Low AMH at 29 (Surrey/London based)- very worried, experiences please

[PeoniesinMay]

Hello,

Any experiences/success stories would be so appreciated please. I am 29 and my husband is 35- we have only been TTC for a few months (with no hint of a BFP on any occasion), but I had a gut feeling that something wasn't optimal on my side and started the process of private testing this month, mainly for peace of mind and 'just to rule out any problems'.

I do have a history of quite severe anxiety, and work in a stressful job (which I'm finding quite hard in relation to TTC as well because I work in an Early Years setting) which is probably relevant here. Our testing is taking place at the Newlife Clinic in Epsom (which I chose mainly due to positive reviews and it being very local to us).

I haven't had my day 3 blood test yet- since today is CD16 for me- and we are also still waiting for my husband's semen analysis, but I have been really worried by my results so far. My AMH (completed on CD14) was 6.2 (which I gather is really low for my age?) and my AFC 13 (which I gather is okay/normal for my age but could be better?) My TSH was 1.94 which they have told me is optimal?

I do think I ovulate most months, because I always get EWCM mid-cycle, have always had positive LH whenever testing, and had ovulation confirmed on my CD14 transvaginal scan this month. I also had ovulation confirmed on another occasion 18 months ago when I had an ultrasound with colposcopy for post-coital bleeding (all okay there thankfully!)

My husband is only able to go to clinic for his analysis this Monday (4th March) or the following one (11th), and they have said that they don't have any appointments for him on the 4th, so we will need to go with the 11th. This means that I don't have my appointment with the consultant where we will actually discuss my AMH until the 12th March which just feels like an unimaginably long time away. I was told my results by email with no offer of a phone call to see whether I'm okay/how I'm processing them, which I'm quite unhappy about, but don't know whether I'm expecting too much here. Is this is just the reality of how fertility clinics operate?

Needless to say I have been Googling like mad and am finding a real lack of consensus on what I'm realistically likely to be advised to do next. Some (reputable-looking) sources are saying that in women my age who ovulate, the advice is to keep TTC naturally as my chances of conception aren't reduced. However I am seeing many women my age with results similar to mine online who were advised to go straight to IVF?

In all honesty, I don't know which outcome I'm hoping for here. I would never want to trivialise how hard IVF must be for those of you who have experienced it and am well aware that it's far from a guaranteed or easy option (especially if you have lower AMH anyway?) However I am also terrified of continuing to TTC naturally, continuing to get nothing but BFNs, and then coming to IVF anyway with a further reduced AMH a year or two from now.

Thank you so much to anyone who is still reading! Any advice/success stories from people who have been in my situation would mean the world to me. I don't know anyone well IRL who hasn't got pregnant easily & naturally (heard way too many stories of acquaintances/relatives getting pregnant in 2-3 cycles or less recently which isn't helping here), and most of my friends haven't even started TTC yet, so I feel I'm in a very lonely place where, try as they might, most of my support network don't really understand my concerns.

Sorry to hear about your anxiety around TTC it’s not the most pleasant of experiences😢 it sounds like you are really on it with already doing investigations at this stage which is great so you know where you are at.

in regards with fertility clinics the service you get can be so variable between clinics. I’ve used two clinics and I would say it takes months to get answers/wait for consultants so your timescale of everything would be fast for what I’ve experienced the last 4 years! My current clinic is a 5 mth wait for consultant review (I’m sure private clinics must be a lot less than this).

sorry I don’t have experience regarding your AMH results but I do know they generally look at this result to try predict how you might respond to ivf medications and it doesn’t necessarily mean you can’t conceive naturally.

I wonder if it might help you to try and get some support for your anxiety via counselling or CBT? Or try to find some ways of coping better. The only reason I say this is the infertility journey is so long and you just have no idea when this will stop 😢 I also started doing reflexology that I find helpful and I like using a journal too.

I would definitely see what your consultant advises for your next steps although I would be surprised if they advise you to start treatment yet. IVF is absolutely no guarantee and I would say it can be a massive mental load. On paper I look great I should be super fertile however I’ve already completed 2 cycles of ivf and 3 transfers that I have miscarried every one. I’m also 29 and started trying to conceive when I was 25 - I’m sorry I don’t have a success story for you but wanted to let you know there are definitely people out there your age having difficulty and you are not alone! It doesn’t get any easier if you do move onto start treatment - of course this is only my experience and I think everyone can be really different xxx

@Ellenn I'm so sorry to hear about your losses- that must have been absolutely heartbreaking on top of dealing with so many years of fertility problems in the first place Much as I wish neither of us were in this situation at all it means a lot to hear from someone who understands my position- thank you for reaching out x

That's really tough with the timescales around your clinic, must just add even more stress into what's already a worrying time for you!

I called Newlife today in the end and got through to a really helpful lady who scheduled a call for me with the consultant and was also able to move our next appointments to the 4th.

