 2016 they tested AMH because medical standards changed and it turns out mine was low, so I was diagnosed with DOR. That is when we did our IVF treatment as well.

So not much help there, sorry!

I do think if you post on the TTTC board (there are tons of women there with second time infertility!) it will be seen by more posters who have experience.

Good luck!

[midwest07]

May 8, 2017 13:06:51 GMT -5 shauni27 said:

I didn't want to read without posting, but I do not specifically have an answer for you. I know when I started IF treatments in 2014 they did not test AMH unless your other numbers were low. Mine were not. So I was diagnosed as unexplained. Then in 2016 they tested AMH because medical standards changed and it turns out mine was low, so I was diagnosed with DOR. That is when we did our IVF treatment as well.

So not much help there, sorry!

I do think if you post on the TTTC board (there are tons of women there with second time infertility!) it will be seen by more posters who have experience.

Good luck!

Thank you for the response, this is interesting. Maybe I wasn't tested for it previously and there won't be any comparison. I may also post over on TTTC soon. Thanks!

[EllenGriswold]

I don't know for sure about AMH, but have you had a recent ultrasound with an antral follicle count? I've read some things that say hormone levels may only be part of the story and AFC can be a good estimator. I would ask for that with your next cycle if you don't have a recent one, it may help you make a decision.

[King26]

Ok let me say this. I've done 4 rounds of IVF. Rounds 2 and 3 my AMH was .26 so super sucky. I still got 10 eggs each time though fertilized 2 one time and 4 the other. I didn't get pregnant either time.

However, my first round of IVF sounds similar to yours. My AMH was 1.3 (I think) but I got 22 eggs, 17 mature, 10 fertilized but only 3 made it to blsat. I transferred one and they told me not to freeze the other two. I got pregnant but had a m/c.

Fast forward to round 4. I took CoQ10 for months prior and my AMH was up to 1.0. I ended up with 10 eggs, only 4 fertilized but with my 4 fertilized 3 made it to blast. My fresh transfer was a negative but I'm pregnant with my second embryo.

I tell you all this because my first round was when I was 34, my AMH was ok, and I had a ton of eggs but only 3 made it to blast. IVF 4 was at age 36, with a not great AMH, much less eggs, but still 3 blasts and much better quality. So don't lose hope. Also, I'd start taking CoQ10 immediately. It's the only thing proven to help with AMH. .81 is low AMH but it's not horrible. My .26 was horrible and I was in a bad place but I was still making eggs.

AMH correlates to the number of eggs and the quality but you need other numbers to go with it, generally FSH to do a good comparison of what's going on. Let me know if you have any other questions. When I got my DOR diagnosis and .26 AMH I was really upset and did a lot of research.

[midwest07]

May 8, 2017 18:17:44 GMT -5 EllenGriswold said:

I don't know for sure about AMH, but have you had a recent ultrasound with an antral follicle count? I've read some things that say hormone levels may only be part of the story and AFC can be a good estimator. I would ask for that with your next cycle if you don't have a recent one, it may help you make a decision.

I have not had this done. I didn't hear from the clinic today so this is something that I can ask about. Does this have to be on a certain cycle day/range?

[midwest07]

May 8, 2017 19:52:09 GMT -5 King26 said:

Ok let me say this. I've done 4 rounds of IVF. Rounds 2 and 3 my AMH was .26 so super sucky. I still got 10 eggs each time though fertilized 2 one time and 4 the other. I didn't get pregnant either time.

However, my first round of IVF sounds similar to yours. My AMH was 1.3 (I think) but I got 22 eggs, 17 mature, 10 fertilized but only 3 made it to blsat. I transferred one and they told me not to freeze the other two. I got pregnant but had a m/c.

Fast forward to round 4. I took CoQ10 for months prior and my AMH was up to 1.0. I ended up with 10 eggs, only 4 fertilized but with my 4 fertilized 3 made it to blast. My fresh transfer was a negative but I'm pregnant with my second embryo.

I tell you all this because my first round was when I was 34, my AMH was ok, and I had a ton of eggs but only 3 made it to blast. IVF 4 was at age 36, with a not great AMH, much less eggs, but still 3 blasts and much better quality. So don't lose hope. Also, I'd start taking CoQ10 immediately. It's the only thing proven to help with AMH. .81 is low AMH but it's not horrible. My .26 was horrible and I was in a bad place but I was still making eggs.

