Extremely low AMH but normal/good AFC?(post chemo)

[redwhitestar]

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 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 rather than a blood test, but am not really succeeding.

Any help appreciated. Thanks.

Hi red-white - sorry I don;t know anything about the effects of chemo, but I didn't want your post to go unanswered as I do know how painful bad AMH results are. I retired to bed as soon as I opened mine and filed the letter under the bed. I've now retrieved it to look at the classification boundaries. 0.3 does seem very low (although I have seen different ways of reporting this data). However, my consultant said to me that it is indicative of number of eggs left not quality. And (here's an old chestnut), it only takes one good egg.... My result was 4.27 pmol/l. Although my round of IVF failed, I got 5 eggs with three fertilised. On this NHS round I paid for a private drug that helped in the final stage to mature the (3) follicles, so for me that made a difference.

I think there is no substitute for talking to your consultant on this one. Sonography shows follicles only, there may be no eggs there.

I'm sorry you've had more bad news when you've obviously had other illness to cope with. I did make it out of bed eventually but for me it was up there on a par with the failed ivf cycle so I do know how much it hurts.

Thanks Lozster. That's exactly what I feel like doing. I just don't have the energy to get through the next few days/months/years of seeing what's going on.

0.3 is so low that it just seems wrong: neither my oncologist (who's vv well known for what he does) nor my consultant thought that the chemo would affect anything. None of the medical surveys I've looked at suggest any issue at all with the type of chemo I had. I've found some suggestions that it can take at least 6m for everything to sort itself out post chemo and therefore for tests to be accurate, so I hope that's right.

Didn't realise that follicles could be empty. That's scary.

bump to see if anyone else can help. Thanks.

Hi red

Like loz I'm sorry that you've had more bad news when you've also had illness.

I just wanted to say that although test results and statistics can tell you a great deal, everyone is a different combination of results and will react differently to assisted conception or will have varying degrees of luck trying naturally. A AMH of 0.3 is only one part of you, if that makes sense?

Also to say that your age is a huge positive and I found viewing my chances from a 'glass half full' rather than 'half empty' perspective kept me going when I was low.

We started down the ICSI route because of DH's low sperm count but it became clear that I have wrinkly ovaries for my age - I was 33 when I went through treatment. My AMH is 2 and my 'resting' AFC was 4. I was told that I was likely to produce very few eggs when stimulated and as a result our chances of success were low. However, age meant that there was a good chance my eggs would be good quality and that one good egg could mean success. My first cycle produced just 3 eggs and failed. My second cycle again only produced 3 but I'm currently 13 weeks pregnant with twins . It really does only take one.

In terms of AFC I was told that this can vary by 1 or 2 each month but as loz said, it's possible that some might not grow and it's possible that those that do might not grow an egg. But it sounds like your AFC is good, which is a good thing, and as I say above, we're all a combination of varying results so it's really difficult to predict what might happen so try to stay positive.

Hope that helps and good luck x.

Thanks Teds77 - glad your story had a happy ending :)

If I ignore the AMH result and look at my scans, and the fact that I'm cycling pretty 'normally' three months post hard-core chemo/IVF (we froze some embryos)/huge abdominal operation, then it's all very happy and lovely. It's just this one result which has really thrown me for six.

I'm a bit more sanguine about it today. I spoke again with my sonographer who believes that the result is so low as to make her almost believe that there was a mistake at the lab (I had my AMH done pre-chemo and it was very healthy). She just doesn't see how it could be like that and my scans look like they do (she counted my follicles today and there were 8 on my one ovary (had one removed last year), and she believed there'd be some more which were hidden by the dominant follicle - more than 7 on one ovary seems like a pretty good number to me for someone and just doesn't seem to correspond with my AMH's suggestion that I'm pretty much menopausal).

I've emailed my consultant to try to get his opinion before Friday when we're seeing him again, but I (and DH) are increasingly of the opinion that we just 'ignore' the test: there is no medical evidence that my type of chemo affects fertility in any way, my oncologist didn't expect it to, and it definitely doesn't seem to have done so according to my scans....

Hello, sorry to hear of your distress...obviously your consultant will know more about your particular case but can u just say that I was told I had an AMH of 0.7. I got the result, saw the consultant two days later who was sure natural conception would be v v v hard and I should go down the egg donor route (actually, I make her sound quite nice when she was a total bitch ) and yet I conceived two days later... I have a 13 month old beautiful son. It really is about quality/quantity and I didn't have any of the other positive things going for me that you do (I'm 42 now)

Good luck- it sounds like you've already been tested if you've had chemo but keep the faith. The journey isn't always straight

X

Hi red what scale is that on? Pmol?

