Drastic changing AMH

[2mumlife]

Hi everyone,

Does anyone have experience / knowledge of why AMH will vary quite drastically?

My AMH was tested last March as 18.8. I've just has results back from a retest, which has come back as 32.3.

I'm not sure what to think, as my response to IVF drugs (in Feb/March this year) was awful (we only got 4 eggs, 2 mature eggs) so I can't understand what is going on when they are now saying I'm at risk of an "excessive" response to IVF drugs, but I was labelled a "poor responder" after our first IVF attempt!?!?

Any insights appreciated, as I'm really confused about what, exactly, is going on

Hi @2mumlife I remember back in May you mentioned having ovaries that looked polycystic in the last and longer cycles, but that PCOS had been ruled out. PCOS can cause a high AMH, I don't know the ins and outs of it, but that's the only thing I can thing of.

I'm not sure AMH is really that relevant anyway, the many thing is what the AFC is because that's going to determine the response to stims.

@Gardenlady543 Hi :) Yeah had a scan in my early 20s where they they'd said ovaries had polycystic appearance, but my various scans doing IUIs/IVFs have never shown that many follicules (exceot maybe the IVF round where I had lots of small follicules). In the IVF round they say 7 "follicules" that were bug but my estrogen levels only suggested 2 or possibly 3 eggs, and we only did get 2 mature eggs (and only 4 eggs in total) which does make me think now maybe some of those "follicules" could have been cysts. My clinic have never actually given me an AFC number - when I asked for this I was given my baseline scan report but that only says no follicules were bigger than 9mm not how many there were, and my clinic doesn't regularly do baseline scans (my only baseline scan was taken at my first IUI).

@Gardenlady543 How are you?

Hi @2mumlife - I also had quite a different AMH level over a year, from 5.78 to 11.3... the only comment I got was that maybe it was due to a hormonal imbalance as my TSH was pretty high last year and is now at a good level as I take thyroxine. Have any other values been tested and shown quite a difference maybe?

I'm afraid I have no idea about poor vs excessive response as my levels are always low, but my clinic confirmed what @Gardenlady543 said, that they go off AFC (that has always remained quite stable in my case - always 9-12 follicles over 4 different scans over the year).

I hope you're well and having a nice weekend :)

Hi @2mumlife I think for your next egg collection cycle your clinic need to make sure they have you on the right protocol, they'll need to be clear about the AFC to do this. Have you got an appointment booked in to discuss the results of the tests you're having now and what will happen next?

I am ok, well as ok as any of us ever are in this journey! After the 3rd unsuccessful transfer I asked to repeat the EMMA and ERA, before doing that I asked for a scan in my natural cycle, my specialist then called to say the lining looks thin at the bottom of my uterus and this has been an issue throughout my treatment, she mentioned a hysteroscopy, we had spoken about this before and I has been hesitant, you only need one if there is a reason to do it. I had previously seen as a specialist in London about Ashermans syndrome and it was ruled out after a HSG. But he has agreed to do the hysteroscopy on Tuesday, it will either be reassuring or it will find something that hopefully he will treat like adhesions.

Meanwhile I'll be having an NK biopsy this cycle, there is no evidence for this stuff, but since I've done everything with evidence what else can I do. Then I'll do the ERA and EMMA after. Once the hysteroscopy, NK biopsy and ERA and EMMA are done, that's it, there are no more tests, it will just come down to repeated transfers.

@beachbum85 Thanks for sharing your experience. My TSH was tested last year and was 0.93 so I don't think thats an issue for me. They've only retested my AMH nothing else.

@Gardenlady543 Plan from my last review appointment was that as long as my AMH was above 8.3 still to move me to an antagonist protocol, with high does FSH and push me for longer (so let follicules grow bigger than 18mm before trigger). I've been trying to get one of the nurses to call me back since Saturday to confirm next steps.

Sounds like another delay for you doing these various tests. I hope they're able to give you some answers. Best of luck for Tuesday!

