AMH of 3.5 (36 y/o)

[Pep1952]

Hi all,
I got a call from my fertility clinic at Guy’s today, unfortunately my AMH is 3.5 and will not qualify for NHS IVF funding. This all came as a shock because my cycles are regular like clockwork and I ovulate every month. My FSH is normal (forgot to ask the exact number) so I will be scheduled for an ultrasound to count the follicles and also check my tubes. I am obviously devastated and was crying all morning. I am 36 y/o and was told that i can still conceive naturally (DH’s sperm results all good), but that my chances for successful IVF is diminished significantly compared to others who have AMH within normal range. We are scheduled to speak to the dr but I would appreciate advice from women who were on the same boat please. We can afford to do IVF privately but it won’t be comfortable if that makes sense. We only have just enough in savings. We’re not sure if we should keep trying for the rest of the year and re-assess in January but worried it’ll all be too late but then. Equally, also worried we will be spending monies on IVF when my chances aren’t great to begin with. Just confused right now tbh!

Oh hun, so sorry you are still delayed in your baby journey. How can we support you moving forward? X

Just adding my story and learning @Pep1952 in case it's of use. TTC 18 months age 30/31 with no success. Went for private fertility assessment age 31 and told I had an AMH of 6, AFC of 5 (this will always fluctuate, I have had an AFC of 12 on occasions and sometimes 3). Consultant advised we could do IVF but not to rush into it. We did anyway and got extremely lucky with our daughter from our only viable embryo from our first round. Fast forwards to 2023, 2 years of TTC naturally unsuccessfully (I didn't go back on contraception) and 3 unsuccessful rounds of IVF for a sibling followed. Drew the line and decided to move on as a family of 3. Conceived naturally in March this year age 35 but sadly miscarried. I've just conceived naturally again (6 weeks).

From one blood test you can't know if your AMH is on decline or is just chronically low. It certainly won't drop off a cliff. You will unfortunately probably be a poor candidate for IVF - usually you get roughly the same no. of eggs as your AMH (I got 6 on all 4 collections I did). Of my 6 I only ever ended up with 1 embryo to transfer each time, all poor quality on paper (note this isn't everything though). The drop off rate means if you only have 3 eggs to start with getting an embryo for transfer is tough. As your consultant said, low AMH doesn't stop you conceiving naturally. If you've had the basic tests and know nothing else is wrong you are almost certainly more likely to conceive naturally than via IVF, but of course you might get lucky as some people (like me) inevitably do. Robert Winston writes brilliantly on the trials and pitfalls of fertility treatment, highly recommend his website The Genesis Research Trust and book The Essential Fertility Guide. Wishing you lots of luck.

@SErunner Thanks for your message! Congrats on your pregnancy, i hope it all goes well.
Re IVF I also thought I had the lowest of chances due to my AMH but the consultant was quite positive about it and didn’t seem phased by it. He used the clinic’s pregnancy calculator to input my age and AMH and predict live birth for each IVF cycle and it was better than I expected. I thought it was a marketing strategy but he actually didn’t recommend us to do IVF straight away so I felt I could trust him. However, he also didn’t consider me as a ‘poor’ candidate for IVF so I will rather take that. :) The consultant did put a lot of emphasis on age, and said that a younger woman with a lower AMH has a higher chance of IVF (or natural) success compared to a an older woman with a good AMH level. This seems to be backed by the studies online too. It’s interesting you had the same number of eggs for each collection! My understanding is if AMH is low, AFC (and therefore eggs) will also be on the low side but not sure about it being the same number. It’s an interesting theory though. But as they say, it only takes one!

Thank you. It was our consultant who advised re the AMH/eggs collected link and it certainly mapped for us, even on cycles when I had 12 follicles at baseline they only collected 6 eggs. Little in fertility treatment is an exact science and even the best informed consultants are working off a lot of hypotheses rather than well evidenced fact. The HFEA website summarises the current state of evidence best in terms of what is recommended and what isn't. Yes age definitely comes into play with under 35 being most optimal then a gradual decline from then onwards for most. Wishing you luck going forwards too.

Thanks so much for your kind words @Eiradu1 and @Pep1952 .

The clinic will make a decision about what's next this Friday and I can call and find out what's next on the Monday. In a way I'm thankful to have had good results from such low chances. I do hope they think there's reason to fund a round two. Starting getting cramps so imagine AF is en route, which would be a good indication that my body is back to its own cycle.

