*UPDATE*Low AMH and IUI's (**siggy warning possible** all welcome with any info!)

rslh10

Hi Ladies,

After finishing another medicated cycle of Clomid CD 3-7, triggering with great follies (18mm-22mm always, 3+ each round) , and progesterone supplements during the LP I have gotten another BFN. August marks one year of us trying (9 months non medicated, and then DX of low amh + 3 months of medicated cycles with one Ectopic in May). 

I am calling on everyone (PgAL, PAL, whoever!)  with any stories about low AMH/DOR and IUI to lend their stories. All of the information I have read is that low AMH does not point to your egg quality, but just the quantity. After searching other forums and this one as well, it seems that a lot of low AMH ladies don't have very good luck with IUI's. I've also read that a lot of fertility clinics suggest women with low AMH use a donor egg right off the bat when doing IVF? All of this information is just so overwhelming and scary. 

I guess I just want to know your opinions on low AMH and IUI's. Did you have any luck? Do you believe there is a correlation between low amh and egg quality? What's your personal opinion on it all?

Also, I'm just going to add that I just called to schedule an appointment with an RE because I haven't been seeing one. Now after looking at my lab papers and seeing no tests ran for estradiol, progesterone (even though I'm on supplements?!) , LH, or Prolactin, I just feel like I've been lied to. I thought I could trust my OB and that she was doing a great job for me and had my best interests at heart? She tested my fasting insulin, and didn't even have me fast!!!  WHAT? 

She want's me to do a medicated IUI round with her this cycle, which will be starting soon (maybe tomorrow or thursday) and I just don't know if that's the right step or not.

A little bit about me:

Low AMH(.58) discovered 3/14/14 

CD 3 blood work (3/14/14) showed all tests ran to be within the normal range.  (EDIT: I'm looking at a list of the tests that should be completed on CD3 and I'm looking at my results... I do not see any of the same tests. I am now wondering if I have even had a cd3 blood work up! WTF) 

FSH 7.5 on 4/9/14

TSH tested twice 1st @ 1.940 in 2/14, and 1.960 in 3/14

Thyroid Antibodies are normal as well (Do not have the actual numbers results on that)

Thank you in advance for all of your advice. I feel a little lost, and don't know where to go from here. It's been suggested that I only do one type of medicated cycle 3x, then move on to the next due to the low AMH. It's my 3rd cycle with clomid+ trigger , and I just feel like I need some guidance. 

Big hugs to you all, and also cake and coffee for listening to all that crap!

**update**

I just got home from the RE and I feel ok. I met with my Dr who has been doing this line of work for 20+ years. He wasn't concerned with my AMH like I thought he might be. He stated that my OB is doing exactly what he would do. He actually stated that he thinks she was doing more than she needed to be. He said he wouldn't have me trigger. He had no idea of any reason why my hair loss would be happening, and didn't offer any insight of it being in relation to low AMH.

He prescribed me Clomid 100mg (have been on this for 3 cycles already with my current practice), and he doesn't want me to trigger (have been triggering with current practice). I will come back on CD21 for a  testosterone, progesterone, and AMH blood work. 

He want's to get an HSG on me, even though he said it's probably pointless (by my chart he says that he doesn't think I had an ectopic, but just a regular miscarriage). Also, he want's to get a SA on DH, again, even though he said it probably won't show any information. He doesn't think an IUI is going to make a difference, and said IVF is $13,000. He kept saying he didn't want to be too aggressive with me, and I don't know why. 

So I guess I feel exactly the same as I did before I went. No answers, but maybe the HSG will show something? 

I don't know what I expected to happen going in there today, but it definitely wasn't to hear that my current OB is over-treating me! Yikes. 

MrsG80inTN

I don't have much info other than my doc prefers my thyroid numbers be closer to 1 for fertility purposes, but I have a hashimotos diagnosis so maybe that's why???  Sending you lots of hugs.

buggirl72

My quick two cents is stop treatment with your OB.

Fertility treatment is not her area of expertise and as soon as she found out your low AMH level she should have moved you to an RE.

As far as IUI or IVF - an RE will do a full assessment that will look at more than just your AMH number. You may still be an IVF candidate with your own eggs. The RE may recommend genetic testing on any embryo prior to implantation if they believe you have egg quality issues, or they may suggest donor eggs based on all of your tests.

Wait to do anything until you see your RE and have all of your tests run.

((((Hugs))))

MrsPhD83

no advice to offer, but I wanted to send ((hugs)). I'm sorry about the BFN and I hope some other ladies can offer insight that can get you on the right track!

mpiemont

I want to drive to Ohio and give you a hug. I don't have any advice to offer, I wish I did.

Km380

I don't have much to add but I agree you shouldn't continue treatments with your OB. An RE should be able to give you more guidance and info. As far as the thyroid - my RE likes my levels below the "normal" guidelines.
Sending lots of big hugs you're way, I'm really sorry your dealing with poor care on top of everything else

BookishMomma

I agree it sounds like an RE would be a great next step. ((Hugs)) I hate how much headspace all this crap takes up.

stinybean

Oh darling! (((HUGS))) I'm so sorry that your OB didn't live up to your expectations. I'm glad you have made the appt with the RE. I hope the RE gives you all the answers you've been waiting for. More (((HUGS)))

bunnybun4

buggirl7 said:

My quick two cents is stop treatment with your OB. Fertility treatment is not her area of expertise and as soon as she found out your low AMH level she should have moved you to an RE. As far as IUI or IVF - an RE will do a full assessment that will look at more than just your AMH number. You may still be an IVF candidate with your own eggs. The RE may recommend genetic testing on any embryo prior to implantation if they believe you have egg quality issues, or they may suggest donor eggs based on all of your tests. Wait to do anything until you see your RE and have all of your tests run. ((((Hugs))))

this.  I have lower amh than you (.23) and I fully expected the donor egg bomb to be dropped on me and it wasn't...they are recommending ivf with pgd but told me they still have patients with lower numbers than mine randomly get pregnant on a natural cycle or with iui.

rslh10

I just wanted to post an update that I will be seeing an RE tomorrow at 2:30! I called and they had a cancelation so I got right in. I will update when I come home from the office if anyone is interested!

ellebelle2384

Lots of hugs.  I am glad you are able to be seen tomorrow!  Please post an update, I will be looking out for it.

tlc35

rslh10 said:

I just wanted to post an update that I will be seeing an RE tomorrow at 2:30! I called and they had a cancelation so I got right in. I will update when I come home from the office if anyone is interested!

That is great news.  I am looking forward to your update after the appointment.

Frenchteachermama

bunnybun4 said:

buggirl7 said:

My quick two cents is stop treatment with your OB.

Fertility treatment is not her area of expertise and as soon as she found out your low AMH level she should have moved you to an RE.

As far as IUI or IVF - an RE will do a full assessment that will look at more than just your AMH number. You may still be an IVF candidate with your own eggs. The RE may recommend genetic testing on any embryo prior to implantation if they believe you have egg quality issues, or they may suggest donor eggs based on all of your tests.

Wait to do anything until you see your RE and have all of your tests run.

((((Hugs))))

this.  I have lower amh than you (.23) and I fully expected the donor egg bomb to be dropped on me and it wasn't...they are recommending ivf with pgd but told me they still have patients with lower numbers than mine randomly get pregnant on a natural cycle or with iui.


This is what my RE said. I'm not a success story (yet, but hopefully), I'm in the middle of my first IVF cycle and I have 6 follicles growing. I'm just praying we have at least one healthy embryo by the end of this!! Keep us posted!!!

kittymeowbark

No advice here either but I wanted to send you lots of hugs.

MrsPhD83

rslh10! Keep us posted!

princessisadora

Hi. I personally don't have any experience with low AMH or DOR but do agree with previous posters that you should go to a consult with an RE if you haven't already done so. Also have you tried posting this question in Secondary IF or IF boards? Those girls have a wealth of knowledge in regards to ART treatments and protocols. The only thing we ask if you do post on IF is to label your post siggy warning as you mention a LO in it. 

lincoln79

***Ticker Warning***

Is there a possibility of doing IVF? I have done four cycles. My latest AMH was 0.3, my AFC was 3 and I was 34 at the time.

We had three failed IUI's

Then IVF

#1: 12 R, 10 M, 9 F, 2 transferred, 4 frozen, BFP, loss

#2: 8R, 7M, 6M, 2 transferred, 0 frozen, BFP, loss

#3: 13 R, 11M, 6 Fert with fresh sperm, 0/5 Fert with frozen (pre-cancer) sperm sample, 2 transferred, 2 Frozen, BFP twins, loss

#4: 14 R, 13M, 11 Fert, 7 made it to freeze on day 6 (This was a freeze all for future surrogacy)

This is to say that AMH/AFC doesn't tell the whole story. It was not at all predictive for me.

Feel free to PM me if you want more info.

rslh10

Updated the main post

ellebelle2384

I'm sorry that there wasn't much of a change in the plan, but I hope the HSG gives you some answers and that getting the RE was the good luck charm for your next cycle!

BookishMomma

I'm glad you got in to see the RE. FWIW, before my endometriosis diagnosis, my RE told me that my AMH level would not impact his recommendation unless it came back as less than 0.5. (I still haven't had my AMH tested because it took so long for my betas to drop. My RE was afraid that my lingering HCG levels would mess with the AMH result). 

Endo changed the plan for us and is the reason he recommended IUI for us. It was not due to my age or an AMH score. I will be getting it tested while we're waiting, prior to our first IUI. But I thought it might help to share what my RE sees as a "low" level. 

eta: clarity

Km380

I'm glad you got in to the RE. I'm sorry there's no plan change but at least you know you weren't being under cared for (does that make sense?) GL w the HSG, keep us updated

rslh10

Thank you all! I'm sorry I posted an update and didn't come back to respond. I spent some alone time with DH last night. We just cuddled and talked, without electronics. It was really nice. We both decided that were going to continue our current med situation for 3 more cycles, then go from there. At my initial appointment with My OB back in March, she told me that she wouldn't recommend more than 3 cycles with one type of treatment due to my AMH. After talking to an RE about it, I feel that I may have a little more time to try Clomid again. I respond well, and my lining is nice and thick on it. 

This whole thing is confusing and trying. I guess I also need to learn some patience. 

I love you all! You're all so kind to care so much about what is going on with me, and for that I thank you so much!!!!!

kyliehopeful

Hi I was diagnosed with high fsh and low ovarian reserve and advised donor only. Your fsh seems great though and usually they go hand in hand. Was your amh tested after a 15min rest before the blood was drawn? Sorry to ask however is there a reason why they are choosing iui instead of ivf? I decided to go to a Chinese fertility acupuncture doctor and he put me on acupuncture, Chinese herbs, no dairy until pregnant as well as royal jelly, coQ10 , dhea and wheat grass shots. This has improved my own fertility problem for natural conception.