Amh and follicle count

[Blacksheep33]

Hi,

I was just wondering if anyone had experience of having a low amh but a high afc?

I’ve had one round of ICSI which failed. We have male factor infertility but I also have a low amh (about 5) which is probably due to the fact I had surgery on one ovary to remove a cyst. On first ICSI I had 8 follicles to begin (and 1 on the other ovary which never grew - I was told that surgery may have damaged that ovary). Of those 8 follicles we got 6 eggs, 4 mature, 3 fertilised and 2 put in on day 3. They looked to be questionable quality.

Anyway, we are now on icsi number 2 and at my baseline scan I was expecting the same sort of follicle numbers. But this time they counted 15 on one ovary and another 7 on the other (probably non working) ovary. Overall that was more follicles than I expected.

I’m on a high level of stims again due to the low amh but I wondered if anyone has any experience of having follicle count vary so much month to month? Or experience of whether follicle count at baseline actually means anything??

Hi, I haven’t had that experience but thought this study might be of interest.

I had quite a high AFC count (28) on my first cycle but only got 16 eggs, a lot is dependent on stim dosage and timing of trigger. Maybe discuss with your dr if they have a different strategy this time due to the higher number of follicles.

Hi @chillichutney1

Thanks so much for your response. The AFC was done at my baseline scan when they gave me the go ahead to start stims (I’m on a high dosage - 375 Menopur). The go ahead was given by the nurse and so I doubt my consultant will be aware that there is discordance this month.

I probably should have asked to see my consultant/have them informed but at the time I didn’t think much of it. I’m not worried that my starting dose is too high!

I have my first scan tomorrow (after day 4 of stims) so hopefully there is time to correct the dosage if needed.

You’re right though that more follicles doesn’t necessarily mean more eggs so I think I will still be a poor responder despite more follicles!

Whereabouts are you in terms of IVF? Was your first round successful?

That should read ‘now worried that my starting dose is too high!’

They should correct the dosage if need be after each scan, I used to get a text or email confirming which dose of menopur to take after each scan.

This was a few years ago now and I had 4 blasts all around 4BB/BC quality, 2 transferred and I got my ds and then the other 2 transferred after 2 years which implanted but were early miscarriage.

Going for second round now but expecting things to be very different at the age of 40! Good luck with this round, I hope it is successful

So I've not tried ivf yet. My AMH is quite low (10 to 12 ish). I've had two scans. On the first, I had 8 follicles, 4 on each side. On the second, 4 months later, I had 22 folllicles (12 on one side, 10 on the other). So my experience is that it can change randomly from month to month. Not sure if this helps because I have no idea why it changed! It makes me wonder if ivf is just a lottery ...

@Chillichutney1 - that’s exactly what I’m hoping, that they’ll change my dose if needs be. I should imagine that I will still need the high dose despite having more follicles this time! Have you started your second round yet? So nice to hear an IVF success story!

@RosettaR - it’s strange how much it can vary by isn’t it? I’m not sure if I should expect a better response on the cycles when I have more follicles. I think you’re right about it being a lottery though - so many variables! It’s such a hard process not to be in control of and feel like I start obsessing about every little thing!

Hi,

My AMH was 8.2 age 31

First ICSI cycle I had 450 menopur and got 29 follicles and 20 mature eggs - 14 fertilised but all died off by day 5 and transferred 1 poor qualoty embryo and none in freezer.

Second cycle had 300 menopur got 32 follicles, 22 mature eggs. This time we surgically removed husbands sperm to try improve quality - 13 fertilised. Transferred 2 day 3 embryos and froze 2 more. Gave birth to one baby who is now 14 months.

Interestingly - naturally conceived since then and 18 weeks pregnant now. Which we of course never thought would happen as they had to surgically retrieve DHs sperm to get any decent blasts!

Hi @Blacksheep33 my first round was similar to yours. AMH 5, afc 8, surgery with endometrioma on left ovary (although it wasn't removed). I got 7 eggs and 6 fertilised, 3 made it to day 5 but quality was low-bfn. I am 31. I was on 450iu menopur. It's crazy you had so many more follicles the second time around. How did you get on? Had your quality also improved? I hope you had a happy ending. X

Congratulations @hoping2018 conceiving naturally now would be the dream. X

Sorry to hop on the bandwagon girls but you seem to have some experience. So far I have only had the tests leading up to IVF and on my letter is said I had an antral follicle count of 34 (so this is a natural count, no stims or anything). Is that too high?

I have no idea about it or if I had a reserve count or anything done and haven't had things explained too well

Hi @spyroC, my second round was much better in terms of numbers - more follicles grew and they targeted 10 follicles. 10 eggs retrieved, 9 mature, 7 fertilised. 5 were high grade at day 3 but by day 5 we had only one good quality embryo - 2 others had made it to blast but weren’t good enough to freeze. The embryologist did say that she thought ours might be a sperm quality issue that caused poor embryos though as that’s our main fertility problem.

The one we had put back in resulted in a positive test - currently waiting for the viability scan so really nerve racking times.

What all this has taught me though is that there are so many variables and it really is a lottery. Wishing you the best of luck! Xx

Congratulations @Blacksheep33 that's great news. I hope the viability scan reassures you. You're right it is a lottery, a very expensive and emotionally draining one! Fingers crossed my second round goes better too. X

@willithappen sorry I don't know much about high counts as I have the opposite problem. The AMH is a blood test. 34 does seem high for afc, I hope your clinic explain things to you. X

@willithappen
Do you have an update at all?

I’m in the exact same position as you were at the moment. We recently went to a fertility clinic to discuss freezing eggs and trying one cycle of IVF. We have been trying for a while and I’m 35 so I would feel better about trying naturally if I know the eggs are there if we need them. My AFC was 34 as well, the specialist said I’m at a high risk of ovarian hypersensitivity syndrome.

@Gardenlady543
Hi, sorry no update here. Covid well and truly got us so since that last appointment I had a few cancelled, eventually got video appointment in May to be put on waiting list and been told I likely won't be contacted until March next year :(

I did ask my doctor about the antral folicile count mentioned and it said it was fine and was a good thing. I had concerns about it making me high risk too but it seems like they aren't interested in me at all until I get to the top of the waiting list.
They are prioritising those aged 40+ at the moment.
We first went to GP in Oct last year so it feels like a very long drawn out process

Hi guys

My AFC and AMH was high - AFC was 43 and AMH 65.7 so I'm on the borderline of PCOS. All my consultant said was that it's positive in terms of I should respond well to treatment and will be on short protocol but a bit higher risk of OHSS so will need to be carefully monitored. Although they carefully monitor you anyway!

@willithappen I’m sorry to hear that, thanks for the update, I hope you get seen soon.

@mf1981 thanks for the reassurance :) the specialist had said something similar to me, that she would use the lowest dose and didn’t seem that worried, so hopefully it will be ok. I was doing some reading about OHSS and in its severe form it can be awful so I’m glad the specialists don’t think a high AFC will be too much of an issue.