I'm sad even though I expected it, but just like you said (and I repeated it to my partner) that it's hopefully just more delays and certainly not the end. I wish I could be just few years younger though! Enjoyed my first glass of wine in a long long time 🌞

@Nosejug I’m sure you enjoyed that well deserved glass!! Go easy on yourself. I’ve read that the first cycle is sometimes considered diagnostic as you and your medical team learn about your body and your response to meds and can therefore tweak the next treatment to hopefully get a better result. It’s definitely not the end. I hope you get funding for another go! Please keep us posted.
Also keep positive as you already are. I personally think the mind set helps a lot! Some people could sometimes bring you down because they think their own negative experience is applicable to all but we need to remember we are all different and our medical team who have access to all our results are the most reliable people who can guide us into making a decision if we are a good candidate for a certain treatment. We will get there and i’m so looking forward to the day that we see our BFP! For now enjoy a glass.. or two!

I think the awesome news is that you have no need to feel negative. That baby is coming of you align other areas of your life to fertility goals. Please believe that. You know the drill, work on egg quality, correct your bmi if needed, no alcohol/cigarettes/caffeine, moderate exercise, acupuncture, Chinese tea, anti inflammatory diet etc.

your AMH is an indication of reserve so it gives you a bit to get cracking, of to freeze eggs. Your age determines quality and at 36 you are only just at an age where decline starts to increase more than it did when younger. This information is POWER to start working at your goal, it’s nowhere near the end.

My AHM isn’t linked to the number of eggs that I have mature, just to mention. But in any case, these stats only matter with ivf. Natural conception is based on age and lifestyle. Like I said, my AMH was less than a third of yours and I was 5 years older with everything stacked against us (hubby with low sperm and very low counts across the board too).

The only sadness is that it didn’t happen as soon as you wanted to. But it’s coming. There’s to a fresh new cycle and another opportunity! Xx

@Eiradu1 thank you and absolutely agree 100% with everything you said. Xx

Thanks @Pep1952 and @Eiradu1 for the kind words (again!) Sorry for the very slow response. I was just quietly trying to work out how I feel about non success, and for sure everything you said eiradu is right. I'm definitely not dreading beginning again, and like the idea that I'm just being impatient as opposed to a more negative outlook. Really good to hear your positivity!

Well we've been approved for second round on NHS which was great news. There's no tweaking of treatment possible because everything was maxxed out already. I've been doing ovulation tests but theres not even a faint line which I usually do have daily. Just got to wait for the drugs to leave me I suppose!

How are you both?x

Hi @Nosejug nice to hear from you. I’m so pleased that you get another free round - i wish they’re as generous in my area! I’m currently on my 2nd letrozole cycle but mentally preparing myself for IVF if we don’t get lucky with ovulation induction. I’m so grateful my husband is very supportive and not putting any pressure on me. I need to learn how not to put pressure on myself! Good luck with your second cycle. Keeping all my fingers crossed for us xx

Hey guys! So good to hear your updates, ladies! I love hearing of opportunity and promise for you both @Pep1952 @Nosejug

In not sure if I said I’d recently miscarried and since we’ve been chatting, surgery and two rounds of medication failed. I have finally tested low enough for HCG and I’m being trigger for ovulation induction on Tuesday all being well. It’s said to be impossible but I always have hope, you never know when your last good egg is! ☺️

Please do let us know how things go and when things are happening for you both xx

Hi @Eiradu1 i am so sorry to hear about your recent miscarriage and failed medicated cycles. All fingers crossed for this cycle for you. Please keep us posted.

I am on cyle 2 of letrozole but weirdly already have a dominant 17mm follicle on my scan today which is just cycle day 7. Lining is 6mm so i was asked to start estradiol again. I’ll come back on Monday for another scan, I hope i have not ovulated by then as I read in another forum that egg quality may not be that good if ovulation happens very early on. I’ll email my consultant to ask about it next week. Trying to keep positive xx

Thank you so much 🖤

how interesting! Are you LH testing? I guess just cover yourself with BD if you are allowed to as part of your protocol?
iVF triggers happen at 18-22mm so I don’t feel like you will be early most likely xx

Sorry about this! I'm confused as I am going through IVF/ICSI right now and I have a low AMH of 1.4/1.6 🤔 I'm in the north west with NHS funding so puzzled why you would be rejected in your area

Hi @Eiradu1 thank you and yes BD-ing all weekend lol! I was also asked to do lh testing and to let the clinic know if I surge.

Hi @Lil89 unfortunately each area has their own rules! I’m very pleased for you, i heard they are quite generous in north london. Can I ask how old are you if you don’t mind and have you ever been pregnant before? I’ll have my first ivf potentially in October (if letrozole doesn’t work) i’d be very keen to hear about the IVF experience of fellow low AMH women. Please keep in touch and I wish you the best of luck!

