High amh (48pmol) - could this be an issue?

[Bluebells1983]

Hi all,

We have been ttc for 18 months and have had blood tests, hormone and sperm tests all carried out. The main issue we seem to be facing is male factor and that is very much what we have been focusing on improving for rhe past number of months.

My hormone levels look OK, and amh is 48pmol which the fertility clinic was pleased with, but I just wanted to check if that level is problematic for natural conception and the clinic were only pleased from the perspective that it means I will react well to drugs. I don't have any other symptoms of pcos and have regular periods so have been assuming that I do ovulate every month.

I jsut wanted to check if anyone had any exoerience of a similar level of amh and got advised to try any particular supplements/drugs to aid natural conception? I jsut want to do all I can to help natural conception before going to treatment.

Thanks

Hi @Bluebells1983 I was waiting to see if anyone else came by who was in a similar situation, I know that those with PCOS often have a high AMH but it's not a part of the diagnostic criteria.

You generally need 2 out of 3 of:
-Clinical Hyperandrogenism/Biochemical Hyperandrogenism (Elevated Total/Free Testosterone)
-Less Than 6-9 Menses per Year) or Oligo-Ovulation
-Polycystic Ovaries on Ultrasound (>= 12 Antral Follicles in One Ovary or Ovarian Volume >= 10 cm3)

I ended up in a similar kind of situation to you as my AFC is a huge 34, I have no other features of PCOS though. And I had a very good response to stims. I do have a friend with a similar AMH to you when she was 40, she conceived naturally the next month and then conceived her second child at age 44 without an issue. How old are you by the way because the AMH normal range varies by age.

I don't think based on the AMH alone anything in particular can be recommended. And if the issue is MFI then looking into what can be done for that will be your nest option. You may want to get an US as the last part of the work up if you haven't already and see what your AFC is
and have a think about your options.

In my case I have recurrent implantation failure, I produced high rates of high quality embryos in my fresh cycle but have never had a BFP. Anyway I've been through a few months of tests and was found to have some issues. Unfortunately investigations for these issues don't happen until a few unsuccessful transfers. So I would get the US and consider your next steps.

Hi @Gardenlady543,

Thanks so much for your response, and I am sorry to hear about your difficulties. This whole process seems to be a lot of trial and error for a lot of us.

Sorry, I should have said I am 38 at the moment and have had an ultrasound which showed about 20 follicles on each ovary, so total of 40. I am encouraged to hear about your friend, thanks for letting me know. I'm just getting frustrated and impatient with all of this and want to make sure that I look into any potential issues that there is as soon as I can. But I don't have any of the other pcos symptoms so should probably stop worrying myself about that.

Yeah we have been focusing on mfi since the start of this year, have seen Mr ramsay, husband has been on antibiotics and also on cordycep mushrooms now. So we are trying to just surrender to time for a few months now and hope things improve at his end. We will get him tested in the next couple months if we have no joy before then.

Really grateful for your response and all the best with your investigations, hope things work out well for you.

Hi @Bluebells1983 oh that's interesting, I have 17 follicles on each ovary, so you're pretty close to me, but my AMH was 17.4 (I'm 35). If you have regular cycles and your hormones were fine then I really don't think there is anything more you can do from your end. You should be producing a good egg in your cycles with so many follicles for your body to choose from, so if your partner's spent numbers can improve hopefully things will happen. You may want to put a timeframe on how long you'll try for before you look into IVF though, because time goes so quickly in this process and I'm sure you know that the chance of a genetically abnormal embryo increases as we age, meaning that IVF can be more difficult the older we get.

Yeah that is pretty much what we have been doing trying to get his sperm improved and keeping the fingers crossed. Yeah we are going to look at ivf early autum if nothing happens over the next few months as don't want time to keep slipping by.

That sounds like a good plan @Bluebells1983 I think we may have been on similar timelines, as me and DH started TTC in October 2019, so I know that it feels like forever. Have you looked into a NHS referral in your local area, I didn't want to try for the length of time required at my age so have self funded, but you would have been trying for about 2 years when autumn comes.

Similar to what @Gardenlady543 said, I would also suggest getting a scan to check your AFC @Bluebells1983. I’m also 38, AMH 36/AFC 28 at last check. It’s not a bad thing, you should respond well to stims and have lots of eggs, all being well.

Hiya
@Gardenlady543 yeah my gp was v good and referred us last year but with covid we have only had our first consultation with the NHS doctor and aware that even once they say we are recommended for ivf/icsi it will be another year of waiting. Based in Northern Ireland and the wait times are awful at the moment. So have been to see a local private clinic too and keeping it as an option.

@thislittlebird thanks for response. And yeah I have already done the afc thing and it's 40 so just gonna focus back on improving sperm. But it's good to hear that the afc should yeild a lot of eggs, will be a good start!

@Bluebells1983 the only other thing to mention for IVF is that those with a high AFC are at risk of OHSS, for this reason I was put on low dose stims, I was brought in for my first scan earlier and has oestrogen levels closely monitored and only needed 8 days of stims. I still did very well, I ended up with 12 eggs and 9 blastocytes. I didn't experience OHSS luckily. Probably something to discuss with your specialist if you go for IVF in the future to make sure they put all the precautions in place. Good luck with it all

Sorry @Bluebells1983 I thought you said you had done AMH but not AFC, must have misread. As gardenlady said, OHSS is the key thing, I’ve just started the same conversation with our ivf doc (private at present because the nhs rejected my husband’s low motility as an explanation) and found it reassuring to hear them talk about lower doses and trying to get quality over quantity etc.

