Ovarian Reserve Test - Zita West

[CuppaTeaAndAJammieDodger]

Hi, DP and I have recently been discussing the possibility of having a baby. I've got a DD from my first marriage and he has 2 from his. Thing is he's had a vasectomy, which he would like to reverse....when we can afford it. problem is I'm already 35, and they say that you shouldn't expect a result after a reversal for at least a year (if at all), add on the time we need to save for it and we're looking at a couple of years easily, at which time I'll be pushing 38, at which stage my fertility may have plummeted!

I was thinking of getting an ovarian reserve test with Zita West to see what's going on in there and how my fertility is at the moment; I'd hate to fork out £3k for a vasectomy reversal just to find out my eggs are on their last legs and the chance of conceiving are remote.

Anyone had a similar dilemma/experience or have had the same test (or any experience with the Zita West Clinic?)

When did he have his vasectomy operation performed?. I ask this as generally speaking successful reversals are less likely to happen if the op was done many years ago.

I would have a discussion with the GP in the first instance, the two of you need to talk to a medical professional like a gynae now.

Personally I wouldn't bother with the test.

My AMH result (which is what I am assuming an Ovarian Reserve Test is) was lowish but normal for my age then (36) and did not indicate that there would be any problem conceiving. All the other standard tests and scans also came back normal. We can't conceive, although on paper there is no reason why we shouldn't. The only real test of your fertility is trying to conceive and seeing what happens. One third of infertility cases are unexplained, so even if everything looks ok on paper, you might still have problems. The results don't tell you much. Also, lots of people conceive with low AMH levels. One of the women on this board recently conceived naturally with a very low AMH (of 1) after failed IVF. I think the ovarian reserve test is pointless, frankly.

Thanks for the replies.

AttilaTheMeerkat it was about 3 years ago.

EuroShaggleton thing is, although if they come back positive (i.e. a good result) it is in no way a guarantee of conceiving, if they come back very low surely that's an indication that with low egg reserves, plus the fact that vasectomy reversals are in no way guaranteed to work, our chances of conception would be very low and might make us rethink things (not necessarily give up altogether, but maybe go with ISCI instead)?

The thing is, there are plenty of people with very low reserves who do conceive naturally (and others who don't). And there are people with good reserves who struggle. If you want the test then go for it. I am just unconvinced it will tell you anything useful.

I can only give you my experience. My DP and I had a fertility consultation - I ovulate regularly, all my blood tests were normal and a trans vaginal scan showed that my uterine lining and ovaries (well the one that works) looked good. I had the AMH test done and the consultant said on the basis of what he had seen he expected it be normal or slightly above normal.

In fact it came back extremely low at 1.3 (20 is the start of the normal range). I was very upset as coupled with my DPs sperm being a bit slow of the mark it meant our chances of conception were very low but I conceived that month! I am now 9 weeks and will be 44 next week. A scan yesterday showed all is going well (heartbeat and wriggling around).

ahh that's lovely news greenlizard congratulations!

EuroShaggleton what would you do in our position (genuinely interested), just go for the reversal?

And there's an example of someone with a low AMH who got a win! Very pelased to hear that the scan was good lizard.

Cuppa I think I would just go for the reversal ASAP as you know you want to try and fertility does decline with age.

I have very limited faith in the reserve test also. I got tested post-chemo treatment and got 1.something. Very low. The very same day I had an ultrasound which showed multiple follicles (ie totally normal ovaries for someone my age, not the menopausal ones I was told to expect following the test results). I then got pg naturally first cycle trying (said baby is currently BF as I type this).

I accept that the chemo may somehow have screwed with the test, but my experience of it has been that it's a waste of time.

Hiya cuppa (great name by the way), I'm not sure if any of this will help, but I will tell you about my experiences anyway. DH, 50, me, 37. DH had a reversal in 2010, 21 years after the vasectomy and I got pregnant 4(short) cycles later but miscarried at 6 weeks. Fast forward a year of nothing happening and me having surgery to remove a large ovarian cyst and a referral for fertility treatment. I had the AMH test a year ago and it came back at 0.23. DH had 0% motility just over a year ago, so had a surgical sperm retrieval and we have 10 vials left. I had #2 of IVF in March and got pregnant but had miscarried by 6 weeks. I think I would have the test if it were me and then could it be a possibility to go straight to IVF and not have the reversal? I don't suppose you'd be eligible on the NHS though with previous DCs.

