Low AMH Level

wenikilina · September 2015

Hi all! I hope I am posting in the correct place this time. I am interested to know of others that have a low AMH level and what their journey has been like.

I am 31 years old and my husband is 32. I have been off of birth control for 20 months now. I have pretty regular periods but at times they can run a bit short. We have tried two cycles of Clomid. Two more cycles we were unable to take the Clomid due to large cysts that had formed on my ovary from taking the medication. We considered one more round of Clomid and then IUI as our next step. However, I then received my Anti-Mullerian Hormone (AMH) level result (the test that measures ovarian reserve) and it was very low. My level is at 0.49. My RE has recommended that we go straight to IVF now.

Is anyone else in a similar or same situation? What is your AMH level? What is your next step?

ShayLatrice · September 2015

I was 33 when I found out my AMH level was 0.39 and my RE recommended IVF for me as well. The one thing you need to do is make sure they have an aggressive enough plan for you. We found out the hard way that my first IVF protocol wasn't strong enough so I didn't get enough follicles. This time around we are being a tad more aggressive with the medicine. We were planning to bank for the chance at a second child, but after the first cycle failed we decided that our goal is to just try for pregnancy now and understand that we may only have one child. I do recommend Fertility Acupuncture if you can afford it... it has definitely manage stress as well as help my cycles and blood flow/circulation issues.

wenikilina · September 2015

Wow, thank you. I hope this time around will bring you much success.

How will I know if my plan is aggressive enough? My first IVF consult is on October 5th.

I have heard from multiple people now that they recommend acupuncture so it seems I should look into that!

ShayLatrice · September 2015

There is really know way to know if it is aggressive enough until you are in a cycle and your RE can adjust the dosage amount or add/change the medicine if they see you aren't responding to it well. You aren't the doctor, but don't be afraid to ask questions and speak up about your concerns as soon as you can. My doctor said the first round of meds are seldom the right dosage but it does help them to figure out how well you will respond and helps them make adjustments so that you have a better chance in the second round. So be patient...this journey is def one full of unknowns.

bsckgb7 · September 2015

I knew you would get responses over here!!

rachlee2010 · September 2015

I was also recently diagnosed with DOR (diminished ovarian reserve) with a low amh. I got it tested at my first RE's office in late march and it was 0.36..then we switched RE's in early may and the new dr did it again and it was 0.1. I am 32. The good news is I have an almost 3 year old son who I conceived with no problems at 29. I must have had low AMH then but we didn't know about or have any idea how low. when starting to try for #2 it took us 8 months but we did get a natural BFP but it ended in miscarriage at 7 weeks. Since going to an RE after the miscarriage we did one cycle of clomid that was a huge fail as I got a big cyst and didn't grow any follicles or ovulate that month. Starting in July we have done 2 IUI pill/injectable combo cycles. Both got BFN..we are in the middle of our third IUI but as of CD 9 I wasn't responding to the meds yet..I go back tomorrow. If this doesn't work we are going to go on to IVF most likely as well. My DH is very nervous about IVF because we know there is a chance I won't respond well to the meds and we will still have spent all the money on the meds. I don't know what meds exactly the dr has in mind but I know it is a very high dose. I have heard of a lot of women with low AMH who got pregnant every which way, naturally, IUI and IVF..every case is different but what I have heard is at our age that is a big plus as the quality of your eggs should still be good. AMH is about quantity not so much the quality. Dr's recommend going straight to IVF because time is not on our side and you don't want to waste too much time trying other ways. There is a board on babycenter that is just for low amh that is really helpful that you might want to join.