Thanks to you both. I have been aware of the risk of ohss given the high amh and afc, and was definitely going to raise it with my doctor when we get to that stage.

Appreciate all the advice and guidance on this 👍👍

@Bluebells1983 Hi there. Can I ask which clinic you went to? I'm based in NI as well and have been to Belfast Fertility Clinic, but now with In-Ovo as had some issues with BFC.

I just turned 40 this week. My AMH is 32 but BFC didn't note my follicle count on scans last summer (helpful!). I am not ovulating and was put on Clomid and got pregnant quickly but had a MMC in Feb of this year. Had consultation at In-Ovo last weekend and the consultant said that my AMH is indicative of PCOS. Also, I've been bleeding since the MMC and so he thinks there may be some retained tissue. I'm due to go back for a HyFoSy in two weeks to check for retained tissue and also AFC and to confirm if I have PCOS. We were referred for IVF a year ago as an urgent case with NHS and still not appointment in sight!

Just interested to see which clinic you've been to and how you are finding it.

The NHS wait times are a joke over here. I am with in ovo, and so far an happy enough. To be honest we aren't that far on in the process. We went for a first consultation back in january, I got my amh taken at that appt and a hyfosy a couple of months later. It was fine and I feel pretty well informed by them with it all, he talked to me a lot during the hyfosy to show me on the screen what he was talking about. Male factor has been our issue so far, the clinic seems to think there isn't much you can do to improve it, but I wanted to try a few different things before jumping into icsi. So that is what we are doing at the moment. Due to go back to in ovo mid August after my husband has another sperm dna test to see if things have improved and discuss the way forward. This wil be our first try at ivf so have nothing to compare it to, but so far I feel happy with their approach. He didn't rush us into treatment, which I liked. And he has always called me when he said he would. The guy on the front desk seems efficient and helpful now too as well.

Hope it goes well for you with them

Also I think if you go onto the regional fertility centre website they have estimated dates for when you will be called for treatment based on when you were referred for ivf. We haven't been referred yet, and have been told the wait will likely be a year once we are. But maybe you arent that far off.

@Bluebells1983 Ah, I see. Yes, we found him to be very informative as well, and not pushing us into IVF either. Our options are injections or IVF. As well as my lack of ovulation, DH has low morphology (2%). So we are going to just go for IVF. He said that after the HyFoSy we can start airbag straightaway so hoping there is no retained tissue as that would slow things down.

I must have a check at the wait time out of interest. I was told by my GO last June that it would be 4 months but nothing at all.

Yeah we have low morphology too and high dna fragmentation so want to get that down before going for it and keeping fingers crossed that it does go down. We are doing Chinese medicine in the hope that it might help.

Worth checking with gp too though in case it is anytime soon you are due to start.

The whole thing is such mental torture at times.. Just trying to remain positive.

@Bluebells1983 can I ask what his dna frag was? I’m dreading getting the results for my husband’s anticipating it being bad.

It was 48% back in February which is pretty bad. We went to see Dr Ramsey in London and he was on 2 weeks of antibiotics for a suspected bacterial infection and also been on the Chinese herbs. Will get retested at end of July and hoping for an improvement.

I have read a lot of places where people were able to improve it a lot in a matter of months so just praying we are the same.

@Bluebells1983 yeah we saw Mr Ramsay recently, waiting for the results and hopefully will have them at the end of the month. He has a small varicocele and I’m concerned about the cost of private surgery for that, hoping it’s too small to be the cause.

I’m so worried about ICSI failing. We can’t afford to keep paying for endless rounds of ivf so I’m hoping we can improve it a bit before we start. The NHS have been very unhelpful and I’ve now logged a formal complaint because they claim we’re unexplained despite his problems, and if we could get our one round we’re entitled to I could breathe a little easier about the cost of private if we have to have multiple rounds.

@Bluebells1983 I hope you don’t mind me asking, did your husbands dna frag improve following antibiotics?

We are a week away from finding out if antibiotics will have made a difference to my OH. He also had a bacterial infection. He’s also taking 3 months of anastrazole in the hope it will improve his count. it’s an anxious wait.

Hiya @Halftime23, funny you ask, we are getting the results at the end of this week. He was only on them for about 2 weeks in May, but we thogght we would wait a couple months before getting retested. It is an anxious wait, but I will let you know.

I am hopeful and fingers crossed for you too x

@Bluebells1983 I’ll be keeping fingers crossed for you both.
My OH had a week of antibiotics and was only
5 weeks through the anastrazole when he had his DNA frag, so hoping it will have done enough for us to know it’s working and that we can go ahead with ICSI at the end of Sept.

Hi ladies , I was just wondering if you could post an update with how you got on . I'm in n.i also and would really like to know about your experience with the clinics here

@MK85 we went on to have ICSI with the Lister at the end of September 2021 and our little boy turns 12 weeks this week. We were very very lucky that it worked first time. We have no idea about whether my husbands DNA frag motives because we never tested it again, but they managed to use a fresh sample on the day of egg collection and we managed to get 3 embryos on day 5, one of with us our little boy.

Motives = improved sign

@MK85 we started our only round of nhs funded ivf in January/February. We made 4 embryos, with low motility issues and low vitality and my amh (36 last checked, I think). We’ve transferred two embryos and had two BFNs. Last two will be transferred on Sunday. Assuming this won’t work, we’ll be moving to private with Lister in the autumn.