Dramatic Drop in AMH Levels

[grcrobbo]

Hi all,

I am reeling from an awful phone call with the nurse at my clinic yesterday and was wondering if anyone else has experienced a dramatic drop in their AMH since starting IVF?

I first had my levels tested in September 2020. AMH was 10 and follicle count was 17.

We had our first retrieval April 2021 - 8 eggs retrieved which was a bit disappointing. Total follicles seen were between 12 - 16 but only 8 big enough to contain mature egg. 5 blasts, 2 passed PGD/PGS testing. One missed miscarried and one BFN.

I have just had my AMH levels checked again on Friday and was told yesterday it was 1.3. They couldn't do an accurate follicle count as I have a cyst following my failed FET but they could see about 8 follicles in addition to the cyst.

I am absolutely horrified by a drop from 10 to 1.3 in just 18 months. How has this happened?!

Since March 2021, I have been on/off various IVF meds almost constantly - prep month, stims and egg retrieval, prep month, ERA cycle, prep month, transfer (successful but ended in mmc at 8 weeks), 2 subsequent medicated transfers cancelled due to lining issues (Nov 2021 and Jan 2022), and now a modified natural transfer in Feb which completely failed and has given me a cyst.

Could all of the above have impacted my AMH? The nurse didn't think so. I am so upset and don't know what to think.

Please help :(

Hi @grcrobbo, sorry to hear what you’re going through. I don’t know the answer to your question about what could have caused it but I suffered a similar decrease in the 11 months between having our fertility tests and starting our first round of IVF so I know how devastating it can be. My consultant said such a dramatic drop is unusual so he would normally suspect one of the results was inaccurate. My response to that first round of stims was consistent with the lower AMH so I didn’t see any point in retesting as I was fairly sure it was accurate. You responded pretty well in April 2021 so while I don’t want to give you false hope, it may be that your latest test was inaccurate. Even if it is accurate though, it’s not the end of the road, you just need to be realistic about your chances of success. So if you’re 30 but have the AMH of an average 40 year old, you should look at the IVF success rates for 40 year olds and base your expectations and decisions about next steps on that, rather than the success rates for your own age group.

I would say that the AMH was reading an error or has been skewed by the constant ivf medication over the last 18 months - you don't normally get a follicle count of 8 with an AMH of 1? I did 5 rounds of IVF in 18 months and 4 transfers and my AMH dropped from 12 to 1 but this was supported by the follicle count - I was getting 12 follicles in the first cycles and could barely manage 2 by the end

Thank you both so much, it’s really helpful to hear your replies. I did suspect it had decreased as during my natural modified transfer cycle in Feb 2022, they only counted 8 follicles which was a shock to me. I didn’t ask whether it was 8 measurable follicles, or 8 in total. Either way, I would hope that this would indicate my AMH is better than 1.3?!

It’s interesting to hear that yours did decrease quite significantly in a similar time period @workingmomlife. I actually just didn’t think it could/would drop so fast. I’m sorry this has happened to you too.

I’m 35 now and doing IVF for genetic reasons so every egg really does count so this has come as an awful shock. Not speaking to doctor until next week so just left to worry.

Thanks again. Xx

@grcrobbo your AMH and follicle count don't seem to match ie your follicle count is better than your AMH level suggests so the AMH result might not be accurate. My AMH was 1.0 and my follicle count was 2.

@MabelG thank you so much. I am clinging on to that hope. X

@grcrobbo I am sorry for all you're been going through. IVF is such a weird time. I don't think the fertility meds affect this but I'm no doctor..

Hi,

Came across this thread as I also saw a dramatic drop in my AMH levels in just over 18months. It dropped from a 9.2 to a 5.1. We were planning on starting IVF (ICSI) because of male factor infertility so having this thrown into the mix has really upset and shaken me. Our dr recommended that DHEA could help? I am turning 36 this summer and panicking that if we wait another 3+ months for the DHEA to kick in, my AMH may have dropped further. We are scheduling a meeting with our dr to go over things as we just found out about the results this morning but I was hoping someone here might have some similar experiences that they would be willing to share?

My amh was 5.1 at 34 when I started ivf. My follicle count was always around 10-15 which was higher than you’d expect with an amh of that level, so I have personally found that follicle count is a better indicator of response to ivf medication than amh (I produced 10 eggs on that round and had 1 embryo to transfer on day 5 which was successful).

When I went for ivf again 2.5 years later I didn’t re-test my amh (it would definitely have dropped dramatically) - my clinic felt that it wasn’t useful to test as (a) I was already on a high dose of Menopur and (b) follicle count is a better indicator. My follicle count had dropped to around 7ish. I had 4 eggs retrieved, 2 fertilised and 1 embryo on day 5 which I had transferred and am currently pregnant.

