AMH levels

[thisismadness77]

Hi, I had a basic fertility check yesterday as we are still wobbling as to whether to try again for a 2nd after 3 consecutive MC. I knew time was not on my side as I’m 40 and my sister had an early menopause. My AMH levels were really low around 2.7 and the doctor said this was not a good result. Understood. I haven’t really got a perspective of how low they have to be to be hopeless, she just said to crack on asap. We don’t want to do IVF, so I wondered if anyone would share their experience with me of AMH levels and conceiving. Thank you.

Do you mind if I ask why you wouldn't want to do IVF? At your age and with your AMH it may well be the best option of having a second DC, especially if you combine it with PGS screening.

The AMH result is pretty low, but the more pressing issue is your age. at your age, around 70% of your eggs will be aneuploid, which if you had a high AMH (hence lots of eggs left) would be less of an issue.

Few eggs, of which 70%ish are likely to be non-viable is a fairly serious problem.

To give you a bit of context, I am 38, with AMH of 4.9 and AFC of around 10/11 on average. My consultant is still very optimistic that we will be successful, but I have no time at all to waste as it will likely take us several cycles to conceive. We already have a DD conceived at first attempt at IVF (age 35 with AMH of 13).

I guess what it will come down to is just how much you want a second DC. If you're not really that fussed, then there's no harm in just carrying on naturally. If it would be a life changing disaster not to conceive again, then the IVF would be the best option really.

Thanks for the response West, it’s really helpful. The answer is simply that we aren’t sure we want to, and don’t have the money. Of course we would find it if we had to, but with a 5 yr old and being in two minds as it is, it’s kind of what will be will be. :)
Also of my 4 pregnancies, I got pregnant on first attempt, most recently last year. So I guess I think that as my problem is maintaining a pg rather than getting pg, that it’s not the way forward for us. I didn’t really spell that out to the doctor, but I don’t think ivf would reduce the mc risk?

The problem is though that the eggs with which you conceived were aneuploid, hence the pregnancies were non-viable and ended in m/c.

I'm not sure what your experiences were, but I have also had a series of early m/c, all 3 of which took at least 3 months to resolve and for us to be able to try again. For us (when I was 37), that was a worrying waste of fertile time, but when you are already in your 40's, you simply don't have that sort of time to waste.

A cycle of IVF basically gives you perhaps 6 months of trying in one go (assuming you produce 6 decent eggs). This greatly speeds things up and increases your chances of success - the aneuploid eggs will be unlikely to make good blastocysts and can be eliminated from the 'pool' thus saving you from another m/c

Its really not so bad either - the decision to start IVF seems huge, but once you get going, its really quite quick and painless (take all the anesthetic they will offer you!)

That makes a lot of sense thank you. I think I dismissed it without really looking into it. Hmmm more thought required.

The Problem with ivf with low amh is that you are less likely to respond to the drugs they give you and could end up with a very small number of eggs. I say could- it’s not a definite.

For what it’s worth- my amh was 2.7 when I was 34. I’ve had 3 pregnancies and 2 live births since then. One of those pregnancies was through ivf - and I responded really badly - only 2 eggs were retrieved, but 1 became an embryo and stuck! So it is possible.

For what it’s worth I’m 37 my AFC is 15 and my AMH is 23.7, have never been pregnant. I was told to commence IVF as soon as possible.

There are some good articles on natural fertility about low AMH and trying to conceive at 40. Also look into IVF overseas, facilities and success rates are better but a lot cheaper.

Thanks AniSL

Why has IVF been recommended for you AniSL, if you don't mind my being nosy?

Have you been diagnosed with DOR based on those numbers?

Hi OP

I had my AMH checked just after I turned 39 last year and it was around 3.9 (can't remember exact figure).

This was at a subfertility clinic after I'd requested a referral from my GP.
Plus my DH's sperm result had shown 1% morphology which apparently is pretty bad.

The consultant basically told us to self refer for self-funded IVF (we already have a child).

I then conceived around a month after that appointment and am now 18 weeks.

At the time of getting the AMH result I had googled like crazy to see what it meant in terms of our chances.

For context, my first two pregnancies were conceived v quickly aged 35 and 37 but the second one ended in MMC at the dating scan.

It had been over 1 year of TTC post MMC when I asked to be referred for further tests.

Sorry I can't shed much light on what the result mean but wishing you lots of luck on your journey

Hi Turquoise, that’s the kind of googling I have been doing! Your story is very reassuring. This weekend I’m still really wavering over whether to try again. Easter is my self imposed deadline.

In my opinion the amh test is most useful for ivf and seeing how you’ll respond to the drugs. I don’t think they know what’s its impact Is on natural conception. The main thing it tells you is that you’re running out of time- but that doesn’t mean you can’t get pregnant (unless there are other things going on).

I was told I needed ivf at 34 because of my amh result, so I did ivf and amazingly it worked. As soon as the ivf baby was 8/9 months old and my period came back we started trying naturally again. Mainly so quickly because I had been given the impression that it would be “difficult”.

I got a bfp 2 weeks later and now have 16.5 months between my 2 boys.

Could have been a total fluke I suppose, but there are a fair amount of stories like this around.

430West the consultants said my AMH and FC was at an optimum level for what they define as high success levels for IVF, I have been dumped in the unexplained category, DH is azoospermic also unexplained as all his other scans and tests came back normal too

With 3 miscarriages, have you had investigations as to why they pregnancies might have failed? Whilst it's true that the most common problem is dodgy chromosomes that can't make a healthy baby, about 50% of recurrent miscarriage is due to other factors, eg thyroid problems (and a long list of stuff but I'm no expert).

I think I'd push with those investigations whilst being super healthy (no smoking, drinking, exercise, 10 of your 5 a day, supplements etc). Also make sure that your husband is being just as healthy as sperm fragmentation is also linked to miscarriages. Supplements for him could be Profertil or Proxeed.

My consultant said that the combined evidence of my age (37 at the time) and the fact that I had previously carried a pregnancy successfully meant that there was around a 90% probability that the issue was chromosomally abnormal eggs.

Probably a good idea to have your TSH tested (ideally it needs to be under 2), but I have to say mine was perfect and still miscarrying on a regular basis...

AniSL, I don't want to derail the thread, but how have you been diagnosed with unexplained infertility when your DH is azoospermic? Surely that is the issue right there?

It sounds to me like you're perfectly fertile!

430West yes we have been diagnosed with male factor but it’s a bit strange as even though his diagnosis is azoospermic, the investigations for him show that everything is working just fine, no blockages, hormones all correct, they said they could not explain why he was azoospermic. In terms of me, they plonked me in unexplained because I’ve never had a pregnancy, this is despite me telling them that I never tried before.

Tbh I don’t actually think that all these specialists know what they are fully talking about anyway.