AMH correlates to the number of eggs and the quality but you need other numbers to go with it, generally FSH to do a good comparison of what's going on. Let me know if you have any other questions. When I got my DOR diagnosis and .26 AMH I was really upset and did a lot of research.

Congratulations on your pregnancy BTW. I lurk here a lot (too much!) and was really happy to see your news!

I did start taking CoQ10. Any advice on dosage? I was starting with 300 mg a day, and it's the ubiquinol one. I am also trying to eat more protein.

I do know that I had my FSH level tested when I was doing testing in 2014 and it was low. That seems a bit at odds with DOR from what I was reading just now, maybe that should be tested again as well.

How long did you take CoQ10 and focus on egg quality? I was reading it is about a 90 day cycle and to start that far in advance of IVF.

ETA: Also did you spread out take the dosage throughout the day? Rather than all the pills at once?

[EllenGriswold]

May 8, 2017 20:16:43 GMT -5 midwest07 said:

May 8, 2017 18:17:44 GMT -5 EllenGriswold said:

I don't know for sure about AMH, but have you had a recent ultrasound with an antral follicle count? I've read some things that say hormone levels may only be part of the story and AFC can be a good estimator. I would ask for that with your next cycle if you don't have a recent one, it may help you make a decision.

I have not had this done. I didn't hear from the clinic today so this is something that I can ask about. Does this have to be on a certain cycle day/range?

I think the beginning of your cycle (around day 3 or so). It's just a quick ultrasound, they measure the number of follicles they see - and that's basically the upper limit of the eggs you could produce in one cycle.

[King26]

midwest07, I started at 400mg of CoQ10 and then I went down to 200mg. I took it all at once. I've also heard to do it 90 days or 3 cycles in advance of a cycle. I believe my AMH was retested 6 months after taking the CoQ10.

[azurely]

I don't have any AMH advice, because mine was never tested, but we were also unexplained and I suspect we had an egg quality issue. I had a large amount of eggs retrieved but only 5 made it to freeze. We used two to get pregnant with C, so we have three embryos frozen still from our IVF cycle in 2014, but like you, they are not the best quality so I'm unsure if we will ever use them.

So no real advice, but I can commiserate with the uncertainty of FET vs. IVF. Good luck making your decision.

[midwest07]

shauni27 , EllenGriswold, King26,

I thought I would give those of you an update who had comments about further testing. I talked to the nurse this morning and the RE wants to test FSH and estradiol on CD3 to get a better picture of ovarian reserve. The nurse did say that a few years ago the doctors tended to just test FSH and now they start with AMH, but she went back and I have an AMH from Sept 2014 and it was 1.84 at that time. So a decrease of around a point over 2.5 years. The nurse also said the RE is encouraging us to consider IVF sooner rather than later. So I think we will finish this cycle and next to get the testing done and probably move to IVF by early summer. And I will keep taking the CoQ10. Thanks all!

[shauni27]

midwest07 , even if it sucks, it is still good to have answers and a plan. I took the CoQ10 as soon as I found out my reserves were low. Good luck!

ETA: I just looked back at m history. On my AMH lab work it says normal is anything from .66-8.75. So while yours dropped, as I believe is normal with age, it is still technically not too low. My guess is they are being good and proactive, since IVF has a higher success rate with women who have DOR.

For what it is worth, my number was .5 and I got 6 eggs out of our retrieval. 5 were good quality and took to insemination.

[jessnpaul]

midwest07 I also had terrible AMH (0.26, like King26 ). I took 300mg of Ubiquinol for a really long time (6+ months) and even took DHEA when I felt like the Ubiquinol wasn't working. I'm older (41 at the time) so that wasn't working in my favor either.

I read "It Starts with the Egg" and also switched my toothpaste to a more natural one (Toms), changed all my hair products and makeup to paraben-free, etc. Tried eating better too, although I didn't successfully stick with low-carb. I ended up having a miracle pregnancy (no IF treatments that month) and I think it had everything to do with all the stuff I had done to improve egg quality!

Best of luck!!!