Can anyone tell me about low AMH?

[wilburthewalrus]

A close friend has been TTC for some time and has just started receiving treatment. She phoned me in despair having had her AMH checked and been told it was low for her age (I think she said 7 - she is 34). Previously she had been told her FSH was as expected for her age.

I don't really know what this means for her and her partner. Does it mean she's facing early menopause? Does it indicated the quality of her eggs or just the quantity? Is there even any way of finding out egg quality other than just trying to get pregnant?

Everyone keeps telling her that she has time on her side given that she's only 34, but now she feels like she only has a few months before it'll be too late and that even if they try IUI/ IVF it probably won't work. I am desperately sad for her because all her other friends (me included) have had babies in the last few years and they have been trying and trying without success. She is talking to me about it because it also took us a little while to conceive, but we didn't have to have any treatment and so I don't know much about it and don't know how best to support her.

St Mary's hospital don't test AMH for the reason that it really does not mean anything in terms of infertility. It gives an idea of the number of eggs left but not the quality. A young woman can have a high number left but all of them non-viable, and thus with an apparently "good" number but still infertile. Meanwhile at the other end of the scale you can have a "bad" low number, but whilst there are less eggs they might all be good quality and still lead to healthy pregnancies. So really the AMH test is not helpful in terms of talking about infertility or not, and so a test that can be confidently ignored! That is what I have done (another doc insisted I have the test before he would see me, it came out at 2.4 and for my age that is a good number, but for younger women it is terrible), I am ignoring the result as it does not mean I can't get pregnant (I have been pregnant a few times since that test!).

So you can reassure your friend to ignore that result and to look for other investigations to be done. There are other tests that are much more appropriate to look for other reasons for the unexplained infertility in her case.

In IVF/IUI, I believe it is a level below 5 that most places will question whether it is worth it, so she is not in that category yet if her result is 7. You can try to gently reassure her that it is not all doom and gloom yet, but that a good infertility specialist would be the best route to take, if their treatement is not already being handled by one.

I'm so confused
Been to the Bridge Clinic, not 100% happy with them.
But the only test I have had in the AMH test, which came back really low, 0.48 pmol, but they are still suggesting ivf/icsi. And confused about how you quote the AMH level, seems to be 2 different ways.
If below 5 is the level, are they just stringing me along, is it worth it?

I've only just found this infertility topic, off to read and read, and learn something
I have no idea

Witherhills - you might find this link to fertility friends uk helpful. As the first link describes, the idea is that the lower the amh the less responsive to ivf treatment, however there are exceptions to the rule and doctors can sometimes over generalise.

Also please note the difference between pmol/l and ng/ml measures.
and you need to know whether your measures were pmol/ml rather than pmol/l

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

When I was talking about the less than 5 it was with the pmol/l, which is less in ng/ml. Sorry it is very confusing with all the figures. "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. .....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" !" quote

I hope that this helps, please look into getting other tests done too, this will help you decide if ivf/iui could be helpful or a waste of time and money. I wish you all the best.