Low AMH at 31 - unsure of options

[ksd1991]

Hello everyone,

I've been a long term lurker on these boards but this is my first post - I'm very sorry if this isn't the right place to put this.

My husband and I have been TTC for a year now. We've had one miscarriage at 6 weeks and two chemical pregnancies.

I'm having some tests done to see if there's anything that could be causing the losses and as part of the initial tests they've also done an overall fertility check. I'm 31 and my results have thrown up that my AMH is very low for my age - 3.9. My AFC is 12, which I believe is OK. Everything is fine with my husband's sperm and there are no other obvious issues (my TSH was high on a first test, but has come right down since then - not sure why!).

I know that the AMH isn't necessarily causing the miscarriages/chemicals and I'm having some separate tests (thrombophilia/hormones etc.) to look into that. I'm waiting for the results of those before I can book my second consultation with the doctor, but I'm getting increasingly worried about the low AMH in the meantime.

The doctor has said we should discuss whether we continue to try naturally or whether we should consider next steps in terms of treatment given that we now have 'reduced timelines' (his words) but hasn't really given us any more information. I'm just wondering if anyone can help in terms of : how bad is the AMH really? Is there even any point looking to treatment given it'll be less likely to be successful and are we better off just continuing to try naturally? Has anyone with a similar AMH been successful naturally?

We are very lucky in that I have Bupa insurance which will cover most of the costs for a couple of rounds of treatment and investigations - otherwise I don't think we'd even be considering it this early. I just don't know if we should be thinking about starting IVF ASAP given my AMH or are we better off just waiting a bit longer to see what happens?

We've also made the necessary lifestyle changes - supplements, diet, no caffeine/alcohol, acunpuncture etc. etc. so part of me thinks we should wait to see if these make any difference before jumping in to treatment - but obviously if my time is really running out then I suppose it's better to try everything we can, especially if we're at risk of another miscarriage/chemical.

My amh is 2.1 and I'm currently 13 weeks pregnant.

Maybe ask them about your progesterone levels.

I also had an endmetrio procedure and discovered I had a displaced implantation window. My following transfer was a success xx

Thank you for replying - and congratulations! I will get my progesterone levels checked this cycle just in case too.

@ksd1991 they checked this cycle but never before. I needed extra pessaries and a lubion injection every evening x

3.9 is NOT low for your age... It is, in fact, above average, and well above the minimum expected for your age!!!
Unless you got the numbers wrong... Or the lab uses a very different measuring scale?
For context, my AMH was 0.7 last time I tested, a year ago, and even then the doctors were not overly worried (though it was a "straight to IVF" situation.

I think perhaps you're using a different unit for measurement. 3.9 is very low (no disrespect meant. Mine was even lower)

I'm using pmol/L which is how I was given the results - I'm not sure how that translates across but I was told the healthy range for 30 - 35 is from 4.1 - 58.0.

The docs exact words were 'I'm normally quite optimistic but I have to be honest this is very low for your age' - which has really freaked me out!

It definitely is a different measuring scale that seems to only be used in the UK (as even on google, without using the pmol/l, I was getting the same type of measurement I am used to!

Id suggest going straight to IVF. You will have a lot better chances to get pregnant with serious help than you will by just doing what youve been doing.

But talk to the doctor. They will know better.

3.9 is low for your age. Mine was 6 at the same age and that was classed as low. However, the fact you're getting pregnant is odd and perhaps suggests the AMH might be a red herring? Usually the impact of this would be you can't actually get pregnant. I would speak with your clinic about this specifically and ask whether further test are warranted for your recurrent miscarriages before embarking on treatment. I think it sounds like something else is going on personally.

I was diagnosed with low AMH at 31. No conception in 18 months of trying. IVF age 31, successful first round with only viable embryo resulting in daughter now almost 2. Currently having treatment for a sibling.

Good luck 🤞

From my understanding, AMH indicates your level of egg reserve and helps determine how responsive you would be to IVF treatment. It should have no impact on conceiving naturally as you are still releasing one egg each month etc.

It is good you are looking at this in a bit more detail and that your insurance can help cover the costs. I dont know what the chances of success are for things like IUI. But with low AMH and at 35 my dr told me we have a 30% chance of conceiving on the first try with ICSI... So I would suggest you talk to your dr once the tests are all in? It would also depend on how comfortable you are with more or less invasive processes e.g. IVF vs IUI.