A couple of things I would say which I hope are of reassurance to you:

1. amh levels aren’t the be all and end all. They tell you how much drugs you’ll need and tend to correlate with how many eggs you’ll get (but as I say, follicle count tends to be more reliable)
2. I also had ivf primarily for male factor (although low amh thrown into the mix!). Trying to improve sperm is key as no matter how many eggs you get unfortunately the sperm may not be good enough to produce a good embryo - icsi (or IMSI that we had) is very useful in this regard
3. everyone said it to me and I hated hearing it but - it does only take one! I had 10 eggs on round 1 and only 4 on round 2 and both resulted in exactly 1 blast. Not good on paper but both took
4. I was never prescribed DHEA but have heard lots of people who have. I wouldn’t think that a few months will make a huge difference to amh/follicle count - but I do understand feeling like you want to get started asap
5. I think taking a high (400mg or more) dosage of ubiquinol helped me (a pure form of cq100)
6. my husband had a variceole embolisation between rounds 1 and 2 which could explain the better conversion rate from eggs collected to number on day 5. Or not. We’ll never know! But I would say improving sperm if it can be done is key.

good luck!

@Daphnaki mine dropped from 5.7 to 1.0 in the space of 18 months. That was 3 years ago. However I just had it retested and it is now 2.0. What that tells me is that the AMH test is not all that reliable becuase my egg supply certainly has not increased in 3 years! As PP mentioned, follicle count is a better indicator.

@Blacksheep33 Congratulations! Thank you for the info, this is really helpful.
I had 12 follicles which I also thought was average but good.

I will ask our dr more about DHEA and also about ubiquinol. Was this something you got prescribed?

I totally take your point on sperm quality. For us, the complication is my partner's spinal cord injury - basically we have an egg meet sperm situation but also some issues with the morphology and motility of the sperm. He has been thoroughly tested and has had consistent results which gives us some confidence. But this is our first time going for ICSI so we are a bit unsure about the chances of success.

@AMHquestions thank you! I guess it is good to have a high AMH in the sense that it predicts the response to the drugs but it is not the full picture. Encouraging to know that we are not the only ones going through these and others have had similar experiences.

I am in the same situation. My AMH level in April 2022 was 2.6 ng/ml and I usually had 15-17 antral follicules. But in November during IVF only 6 eggs were collected and number of antral follicules now is 5-6 for both. I took AMH test again and it showed 0.4 ng/ml. So it is more than 6 times less and even one year didn't pass. Possibly, covid might be a reason. Don't know

@Maya34 Did you ever take any supplements like DHEA or others as suggested above? I am thinking it might be worth waiting 3 months for the DHEA to kick in before we go for IVF. We are self-funding cause NHS waiting lists are close to a year where I live and it seems like time is of the essence in our case.

@Daphnaki be cautious with DHEA, you should really have your levels checked before taking it as it can actually cause empty follicles. Speak to your consultant first as it may or may not be right for you.

Thank you @AMHquestions yes I would not do something without my dr recommending it and talking it over with them. But as mentioned a few posts above, I have had my levels tested and our dr has told me this is something I need to consider given my low AMH levels. Otherwise I am unlikely to get a good response from the treatment. So just looking for anyone who may have experience with it.

@Daphnaki haven't tried yet, thank you for suggestion!

Hi @Daphnaki , I thought I would chip in with my experience, there might be something relevant or useful in here.
I started initial tests for treatment this time last year. My very first internal scan showed plenty of follicles, so much so that the nurse said I didn't need an AMH test as it would probably be fine. When we eventually got to our clinic, they did a scan and an AMH test. The scan showed a decent number of follicles, maybe 8 on one side and 12_14 on the other. I then had my AMH result back and it was 4.8.
I was very upset as I had thought this wouldn't be a problem and we were having treatment due to MFI.
I had to pay for extra stims even though it was an NHS round. I was on 300mg of Ovaleap. By the end of my stim cycle my blood estrogen was really high and I had to first drop my injections to 150mg, then skip the last 2. I was very close to being hyperstimulated. I did have a lot of follicles, over 20. At egg collection they got 17 mature eggs and I ended up with 5 blasts.
I thought that this response didn't seem at all in line with my AMH. So I suppose what I'm trying to say is that AMH is not everything and that, for me anyway, AFC was a much better predictor of my outcome.

Saying that, my fresh transfer was negative and I'm having my first frozen transfer next week.
My doctor also suggested that taking Impryl could help with AMH. She said any evidence for this was anecdotal, she personally saw some good results with it and it wouldn't be harmful.
Hope there's something useful in there for someone! And good luck with your cycle 🍀

@Maya34 no problem, just make sure to check with your dr so they can advise you whether this is the right fit for you.

Thank you for the encouraging words @Piapea and good luck with your transfer :)