AMH declining rapidly - panicking!

[hellotesting123123]

Don't really know why I'm posting, as I'm sure you can't give me reassurance, but need to vent somewhere! I also think maybe I'm panicking too much and need a bit of calming down.

I'm 36. Single (well, a month into dating someone who is lovely and wants kids, but it's going to be a while before we're ready to conceive!)

Have done two egg freezing rounds this year, one when 35 and the other 36. 11 eggs each time, so 22 in total. Have a third one coming up - I wanted to get 30 as there's an online calculator based on lots and lots of data that shows that at this age, having 30 would almost guarantee my chance of a live birth (and give me a good chance of two).

I've had my AMH measured each time I freeze, and once last year. Started at 26 last July, which is very good, then the next test I got in Jan this year was around 33 (in another lab, and i'm aware they can use different ranges etc). Then, in August, did another and it came back 23. Doctor was worried and said that if it really had gone from 33 to 33 in 8 months that would suggest my fertility was 'falling off a cliff'. Had another test last week, this time using the original lab to see if there had been anomaly with the second, and it's gone down to 15.5 - that's half of what it was just over a year ago!

I'm worried that a) I'm not going to be able to conceive naturally now (my preferred choice by a long run!)

and b) that i'm heading for early menopause if my reserve is going this fast.

Has anyone had experience with this? I'm in a massive panic and also convinced that none of the eggs I've frozen will be viable.

Thinking of paying for ANOTHER round - that will be four in total - and doing frozen embryos as another back up plan, as who knows what will happen with this guy (altho things look promising). Always wanted to do this with any eggs I got over 30 anyway, but doubt I will get this amount now with my final round and the sharp decline.

Was just sent the result via email yesterday, and having an appointment on Tuesday. Please send comforting stories in the meantime...

I know it's about quality when it comes to natural conception and quantity isn't as important, but I'm just worried that I'll have no eggs soon.

Most clinics just use AMH as indicator of response to medication rather than prediction of how many eggs you'll get. I did 5 cycles of IVF in 18 months and they said there was no point testing AMH after the first test.

What I would also say is that it was clear after 5 cycles in a relatively short period of time that my body was just bloody knackered (I was age 36-37 when I did IVF) and it became harder and harder to produce the same numbers of eggs and the same quality it had done before

If you think of it this way - your body has been forced to produce almost 2 years worth of eggs in a couple of months

AMH is made in primary follicles that advance from the primordial stage. AMH is highest in pre antral stage - if you are "using up" a huge proportion of these follicles in 1 egg collection it follows that your AMH on subsequent blood draws would be lower as you have fewer antral follicles around? (As those ones most likely grew as part of the egg collection medication)

So in a nutshell I wouldn't worry about it too much! Your body probably just needs a bit of time to replenish/rest? There is a larger drop off when you freeze eggs vs embryos as you just won't know the fertilisation ability/quality until you've fertilised them. I'd say do the 3rd egg collection and then have a break. You are still relatively "young" in IVF terms (that's what I was told by my IVF clinic at age 36!) so you could then have a break for 2 years and if your relationship with this chap stands the rest of time then you can always try fertilising then?

Thanks @ivfbeenbusy, you were indeed busy! I hope that things are going okay?

I really like what you say about the body 'using up' that energy and the follicles. However, I thought that your body would have lost these follicles anyway, as they sort of get shed when one is picked? So the ones in your ovaries at the beginning of the month are new?

However yes, maybe body is tired!

Hi I’m sorry I don’t have much advice but I’m in the same situation. AMH has dropped rapidly from 25 to 17 to 8 Between 2018 and 2020. I’m 34 now.

My consultant said it was indicative of diminishing ovarian reserve and to test for fragile x as DOR is a symptom of it if there is no other family history of infertility as if I was to have a son he may have severe behavioural issues. So it could be worth getting that test just in case.

My consultant said the best thing to do was embryo banking for a few rounds (I’m doing ivf for male issues unfortunately And I’m responding v poorly) so you are doing the right thing in freezing eggs. Better to have found this out and be proactive rather than finding it out when ttc down the line. You do have a lot of eggs frozen there and while I know a natural conception is the ideal trust me you won’t care if you’re a baby in hour arms. It could better worth getting some counselling as it’s a horribly stressful thing to find out when you think everything would be ok. I am starting counselling next week.

Contrary to @ivfbeenbusy I was told I needed to keep testing it every six months to give me an idea of how soon it’ll be until I hit likely early menopause and to get an idea of how quickly it’s declining to further inform what to do.

A natural conception is also still possible for you - it only takes one and decreasing rapidly over the next few years don’t mean nothing left.

Good luck and mind yourself.

It's my understanding you don't "lose" the follicles each month. You might have an antral follicle count of say 15 one month (measurable follicles on an ultrasound) but the body only selects 1 or maybe 2 as good enough that month to grow to make a dominant follicle to ovulate and release in a natural cycle. The other 14 follicles don't all "disappear" they just wait in the wings until the body thinks they are good enough to become a dominant one?

But with IVF the idea is to force all 15 to grow for collection at one time

I've known plenty of people whose AMH has fluctuated up and down depending on circumstance

It's the antral follicle count which is more important as an indicator of how many eggs you are likely to get in a given IVF collection

thanks @ivfbeenbusy, that's reassuring...

Hi, I hope you don't mind me asking but how much has each round of egg freezing cost?

I'm 40, and have had an initial scan and have an antral follicle count of 10. I am little confused if is this my AMH? I also have 15 p/mol.

My consultant seemed quite positive about these figures for my age, but I am painfully aware that at my age egg freezing is a gamble. The figures for one clinic seem to be around 12k for 3 cycles (including, from what I can work out, everything) or 18k at another clinic (also including everything).

It seems hard to work out the costs and like you I am on a bit of a timescale because of another medication I need to start (and would have to come off for pregnancy).

I am single so can't think of conceiving for 12 months I think. A sperm donor is not in the equation for me.

I am also a little confused what happens if/when you thaw the egg. Am I correct that it would be fertilised into an embryo then artificially implanted, if you were trying to get pregnant? I'm not completely sure I understand the difference between this and IVF, other than IVF costs more.

Wish you success

I had my AMH taken just before my second ICSI cycle at 37 and it was 13- consultant said it was a bit on the low side and I only got 2 x embryos but the cycle gave me DD.

To give you some hope, I have just had a natural conception at 40. Still early days yet but it does go to show that you can conceive naturally with low AMH. I don’t know what my AMH was at 40- never got chance to get tested. But I imagine it was less than 13.

Best thing is to focus on egg quality over quantity and there are resources out there to assist with this.

Honestly I wouldn't stress about amh too much. I had mine checked over a year ago before my first ivf and it was 6. At the age of 30 that's very low. I still managed to get 10 eggs but only 2 made it to a 5day blast to transfer back, neither great quality. I've just had my second round in August (no recheck of the amh because I was on max drugs regardless) and I got 16 eggs and 5 really good embryos. 1 of which I got pregnant but miscarried and 4 that are waiting in the freezer. I really wouldn't stress about amh, it's meant nothing to me!