At 31 you dont see a dramatic change in egg quality etc until you are 35/36 so hopefully that gives you some reassurance that you have some time but obv you may need to be keeping an eye on your AMH. I wish I had looked into things when I was 31!

Lower ovarian reserve = reduced likelihood of releasing a mature/healthy egg so reduced likelyhood of conception and increased likelihood of miscarriage. I was just surprised OP has conceived so many times in a relatively short period perhaps worded it a bit clumsily though. I'd still personally ask re the recurrent miscarriages and whether any further testing is sensible. IVF is the recommended treatment for low AMH, other treatment approaches are generally not effective.

Thanks everyone for your responses. @SErunner I agree that it doesn’t seem to add up and I wouldn’t want to start treatment and risk another miscarriage - my acupuncturist was also quite surprised that my AMH was so low but my follicle count was 12, which I think is not loads but reasonable? Of course she’s not a medical expert, just going on her experience of other people.

@Loulaki this is what the doctor told me too - he basically said that the low AMH doesn’t impact my chances of getting pregnant every month, it just means we have less time in which to fall pregnant. But then he also suggested we talk about treatment in our next consultation, which confused me . I don’t really understand whether my chances will be any higher with IVF (especially given low AMH I think makes it less likely to be successful) or just trying naturally for longer.

I think next steps are to speak to the doctor again and try and get an idea of success rates with different options. Unfortunately I can’t see him for another couple of weeks though so I’ve been driving myself slightly mad thinking about it in the meantime!

With ivf they will be able to hopefully retrieve a host of eggs meaning the process will be hugely speeded up for you

That was what I was thinking @ksd1991. You could spend a lot of money and still have the same issue. An AFC of 12 isn't bad. It can fluctuate month to month (I randomly had a month when it was 12 but usually more like 5/6 which is in line with my AMH). Definitely ask these questions of your clinic and make sure you're happy with the explanations. At your age although you may have a low reserve your egg quality is likely to be good so no major rush.

I don't think I saying it doesn't affect your chances to fall pregnant is quite correct but obviously don't want to challenge a doctor! My understanding is it does as you are less likely to release mature eggs, and immature eggs won't fertilise. IVF will improve the likelihood of getting mature eggs and therefore fertilisation and an embryo. Even with IVF though, with a low AMH your collection numbers are likely to be small. Usually about the same as your AMH number I think - I've collected 6 on both rounds I've done which is what they said they expected. 1 embryo first round, 2 in second.

Both of you should be tested and in tandem, sub fertility is not the sole preserve of the woman and it could be that both of you are contributing to the sub fertility.

You need a diagnosis first and foremost. Do not get too hung up on AMH levels.

@AttilaTheMeerkat my husband has been tested as well, his sperm count is very high and morphology/motility both normal. We’ve still started him on Impryl just in case and he’s making the same lifestyle changes.

@SErunner I will definitely speak to the clinic about this and ask those questions - this has been really helpful thank you!

From what everyone is saying it sounds like I don’t need to panic just yet, especially as I have been falling pregnant, but that I might need to be prepared to consider treatment if we haven’t falllen pregnant again in the next 3-6 months maybe. And in the meantime I can hopefully keep testing for the miscarriages and see if I can get to the bottom of that. I’m still hoping it could just be a horrible coincidence, but I suspect it might be something hormonal or low progesterone.

My amh was 2.8 age 34. I got pregnant which ended in miscarriage. I then did ivf which worked first time despite a low number of eggs. When the ivf baby was 8 months old I thought we’d better try again naturally. 2 weeks later I was looking at d positive pregnancy test.

low amh has no impact on natural conception - look it up - studies have been done. This is because you only release one egg a month naturally anyway. I don’t believe it’s true that you’re less likely to release a mature egg and it was t the case for me. Low amh just means you’ll run out of time quicker than other people - which Is why they suggest ivf.

I second this. I am 42 with very low amh at 2.1. Though ivf I had 7 eggs collected and three came back normal after genetic testing. All seven fertilised as well.

I see many ladies go through ivf with great amh levels and they sadly didn't get as good a result as I did

Thank you @Ilikeviognier and @CR7 - that gives me hope, and does seem to align with what the doc suggested about natural conception.

Anyone manage to conceive ? Ivf or naturally! I'm ttc 3 years now 2 failed ivfs turns out my egg quality is bad which came as a shock as I'm only 31! Doctor thinks there should be 1 good egg in there but we can only afford 1 more cycle so not sure to try again or just go for donor eggs 🥺