AMH/AFC post-chemo

[redwhitestar]

Have posted this in Infertility but thought I might get a better response here.

Please help - am sitting here in tears.

I had chemo last year. Pre-chemo my AMH levels were good/normal.

Chemo finished 3m ago. Since then, I've ovulated twice and had two light periods.

I'm in the middle of a monitored cycle at the moment. Everything looks lovely/normal according to the (very experienced) sonographer. However my AMH has come back at 0.3. I'm 29 and utterly devastated. The sonographer was really shocked since she was expecting a more normal result based on what she saw.

Is it possible that the AMH was taken too soon post-chemo (I had hormones to shut everything down - Zoladex)? Am trying to be positive and rely on what she saw, but am not really succeeding.

I'm seeing my consultant on Friday but I'm hopefully o'ing before then, so if I am about to hit menopause we need to make the most of it.

Any help appreciated. Thanks.

I know nothing about chemo (but do think 3 months is v v short time to expect hormones to be normal again after having been shut down) but I do know about infertility and the pain of that - bumping for you in hope you will get more knowledgeable reassurance than I can provide.

And a ((((redwhitestar)))) in the meantime.

I do know about re-starting hormones after shut down (IVF and m/c veteran here) and as I said, 3 months is not long enough for things to settle down. I would give it 6 months tbh.

Thank you. Am in total shock and can't stop crying.

My sonographer hinted that I'd taken the test too soon, which I'm desperately hoping is the case, but I don't understand why my consultant would have ordered the test if that was so... The fact that I'm having fairly regular cycles immediately post-chemo with totally normal looking ovaries leads me to think that the test is a load of rubbish, but then why did he ask for it?? Wish I'd never agreed to it now.

There's no evidence the chemo I had affects fertility (was a weird type - not breast cancer), which makes it even less likely that the AHM is correct, but there's still something affecting it, even if that's a temporary thing.

Am so upset and fed up with all of this.

bump - anyone else?

Which consultant ordered the test? I'm just thinking that...IME....one sort of specialist is rarely totally on the ball about other specialities. So an oncologist may well have patchy knowledge on fertility, and vice versa.

My gut feeling is to back yours, and guess that the test is too soon. Especially given your age. Is there any way you can talk to your consultant before Friday? Email maybe?

Please update, I'll be thinking of you x

Thank you.

My gynae/fertility guy ordered the test but tbh I don't have much faith in him: he didn't even know which type of chemo I'd had... My oncologist (top top top guy - world renowned) isn't expecting me to have any fertility issues whatsoever and I trust him (quite literally) with my life.

I'm going to try to get in touch with my consultant today. Something just doesn't add up.

Can I ask what chemo you had?
My gut tells me it is too early to be having fertility tests.
Have you already got children?

Of course. It was BEP (bleomycin, etoposide and platinum). It's normally given for testicular cancer, but I had a very rare form of ovarian cancer which it also treats (similar origins to testicular). I've looked up all the studies I can find and all of them say that fertility returns to normal after this treatment.

I have a DD - she's 18m. I fell pregnant first attempt with her so have always considered myself to be quite fertile (ironic huh?).

I am quite sure that a fertility consultant (judging from the many I saw!) would have no idea on the time span of unusual chemo drugs affecting hormone levels. He may know about safe time spans from the foetus's point of view, but not from the effects of drugs on your body.

Definitely question it. It just doens't sound right. Also, I had drug treatment with ribavirin and interferon before I started ttc, and I was advised to wait 6 months before trying - and mentally, tbh, it felt like a minimum time to return to 'normal' after the stress of treatment. Don't let them panic you

Thank you Elibean.

I'm glad it's not just me (and DH) thinking that it all sounds a bit weird. DH is a scientist so is used to dealing with test results and he agrees it doesn't add up.

Am waiting for the clinic to call me back.

redwhitestar it is so early and the results sound good considering it is so early. I finished Chemo in August and no sign of periods returning. Fine by me I don't want any more children. So I think it sounds really hopeful for you. By the way I have two adopted daughters so all hope isn't lost but you probably don't want to hear that. But I do know the pain of infertility.

Good luck and give yourself some time to regain your strength I'm still in a complete state of exhaustion from the Chemo and I would imagine everything you have been through is affecting your emotions. Take a breath and give yourself some time. Three months is early I would imagine the more time you give yourself the more successful it will be in the longterm.

Yes your oncologist is right BEP shouldn't affect your fertility although there remains a slim possibility it might.
I asked about your previous fertility as some women are concerned about their fertility after chemo but really if they don't already have children they may not have been fertile before!
I would wait another 3 months before worrying too much.
Sadly there is very little research on chemo and fertility in women and because doctors (oncologists or gynaecologists) don't know much they aren't able to offer much advice.

Thank you for all your kind words.

The nurse at the clinic wasn't able to help much other than to say that low levels are common post-chemo and that whether or not they improve depends on the type of chemo. Which gives me hope, since I had BEP which is a good one for fertility, as DaintyNuts said.

I've emailed my consultant and am waiting for him to contact me to try to shed a bit more light on the matter.

I only want one more baby so I only need to get pregnant once more...Considering I'm cycling already that seems pretty possible really...

I guess I just don't believe the test results: if they were that low the scans wouldn't show what they showed.... But obviously that's what I want to think...

And daisysue2 - I've always thought about adopting and was planning on looking into once my 'natural' family was complete. So the thought of having to adopt is actually a nice one, just not one I'd hoped to have so early.