Sorry, don't suppose that was particularly helpful, but wanted to try and help ...

The thing is there isn't a whole lot of research on AMH (yet), in particular what the range is like in the whole population. And they say AMH is related to quantity not quality - so you may have few eggs, but they may be totally awesome. Equally you might have a lot of eggs but they're crap and don't fertilise easily.
But the fact the NHS is starting to fund it in some situations means that there must be something in it, I tend to think..

In this kind of situation I like to write down the possible outcomes and consequences. EG if you have the AMH test and it is low, will you really just think, Ah well, never mind, I'll put this baby idea out of my head and get on with life. Because if you want to carry on with TTC anyway, then the AMH test is just a waste of money. Even if you can get it done for free on the NHS, knowing your AMH result may add complications (in terms of messing with your head), and won't actually affect your outcome of TTC if you decide to go ahead and try.

On the other hand, if you really will forget the idea of TTC if you have a low AMH, then maybe go ahead, then your husband won't have to go through an unnecessary medical procedure. But only you can answer that...

Sorry pressed send too soon... I had blood taken for AMH test last Wednesday and can get the results from tomorrow. I can't decide whether to actually phone up and get them now, or wait until just before our next fertility appointment in August. Because knowing it isn't going to change anything for the moment (consultant indicated that if AMH was really low we might be able to fast forward to IVF but I don't know if I want that at the moment anyway).

thanks chocoloco1 :) so sorry about your miscarriages.

v good point moggle - I think I need to sit down and talk to DP about what we'd do based on the outcome of the test.

An AMH test costs about £90 from the Doctor's Lab (ie minus the Zita West branding mark-up) and your GP can put you forward for it. It's not a huge amount of money and at least it will help you focus on the options available to you going forward.

Having said that - and as others have pointed out - the AMH is a very unhelpful test. It gives no indication of quality, and causes a false sense of security in many women and devastates others who get a low result but may then go on to get a natural conception. For this reason it's not covered by the NHS.

The most useful element of AMH is in indicated to your doctor the dosage you'll need in assisted conception.

Before you do anything, get your husband checked out by an andrologist specialising in infertility. There are other ways of retrieving sperm so a vasectomy reversal is not always the recommended course of action.

My best piece of advice is to start saving. God forbid but if you find yourself going down the assisted conception route, the single biggest obstacle is lack of money.

Just want to add, you can get the test on the NHS in some parts, I've just had one. However it was the fertility consultant who asked for it, not our GP (though I had the blood taken at our GP's).

Sorry for barging in, but just wants to say congratulations to greenlizard! Hope you've told our mutual acupuncturist as she will be sure to cite you as a success story!!! Good luck!

I've just had a couple's fertility assessment at a London clinic. They are quite standard tests - transvaginal scan, amh, semen analysis and consultation. I have pcos, so a bit different. I think Amh may be useful taken with other tests, such as a scan, as it confirmed pcos for me.

I have had the AMH test done and it came back "extremely low". Which made me feel a bit sad at the time. However, since having that test I have conceived three times, sadly none of them stuck, but they were at age 44 and 45, so not surprising.

So, the amh test has basically told me that I don't have many eggs left, but it really doesn't make a lot of difference to me, I have continued to ttc anyway.

I had the test done as I was going to see a fertility specialist. I changed my mind as I knew he would suggest donor egg and I didn't want to go down that road.

Since having that AMH test 2 years ago I have ovulated every month (I track it with charting), so low reserve doesn't necessarily mean your time is up.

Incidentally, my DH had a reversal (after 7 years), and we got pregnant 7 months later with our DS, who is almost 5. He was conceived around my 41st birthday. Who knows, if I'd had my AMH tested then, it may have been just as low?

I did a lot of research after getting my "extremely low egg reserve" diagnosis, and found that many women get pregnant and have babies after that diagnosis.

I still hold on to the hope that there may be just one golden egg left and I will catch it one day.

I think if I were you I'd get the reversal done asap as once it is done, if it is successful, you will have every month to have a chance at ttc, whereas if you take the assisted route you won't have as many opportunities and I'm guessing it will be expensive.

I wish you all the best. I wish my DH had had his reversal earlier so that I could have been younger, ttc at my age is a battle.