He basically said that if we want to have a good chance of having more than one child, he would proceed with IVF ASAP so that we'd hopefully have some embryos to freeze. This is due to the rate by which my fertility might already have declined by the time we'd potentially have had one child and then wanted to try again. He then said if we wanted to keep TTC naturally, he would only do this for around another 3 months before looking into IVF anyway.

Of course this has all just come as a massive shock, as I was never expecting IVF to be part of our story this soon in the process. I'd be so interested to know whether anyone else with low AMH has been given the same advice.

Just bumping this in case anyone else sees!

Hello. I have looked into AMH and there is no correlation between natural conception rates and AMH levels. Yes, it would mean time is of the essence but if all other tests are fine then you are just as likely to conceive naturally as someone with normal AMH. AMH is an indicator of how well you would respond to IVF treatment.

I'm no expert and this is just from my own research and I hope it's reassuring for you

As PP low AMH itself doesn't prevent conception but it does need to be considered when thinking about when to move to IVF. Also your AFC is better than your AMH would indicate, plus you are young so your eggs should be good quality. Obviously you need your DH's results but TTC for a further 3 months is probably good advice.

(Also no expert but I have had a lot of IVF!).

We went for testing after 18 months TTC with no success had an AMH of 6 age 31 (AFC 6 too). We decided to go for IVF and had our daughter from our only embryo from our first round. Fast forward a few years, several rounds in to having a second with no success yet. It's hard to know what to do because you don't have a crystal ball. Just because you have a low AMH doesn't necessarily mean it's declining rapidly, it might just always have been low. A one off result tells you nothing about what it will do in the future and the tests also aren't an exact science as AMH levels do fluctuate a bit month to month.

I have no explanation for our failure to conceive naturally other than my low AMH. Every other test we've both had have been fine. I've not been on contraception for more than 6 years and have never had a positive test other than our first IVF round. Clearly for us age is playing a factor now. I think we got lucky with our daughter but I also think my younger age and better egg quality helped. You have to just go with what feels right for you, so that you don't end up regretting any decisions.

Your consultants advice worries me a bit. Ours advised totally the opposite when I was 31, said there was no rush, fertility not about to drop off a cliff, one off test not telling full story etc etc. Also, with an AMH of 6 you are likely to get roughly the same number of eggs and statistically at best that would leave you with 1-2 embryos allowing for normal drop off rates, so the idea of embryo banking doesn't quite hang true either. It is tempting to rush in, and assume IVF will solve the problem, but sadly success rates even when younger are pretty dire, so it's important to go into it with realistic expectations.

Thank you so much for your advice/thoughts everyone- @SErunner I think you hit the nail on the head when you said it's so difficult to know what to do without a crystal ball. I feel like I'm in a huge catch 22 here where I'm risking going into IVF totally unnecessarily, but equally I'd have no way of knowing whether my AMH is on a steady decline until it's already going to have slumped to a level that would affect my chances further?

This element of panic/time pressure makes it so hard to make a sound decision I definitely think I will look for a second opinion elsewhere just to run this advice past other specialists? (If anyone would recommend any other London/Surrey based clinics for this please let me know!)

We are booked in for my husband's semen analysis on Monday and our Newlife consultant says he also wants to discuss some autoimmune tests with me to see whether this could be what's harmed my AMH- do any of you have any experience with this? Then it's just waiting for AF to come so that I can have day 1-3 tests as I've read that my FSH levels should also be part of this decision?

CD18 today and never thought I'd be almost impatient for my period to come only a few months into TTC...!

@PeoniesinMay a second opinion is a good idea. I made the mistake of going to my closest clinic (it was not the same clinic as yours as I live elsewhere) which wasn't actually the best one for my individual circumstances. In the end I had success with Create. I had very low AMH and was 39.

FSH fluctuates each month so AMH is a bit more accurate although even with that my result has fluctuated over time. It is just one part of the picture, I would be encouraged by your AFC.

@PeoniesinMay it's really hard isn't it. I personally wouldn't go down the route of immune testing. I can't understand why it would be warranted at this point, and the whole area of reproductive immunology is a bit sketchy in terms of evidence. Robert Winston's 'the essential fertility guide' is an excellent, evidence based and pragmatic book, his website the genesis research trust is good too. The HFEA website is also useful. Unfortunately there are lots of unscrupulous clinics and doctors who recommended a whole host of unnecessary and unevidenced treatment for financial gain so it is worth reading some reputable sources for advice/info to help inform your planning.

In terms of clinics, we've been with Kings Fertility for all our treatment and I would highly recommend. They are favourable cost wise, a not for profit and put money back into fertility research, and I have never felt I was being sold or pushed to have tests/treatment etc that weren't needed. In fact they have frequently advised me against things I have suggested that would have made them money. I have a lot of trust in their advice being in line with best practice and for my benefit, not their financial gain.