Makes a big difference...

PS I ask because I was on Zoladex for 5 years and it wrecked my AMH.... Long story but 39 weeks now. IVF to conceive but had 11 mature eggs and my periods had restarted after a year of no drugs and no periods thanks I believe to DHEA and other OTC interventions.

I never had more than 4 resting / antral follicles from what I remember...

Hi Topaz - it's pmol... So very low.

Really really really interested to hear about your experience with Zoladex. I saw my consultant today and he mentioned that the Zoladex might be playing a part in it. I only had one lot (28 days' worth) of Zoladex so nothing like as much as you, but combined with chemo I guess it could have a similar effect.

Can I ask a bit more about your situation? When did you get your AMH first tested and did it increase slowly over time or has it been permanently screwed? Do you know what it was before the Zoladex (presumably not)? And is that why you had IVF or were there other reasons? Please ignore the questions if you want: this is just an unresearched area it seems impossible to find any answers...

My consultant today said that my scans suggested that everything was hunky dory, but that the AMH was a 'cause for concern', should it reflect the true position (rather than my initial post-chemo one). However he's optimistic that it's simply a reaction to the chemo and should hopefully start to improve over the next few months. He's going to check with my oncologist and see what he thinks, otherwise I'm in trouble basically. So it's a wait and see game.

Oh and what OTC things can I be doing??

Oh and many congratulations: best wishes for next week!!

Hallo the zoladex completely shut down my system but the low AMH was thought to be genetic. However, after a year of no zoladex periods returned naturally just before my first IVF cycle. Did they test your FSH? That is a very reliable indicator of ovarian reserve. Mine is normal to low (which is good) despite crappy AMH. OTC meds I took based on own research to help fertility:
DHEA - not available in UK but you can buy on amazon.com. Please please research this as it has side effects. I took for two months but had palpitations. Supposed to dramatically improve egg quality.
Agnus Castus
High dose vitamin C
Baby aspirin
Red wine (antioxidants )

Have a look at the boards over at Fertility Friends... They are very very useful.

Hope this helps. Nil desperandum!

Thanks. I think the zoladex is still screwing with me-lovey dominant follicle but no/late lh surge.

Will be having fsh etc tested at the start of my next cycle but I'm not sure how accurate these tests will be if I'm still messed up from the chemo..

Tired of all this now. Ready just to give up.

Don't give up! Don't forget it took me a year to even get ANY follicles after zoladex. Clomid may be an option to induce ovulation? But maybe just time...?

PS how old are you if you don't mind me asking?

Wow. You are so much more patient than I am. I'm just tired of fighting my body all this time - of noticing every little sign and hoping that it means it's back to normal...

I think it is just time though. My body's been to hell and back, and I know rationally that expecting it to be fully fertile again in less than 3 months is ridiculous..

I'm 29 (for another 6 weeks ;) ).

Hi

Just wanted to update this in case anyone finds the thread looking for answers.

I saw my oncologist yesterday for my general catch-up, and he said that it was too soon for any hormone tests. He said that they wouldn't be accurate until at least 6m post-chemo.

He also said that BEP shouldn't affect fertility and that I should hit menopause at the same sort of time I would have done anyway.

So I'm not going to have any more hormone tests: waste of time and money (and stress).

Hey that's great news apart from the waiting!

:) Indeed - feel so much happier today, knowing that I've got a good few years of PMT ahead of me :)

Hello

Just wanted to say don't put too much stay by the amh test. Mine was 2.2 pcmol/l when I fell pregnant - naturally- with my daughter and 0.8 pcmol/l when I fell pregnant with my son. I fell pregnant v quickly with both and only had my levels checked cos of my v v short cycles.

Best of luck!

Good evening ladies. Is anyone still around?
Your advices will be welcome.
I have a low amh level 3.19 😥 i had 6 month of zoladex and when i had this test done i was still under zoladex. Shall i repet the test? I am looking for any hope to improve my chances for pregnancy.

I'm the OP. Very odd to see this thread again.

I hope that my story post-thread can give you hope.

In the May of 2012 I was allowed to ttc naturally (6m wait after chemo). I got pregnant immediately. He's now 3.5yrs old.

After he was born I bf for a year (which kept away my cycles). I then got pregnant again (planned) with my first postpartum cycle. She is almost 2.

So despite my levels I had three babies in under 4.5 years, having never tried for longer than a cycle for any of them...

I never had my levels measured again but for me they were clearly utter rubbish and meant nothing. I'm more fertile than most women despite very low scores.