Thank you so much! I'm in northwest England not London and I'm 35, have been trying for 8 years and only started my ICSI a few weeks ago with my egg collection due next Friday 🥰

@Lil89 wow how very exciting!!! Baby dust to you! Please let me know how you get on xx

Hey friends, I can't quite believe I'm writing this. having only just had our failed ivf last cycle, I've somehow on this delayed and weird cycle, finally gotten to see that longed for second line...! I'm guessing ivf had sommmmething to do with it as we've been trying 3+ years without a sniff of a pregnancy. Bated breath, but just trying to enjoy each day as it comes...

Excellent news @Nosejug 🥳🥳🥳🥳 congratulations 🥳

@Nosejug omg i’m so, so, so pleased for you!!! This really made me so happy! Congratulations, I hope it all goes well and you enjoy every moment of it x

ohhh this is incredible news! I’m so happy for you! And I love that this thread has stayed active beyond the original topic and when someone searches for this in the future they get to read such positivity! It gives hope!

You so deserve this. 3 years is so long! you must must keep us updated on everything!! We want to know all about your appointments and scans orb whatever you to share xxx

Thanks so much @Lil89 @Pep1952 @Eiradu1 ! If I'm honest I'm still reeling. I've been working such long hours (only one more week of this job though which is good!) that I hadn't been thinking much about the fact that I was late for AF.

Also just wanted to say sorry as I was in a bit of shock when I wrote that message, and hadn't caught up reading everyone else's news (which I've just done). Was really sorry to read about your recent loss @Eiradu1 , have you already had ovulation induction since? And @Pep1952 does that mean you've had your three stim cycles if you're moving on to ivf next month? I'm glad this is such a positive thread. Reading back it's just full of hope and resilience. So encouraging whatever our outcomes. @Lil89 I hope egg collection went well. I hope you're somewhere in your 2ww. (I'm not great at working out dates!)

I had a little bleed this week and was worried/feeling sad, but it was so little and there's been nothing more, so back to a day at a time mode. I'm letting myself do a weekly "weeks indicator" test just to make sure I've not had a missed mc, but so far so good. Because of bleed (it really was slight) they've given me an earlier scan date, about 11 days away. I'm going to be joyous if I start feeling nauseous soon hah. Really just trying to be glad to discover my body is capable, as I had such doubts. Hopefully hope for us all!

Hi @Nosejug great to hear you got an earlier scan date. Very exciting, but i imagine nerve wrecking too. I’ll be thinking of you.

I’m currently on my third cycle of sims, they found 5 follicles on my monthly baseline scan last week. I did have 9 follicles at my work up investigations in July and know the number could vary each cycle but only had 4-5 since I started sims which is quite odd. The scan where 9 follicles was done by a doctor while the baseline scans I get in my fertility clinic are done by a sonographer. Not sure if that has got anything to do with it but fingers crossed my AMH has not dropped further since July.

Anyway! We have an appointment with our consultant next week so that I’m ready to get on to IVF in October if this 3rd sim cycle doesn’t work. Can I ask if they put you on long or short protocol with your one? Sorry if you already mentioned it previously! Xx

Thanks for your kind words! Still getting scared by very light pink discharge occasionally, but there’s nothing I can do but try be positive.

I was on long protocol (9) and on the maximum of everything. If you do end up doing it, feel free to ask anything you want. I was relieved that it wasn’t at all bad for me (I was nervous of injecting and of what my stability would be like) I had a couple of wobbles, but overall felt so good to be actioning something. The level of monitoring (though you may be receiving that now) felt helpful too.

I’m not sure about the changing number of follicles but I feel doubtful that it would be a sudden amh drop causing it. Is it possible the body can just perform differently from month to month?

With your treatment, does that mean they wait till you release/trigger release of your eggs and you then conceive naturally? Does that mean multiple eggs get released at once? If so it seems like a pretty good system. We were recommended for icsi becuase of male factor subnormal morphology. He’s due another test though as he had a (scary) operation to help improve it. We weren’t allowed other treatments as they said icsi was our highest chance (and me being 38).

sorry if that was all rambling! Writing in the car before work heh.

Hi @Nosejug how are you getting on?? Sorry for the delay but it has been mental at work.
Yes finally doing ivf this month! Excited and nervous. I’m also managing my expectations and considering first ivf cycle as diagnostic really! But I do love it when i read miracle stories online lol
I hope all’s well with the pregnancy xx