ShayLatrice · September 2015

rachlee2010 YES... QUALITY OVER QUANTITY!! My RE said she isn't concerned about the quality of my eggs yet, but I'm one year away from 35 and since most times having low AMH being diagnosed DOR that it puts you at risk for early menopause she is wanting me to speed ahead as fast as possible for a pregnancy. She didn't even want me to take a month off, but I needed to. We got pregnant naturally on our own last year but it ended in a miscarriage at 10 weeks. I'll check out the AMH board... thanks for reminding me about Quality over Quantity.

wenikilina · September 2015

@ShayLatrice I will keep this in mind. Thanks for the heads up on that.

wenikilina · September 2015

@rachlee2010 Good luck at your appointment today, let us know how it goes. You are absolutely right about quality being much more important than quantity at this point. I had read that the two may correlate, but the more I find out the more I do not think that is true, especially for the younger females. Thank you! I will also check out the low AMH board on babycenter.

tennesseelove · September 2015

I also have diminished ovarian reserve. I just turned 26 and have an AMH of .76. Because my husband has a very low sperm count we were advised to go straight to IVF. We started our first cycle a few weeks ago and I was recently canceled on day 6 of stims due to poor response. Just waiting on af to start the next one with an even more aggressive protocol, micro flare. One thing I would suggest when doing IVF is if they put you on birth control, ask questions about possibly being over suppressed. I think that was one of my issues. I've done a lot of research on birth control and over suppression, dr. Sher has some great articles, and my clinic did not do the bcp part right from what I understand.

rachlee2010 · September 2015

@tennesseelove please let us know how your next cycle goes. We are thinking of possibly doing IVF but my husband is very hesitant to spend the money and possibly not respond to the meds and basically throw that money out. Do you mind me asking what your AFC (follicle count on day 3 is?)

My appointment today sucked. It was CD 12 and I am not responding at all, no follicles are growing so we are scraping this cycle. The dr gave us 3 options/thoughts as to what to do next. 1) is to try clomid (the past 3 months I have used Femara) I was on clomid back in April and I didn't ovulate or grow follicles and got a cyst so i am very hesitant to try it again but she thinks it is worth giving another shot. 2) She suggesting taking a 2 month break and taking DHEA as a supplement and possibly acupuncture and then seeing if my amh and/or afc go up. 3) IVF but she is hesitant to do that if my AFC is low like it was today. So that would be a game time decision I think if my follicle count is fairly good.

Not sure what we are going to do at this point. Sometimes I think all these meds just aren't going to work for my body and we would have a better shot and just trying naturally. But then I get impatient and just want a baby now and think meds are the way to go. If only it weren't so expensive.

tennesseelove · September 2015

I'll keep updating. I think if your clinic has experience with DOR you'll have a good chance. One thing to keep in mind is the first cycle is like a trial run. My last afc count for the last cycle was 12. Because your only 31 your egg quality is probably still good. The thing with DOR is you probably won't get many eggs but if the ones you have are good quality then you have a good chance.

wenikilina · September 2015

@tennesseelove Oh no! I am sorry that you are going through this. I have also read about birth control and over suppression and if at all possible I am hoping that I can request to not be on BC. I am curious as to what meds I may be put on. How often were your appointments?

wenikilina · September 2015

@rachlee2010 I have the same worries. I worry that I may not respond to the medication. But there is only one way to find out! Let us know what you decide to do next.

tennesseelove · September 2015

Wenikilina, once I started stims, I had my first check up 4 days after and then about every other day. Also, after further research, I have read that birth control can be beneficial for dor depending on how bad it is, as long as it is used with a grnh agonist medication such as lupron the last 4-5 days of being on bc. But if your afc number is really low and FSH is really high you should ask about the estrogen priming protocol. If this is your first IVF, many clinics like to start with the antagonist protocol, so the FSH drug (usually a high dose) and ganirelix. That's what did not work for me but it may for some.

rachlee2010 · September 2015

Right now we decided to try the clomid/injectable combo..I am taking provera now to make a period come so I have to take that for a week and then AF should show anywhere from 2-7ish days after I'm done taking it so should be about 2 weeks until we have to truly decide. We have an appointment with the other dr in the practice to just talk and get his take on our situation on Oct 7 so I am hoping it works out that we talk to him just before or on CD1or 2 of my next cycle so that if he has better advice or ideas we can go with him before we start the clomid. The dr really thinks clomid will give us a better shot at getting more than 1 follicle that femara got us. She also said if we do well with the clomid/inject combo and get multiple follicles it's a low dose ivf protocol we can consider. So we will see

susykat77 · September 2015

I also have a low AHM, 0.1. We were told that we should move right on to IVF as well. I had only two mature eggs my first cycle (one fertilized) and one my second cycle. I took a month off from the meds and did a natural cycle. My most recent cycle, they retrieved 12 eggs!! Eight fertilized and 4 made it to day 5 blast. For all 3 cycles I was on the highest dose of Menopur. Sorry that you are heading down this road but this board is a great resource.

rachlee2010 · September 2015

@susykat77 how does a natural cycle work?? You just take nothing at all and they monitor you and retrieve eggs?? Also for your medicated cycles how did that work? Starting on cd3 you took the highest dose menopur every day? For how many days?