@2mumlife you're very welcome. Glad to hear your TSH is fine and I hope you get to the bottom of it... it's tough enough as it is without the additional confusion... and I really hope the nurse gets back to you soon! xx

@Gardenlady543 good luck for today!

Hi @2mumlife,
Did you get more info about the AMH?
I myself have never had it tested, here in NL they don't check any hormones at all which I find disturbing as I know at least my TSH should be controlled. Last time I had it checked it was 3.

I got myself 2 appointments with clinics abroad, and the one in Czech Republic want me to get the hormones checked before it. Looks like they try to tailor the scheme to the person unlike here...

On another note, I have had a FET and got positive tests from the day I started testing (day 7), and day 9 was the official testing day, but the test line is just faint and they told me to test again in 2 days. Tests on day 10 and 11 are fainter than 8 and 9 and I am just so sad...

@TheDutchess3 Not not really got any more information about AMH other than it can vary. Have you had AFC instead of AMH then? Interesting how much things vary. I'm sorry to hear about your latest news. I had a chemical pregnancy with our FET, and its tough after the excitement of finally getting a positive test for the spark of joy to be gone so soon. How have you found using clinics abroad? I guess that would really be our next option if this final IVF cycle doesn't work out for us.

@beachbum85 Not convinced we'll ever get to bottom of it. Clinic confirmed we can move to an antagonist protocol (sadly with a mandatory freeze all) for next cycle, and they don't want to retest anything else or do AFC, so starting Nothisterone in 2-3 weeks at the end of this current cycle and start stims with next bleed. There is a bit of a debate about my FSH dosage, as nurse said I'd be on 150iu a day, so I queried this with the consultant saying they'd have my on 300iu a day at our last consultation, so still waiting to hear back about that.

@2mumlife,
Indeed, so many differences per clinic/country.

At the start of my treatment a year ago I had an ultrasound where they said the ovary reserve looked normal and it says 10 and 12 follicles per ovary in my file. I have read an ESHRE report and I think it indeed says AMH can only be used as additional information but AFC is more important.

Sorry to hear about your FET too...How did you find out it was chemical? My clinic doesn't do HCG blood tests... It is so disheartening and the worst part is always this "unknown". We are just hoping and always waiting and are never certain in anything along this IVF journey.

As for the clinics abroad, I have been reading and following some IVF doctors in different countries for a while (in instagram), comparing their approaches and reading reviews and assessing whether they base their treatment on evidence-based medicine or not. Eventually I narrowed down to 2 (also keeping travel distance in mind): Ghent in Belgium and Gynem in Prague. The last one offer IVF package for 2400 euros and I got a recommendation for their best doctor and they were able to find an appointment in a very short time while the Ghent clinic in Belgium has me scheduled for the end of December... So if I decide to go I am likely to end up where there are no waiting lists. We all know time is our worst enemy and I am already super impatient after all the previous delays in the treatment process.

Hi @2mumlife

I think I read somewhere recently that an ovarian cyst can cause an increase in AMH and as you have a history of this I’d be tempted to ask for another scan or insist on a baseline before you start stims to check. (And while you’re there you can ask the nurse to tell you how many follicles you have as she scans you).

While AMH can vary it’s usually only by a few points either way, as yours has gone up quite a lot it’s definitely worth investigating IMO.

As far as I know, it’s not uncommon to develop a cyst after IVF and if there is one there already, it might be better to sort it out before you go into your next round.

Also I’m sorry to hear about your chemical, and for others that have suffered losses, it’s a cruel bloody roller coaster this IVF business!

