Low AMH but all other tests are within normal range, help!

[Twomommyfamily]

Hi all,

I'm curious to hear some opinions on this. I just had my follow up appointment with the RE to review the testing I had done over the last month. My FSH and Estradiol were in the normal range, antral follicle count was 11 on one side and 7 on the other, and then my HSG appears basically fine, no blocked tubes. My TSH is in the low end of normal, but not sure if hyperthyroid would have any impact, I think hypothyroid is a bigger concern? Anyways, the alarming part was my AMH level- .88, which is low. Not ridiculously low, but lower than the RE expected given the FSH and follicle count. I retook the test yesterday because the RE thought the low level was such an anomally that maybe something was wrong with the test.

If the test is accurate and really .88, she wants to start off with clomid+menopur injectable cycle, if the test was inaccurate and my AMH is within the normal range then she said we could do a clomid only cycle or even a natural cycle. Since all the other test results indicate that I don't have DOR, would it still make sense to start out with an injectable cycle if I have low AMH? I'm worried about overstimulation, risk of multiples, etc. Anyone else have low AMH but everything else in normal range?

thanks!!

[hippiemombian]

Hey there! My DP was diagnosed with low AMH not to long ago also. She was 22 at time time so the RE didn't believe it, but sure enough she does. 

If it were us, we would listen to what our RE suggested. Their job is to get you pregnant, so obviously they want to do what they think is best to get you there. I also wouldn't want to start less aggressive and then have to do it month after month. The medications used to stimulate your ovaries aren't exactly healthy for you body month after month. As far as twins go, we personally would rather have two babies than no babies. I know some people that are the opposite though. 

With IUIs being only at a 20-25% chance of working each month, I would take a bigger risk to increase my odds. But that is just us. We've been at this trying to get pregnant thing for over a year. 

[Twomommyfamily]

Thank you Hippiemombian! That's what I thinking too! I should trust the RE in this case.

[Tammy77]

Hi There,

I hope it's okay that I chime in to share my personal experience. I have DOR as well, but mine was .57 (so lower than yours), and only one functioning ovary and tube. I'm 36 and we'd been TTC for 14 months, two of which were clomid only with my ob (seriously messed up my lining and cm, ugh) before going to an RE. My AFC was 0 on my left side (no surprises there) and either 3-4 on the right side.

Even with my stats, because I did NOT want multiples (my uterus is misshapen, so twins would be a serious complication/risk) she started me out on 5mg of Femara from CD 3-7, trigger shot when my OPK turned positive and my IUI the next day. I was disappointed because after all of that I only had ONE good 25mm egg on my good side, and nothing on the bad one. Well, the first cycle worked! I'm currently 7.5 weeks and we saw the heartbeat at 6 weeks.

I highly suggest taking the conservative route first. Oh, also if you're not on it  yet, try YS Royal Jelly. I took it for 6wks before my IUI and I'm absolutely convinced that it helped to improve my eggs.

At the end of the day, it only takes one good egg, a well timed IUI and a good sample! Good luck!! :)
 

[toothfairy2be]

I would also recommend letrazole if possible over clomid. Not only does it not affect your lining or CM but it also helps to develop one strong egg instead of multiple eggs (like clomid). 

Also there is evidence that having a Vitamin D deficiency can give you a falsely low AMH. Mine was 1.1 before IVF so also on the low side for my age. It is still very possible you will get great eggs. My understanding is too that AMH can change from month to month depending on what you developing for follicles. 

The royal jelly is also a good suggestion, it helps with egg quality for sure.

Good luck!

[tangledblue]

I had very low amh, less than 0.1, and higher FSH than you (over 21) and when I went to the RE and they were looking at my ovaries, they gave me some progesterone just in case while waiting for some other lab results, b/c apparently I had just (barely) ovulated. AF count was lousy.

The progesterone did the trick and helped that (last good?) egg stick and I had a healthy baby 9 months later, so don't give up hope. I scoured the interwebs for stories like this after I got my first labs back, so hope this is helpful for someone. I know I am very lucky. Clomid would have been the next step of course. Also after getting those initial awful labs back, I completely cut out alcohol and caffeine and started eating lots of kale/superfood drinks. No idea if that had anything to do with it but couldn't have hurt. My friend lent me this book that I highly recommend: http://www.amazon.com/Inconceivable-Womans-Triumph-Despair-Statistics/dp/0767908201

Good luck.

[Twomommyfamily]

Thanks for all the responses! I ended up getting my AMH retested and it was 1.47, so higher than before. Toothfairy- I do believe it that AMH can change month to month even though the RE says it is one hormone that supposedly stays stable. But it seems that it still stays within a general range and mine is low/borderline. 

We ended up not doing injectables, but this will be my first cycle with clomid. I've used progesterone suppositories every cycle to lengthen my lp and to try to get the egg to stick. My antral follicle count on day 2 for this cycle was 9 on one side and 11 on the other. (I'm curious what the antral follicle count typically is for women with DOR). I was prescribed 100 mg, but I chose to half it because clomid can thin lining. If this doesn't work I guess we will try the full 100mg dosage, but I'm going to ask my RE about letrozole. 

[Tammy77]

Wow your test results are great! AFC for a woman with true low AMH would typically be less than a total of 7 eggs, so 3-4 on each side.

Truthfully, if I had your numbers I wouldn't even do fertility drugs unless you have documented low progesterone on your 7 DPO draw. Unless of course you're shooting for multiples.

Good luck and keep us posted!