Sorry for all the questions but we are seriously thinking about IVF but also trying to figure out if its worth it to spend the money on the meds to possibly not even respond

susykat77 · September 2015

@rachlee2010 The natural cycle is no stim meds and they go in a retrieve what ever I may have. It is much cheaper at the clinic I am at to go that route and as I wasn't really responding we though we'd give it a try. As for my medicated cycle, I started on 6 ampules of Menopur on Day 2-4, then 5 ampules day 5-10 (last cycle it was 5-12). I am going through this in the Czech Republic so things may be a little different here...

I didn't respond on the first 2 IVF cycles but then did on the third cycle. It really is quality over quantity. Good luck!!

ShayLatrice · September 2015

susykat77 OMG that is amazing that you had such great results and really give hope to a lot of us. I had a failed cycle with only 1 mature follie on the left and 4 small ones on the right.

ShayLatrice · October 2015

susykat77 Any update on your 2 transferred?

I made it through my ER and my doc retrieved 6, 5 fertilized and 3 made it to blasts. I now have 3 Snowflakes waiting. I was going to do a fresh transfer, but when my RE did ER she noticed I had more fibroids and these were actually inside my uterus. I have to have those removed before we can do a transfer... There is hope ladies... even with DOR/Low AMH!!

wenikilina · October 2015

@ShayLatrice Oh my! I am sorry to hear about the fibroids. I hope those can be taken care of and you will be back on track soon. I am scheduled for my first IVF, starting with stims in late November and ER in early December! I am so excited, nervous, scared!!

wenikilina · October 2015

AND I forgot to mention the most important part!! How exciting about your three snowflakes!!! I hope all goes well with those.

How many do you plan to transfer?

ShayLatrice · October 2015

wenikilina I can't lie, the fibroids were a bummer... but I'm glad she spotted them. We are only going to transfer 1 at a time. I remember when I started... I was all the same feelings, but I promise you, you will be a pro at the injections before your first week is up. They really aren't as bad as they look. Do you have your calendar with medication protocol yet?

wenikilina · October 2015

@ShayLatrice I do not yet have my calendar. Waiting for AF...should show by the end of this week, and then I will schedule my saline sonogram. Picked up my birth control today! I am ready to start.

When are you scheduled for the fibroid removal and when will you be getting back to the IVF?

susykat77 · October 2015

@ShayLatrice last cycle was a bust for me but we transferred 2 frosties on 10/16... I plan to test on 10/24.

How very exciting that you have THREE frosties!! When are you scheduled for the fibroid removal? Maybe they can do an endo scratch at the same time?

rachlee2010 · October 2015

Hi Ladies…good luck @susykat77 I hope one or both of those frosties stick

We are going to try a few more IUI's before moving on to IVF in late Jan/Early February

My current cycle is so messed up as I didn't respond to the meds and on CD 12 I had no measurable follicles. So I took provera to bring on a period but my period never came. On CD 26 I had 2 or 3 (can't remember) follicles around 10 mm…hadn't ovulated yet and estrogen around 183..lining around 5 mm…Dr said I may not ovulate or I may and to wait 2-3 weeks for spotting/AF and to come in..if nothing to come back in 3 weeks to be checked..We are right around the 2 week mark since then and no spotting at all. DH and I have been BDing as much as we can just in case..

Once I am back on track we are trying a clomid/Gonal F cycle to see if I do better on the clomid than on the letrozole..