@TheDutchess3 I had the hcg blood test (which is standard at my clinic) which confirmed my hcg level was lower than should be expected, and a repeat blood test few days later confirmed hcg was decreasing and it was a chemical. But I sort of knew before that as I started testing positive from 6dp5dt and the line never really got darker. I'd be interested to hear how you get on and find scheduling with a clinic abroad. Interestingly, I ended up having a chat with consultant on the phone yesterday and raised the AMH / AFC issue, and he said AMH is a better predictor of response, and that AFC can't predict the follicules recruited (i.e. its not necesserily the follicules they can see at baseline that are recruited for the cycle). So all quite interesting.

@RiverRiot Thats interesting. My clinic don't seem concerned at all about just going ahead with next cycle. I have toyed with the idea of going for fertility assessment type scan at place nearby that does private baby scans, but I think it'll just end up making me worry more.

Chatted with consultant yesterday as they phoned to discuss FSH dosage, so because my AMH has gone up they have concerns about OHSS risk on a 300iu dosage, so they're going with 225 now.

@2mumlife
Yesterday I asked my clinic to also do the blood test as my home tests were darker on days 8 and 9 but fainter on days 10 and 11. So today I had my HCG tested, and they confirmed it’s too low for the normal pregnancy (it was 25, 12 days after the transfer). And morning urine test was also fainter… They asked me to repeat the home test in a week to confirm HCG is no longer detectable and we will see from there.

What did your clinic say about the next steps? I mean chemical is better than BFN as it means we can get pregnant, right? We have a male factor but I was also starting to doubt myself, implantation window, etc. But an attempt to implant means everything is probably OK and it is chemical because of the embryo, right?

@TheDutchess3 You sound not disimilar to me, my first hcg level was 22 I think. Mine came down really quickly, had dropped to nearly nothing 3 days later which is when I stopped luteal phase support, and period came not long after. That was my first BFP (on attempt #6 - we'd had 4 IUIs and 1 fresh tranfer before then FET) so they just said it was an optimistic sign I could actually get pregnant, and as its such a common experience they wouldn't investigate further unless we had repeated early loses.

@2mumlife thanks for sharing!

I had my 2nd covid shot on day 9 after the transfer when the line was most vivid, and the next day there was a significant drop in brightness, so now I can’t but think whether this could have also played a role…

I have had 2 IUIs, 2 fresh transfers and 1 FET and also the 1st BFP for me. I try to look at the positive side but I am also so so sad. The first 3 days when the test line was getting darker I was so happy…

@TheDutchess3 It's really tough when you finally get that BFP to be told it's not going to progress. I did my first covid vaccine day after they told me to stop taking meds after the chemical. I'm due my next 1 day before I start next cycle, so going to do what I did last time and wait for the end of the cycle, particularly as it has to be a freeze all anyway, just in case

I know this is an old thread but the same thing has happened to me. My AMH was 1.0 pmol THREE YEARS ago and I've just had it retested and it has come back at 2.0 pmol. Obviously my egg supply has not miraculously increased in that time so it's left me wondering just how accurate this test actually is and I'm clearly not alone!

@AMHquestions this has given me hope, my AMH has just come back 0.7pmol. Do you have any idea why yours has increased and have you had an AFC count?

@Rosyrose1 I haven't had an explanation as to why it may have increased, I'm not doing anything differently. I haven't had my AFC checked recently but the last time it was checked which was shortly after the 1.0 AMH result it fluctuated between 2 and 5 in total. Just to also mention I did have successful IVF shortly after receiving that 1.0 result.

@AMHquestions These tests seem to be quite hard to interpret, my AMH was 0.7 with an AFC count of 5 which doesn't quite match up, so I'm hoping that my AMH will increase magically too, as I've been told that with current levels I'd only have a 10-15% chance of success with IVF and a fairly similar figure with natural conception. Congratulations on your success ☺️

Interesting… I’ve just done a 2nd test else where and my levels have increased significantly! I just thought maybe the first test is wrong as little evidence to show the levels increase with time. Tests are over a year apart. I’ve had two ERs and 1 ET since…

however, I have gone from 25mg to 62.5mg of levothyroxine…. Maybe that has something to do with it?!