ShayLatrice · October 2015

wenikilina Hopefully AF will come this weekend and she said to call her when get it and they will schedule the fibroid removal. She said they can see them better when AF comes because my lining is thinner. I'm hoping to get AF on Friday.

susykat77 I have to ask about the Endo Scratch, I remember her mentioning something like that before, but I'm not for sure. I hope you get a BFP this cycle!!

wenikilina · October 2015

@suzykat77 Do you have any news for us? Hoping for the best for you!

@ShayLatrice Did AF show? Mine did and I have my saline sono scheduled for Tuesday. I am a little nervous, as my HSG was very painful for me. I was instructed to start BCP yesterday and in the next two weeks I will be receiving my meds/appt schedule! Exciting!

=D>

ShayLatrice · October 2015

wenikilina Yes AF showed up last Thursday and I have my Saline U/S on Wednesday. I started BCP on Thursday as well. I'm so happy that you will be getting a schedule soon!! This is an exciting time.

wenikilina · November 2015

@ShayLatrice Wow! Fibroids were gone? That is excellent!! My (hopefully) embryo transfer should be taking place around December 8th!

ShayLatrice · November 2015

@wenikilina Yes Gone. RE thinks they were because of the hormones and that when AF came it probably helped clear any remaining tissue. Looks like you and I are going to be pretty close with our transfers!! My meds will be coming this week so I can start preparing for the FET! We will be in out 2WW together... which hopefully will help us keep sane. LOL

ShayLatrice · November 2015

@wenikilina Yep. All but one on the outside was gone. My doctor thinks it was just hormonal and that they cleared with AF and my acupuncturist says that was the focus of her treatments for the last 3 weeks along with the raspberry leaf tea. Who knows... I'm just glad they are gone. LOL... Looks like we are going to be Transfer buddies as mine is scheduled for Dec 3rd. My meds arrive on Friday... I thought I was over Lupron injections... but I guess not. I'll be a walking zombie again for 3 weeks. YAY! lolol

wenikilina · November 2015

Oh goodness! My meds have arrived as well, just this past week. Kind of overwhelming seeing them all in that big box. We have our injection training this Wednesday.

It is all going quickly for me now and once my meds arrived it suddenly felt very real (even more so than before). A little scary!! How are you doing? I don't start my injections for one and a half more weeks. Have you started injections again?

ShayLatrice · November 2015

Omg.....yes!!! Time to start them injections!! Don't be scared, this is just one step closer to getting your BFP. I'm 13 days into injections and I feel like crap. Horrible headaches and fatigue. Tomorrow is my first baseline ultrasound and labs. Hopefully my uterus lining is looking perfect!

wenikilina · November 2015

Oh my. I am worried about all of the side effects of the meds!! Good luck with your baseline ultrasound and labs! I hope everything is looking good for you. I will have my baseline ultrasound in one week. I was told that I have to have the baseline done before I can start my meds. It is interesting how this part is different for us.

ShayLatrice · November 2015

I had an ultrasound a week before Ibstarted the meds to recheck for the fibroids which also included another saline ultrasound and the mock transfer. That's when I was told the fibroids were gone...so I guess that was good enough for her? I didnt have this many issues on Lupron before but the dosage was lower and I wasnt on it as long. I'm honestly just counting down the days til my FET because I'm over this Lupron fog I'm in. What meds are you going to be on?

wenikilina · November 2015

The meds I received are the microdose Lupron, Follistim, Menopur, Progesterone, Pregnyl, Estrace. Sound familiar? What meds were you on for your original cycle? Hoping your Lupron fog clears soon!

ShayLatrice · November 2015

For my ER I was on Lupron, Menopur and Gonal - F. For this FET I'm on Lupron and I just started Estrace yesterday.

LSatturo126 · December 2015

Ok I caught up to everyone on this. I was pregnant naturally back in February after 16 months TTC. Then the embryo wasn't viable and had a DNC on 4/14/15. I have low AMH 0.56 and had done 3 cycles of IUI. Just had an HSG and they show some scar tissue around my ovary which could be another reason I'm not getting pregnant. Any luck on your stories ladies?

wenikilina · December 2015

@ShayLatrice How is everything going? Stimulation Day 6 ultrasound is tomorrow for me... find out if the meds are working!

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