Low ovarian reserve results - very upset, please tell me there is hope

[Honeybee]

Hi everyone

I just got some very upsetting results over the phone - my AMH results just came back as 5.9, apparently it should be at least 14.

I'm not even TTC, still BF with no AF and wanted to do some preliminary investigations to find out if I needed to hurry up, wean DS and start TTC number 2.

I haven't spoken to my FS, am seeing him next Tuesday to discuss. But I just feel so upset and hopeless. I'm now wondering if I will ever have another child.

Please, does anyone have any advice? Is this as bad as it sounds? I'm only 35. Has anyone had low ovarian reserve results and gone on to have a successful pregnancy?

I just can't believe that this is happening

[Arimeh]

I have no idea, but I just wanted to pass on a

[dusty]

Hi HB

You poor thing to be stressing when you have to still wait until seeing your FS . BUT an AMH on its own is only one of a number of tests they would do to measure 'possible' ovarian reserves. I don't know if BF and not having AF may also influence the results as you aren't currently O'ing. Also AMH doesn't reflect anything to do with egg quality, which as you know is as, if not more, important that follicle/egg numbers.

I know its scary not having the answers you want right now. I hope you can balance this result against a whole heap of other factors and tests you would need in order to estimate your possible ovarian reserves. None of this is an exact science, they are used as indicators only.

Try not to focus on what you think may be happening. You have had a bub, hence you can fall pg and the odds are higher in favour of you having another baby and as you say you haven't even tried yet.

Sending you positive vibes.
xx DW

[onthefly]

That must have been very upsetting to hear
Hang on till you can talk to your FS - hopefully like Dusty says this can be balanced against better news elsewhere.
All the best~~

[Honeybee]

Thanks so much for replying Arimeh, Dusty and Marcellus. It came as such a shock, as I had assumed that the test would come back fine. Now I'm wondering if I'm going into early menopause and will ever have another baby.

Dusty - thanks so much for your message. I didn't realise that the AMH doesn't reflect poor egg quality, that makes me feel a little better. The nurse I spoke to said that she was going to ask the head FS at the clinic whether BF might impact on AMH, but the asking around she had done so far indicated probably not.

My FS apparently wants to check my FSH on CD2 before coming to any conclusions about my diminishing fertility. But I have to wean in order to ever get to a CD2. The thought of giving up BF my son in order to try for a baby I might never have is awful. The thought that DS might be my only baby makes me want to keep BFing him for as long as possible

Thanks for your positive thoughts - I did get pg, and it was only two years ago. I guess I'm just scared that since then my body has started shutting down, and maybe even early menopause is on the way. I'm now worrying that my cycles aren't being suppressed by BF, but because something bad is going on.

I think the news has taken me back emotionally to where I was when I was TTC my DS, and the thought of going back there to all that uncertainty and misery is just awful.

I guess will just have to hang on until next Tuesday and get the whole picture from my FS.

Thanks again
HB
xxx

[onthefly]

Honeybee, there's a women at the ABA that's done a lot of research into breastfeeding and IVF - she might have a line on this. Worth giving them a call anyway. I wouldn't be surprised if there's little known about the affects of breastfeeding in these circumstances.

Also, while bf in itself may not affect those numbers, the fact that you're currently not have cycles might (i guess). It is possible to have a normal cycle while breastfeeding and even do IVF without weaning - it just depends on the circumstances. How much are you feeding now? Cutting back might be enough to bring af back - it's a compromise, but would give you a better indication of what's going on without fully weaning (hopefully).

The decision to wean your first to try for another is really hard - especially when there's so much uncertainty about conceiving at all. It's why we put off ttc #2 till DS was 2.

Hope the next week isn't too stressful and you can get some clarity from your FS

[briggsy's girl]

Hun, one of my baby buddies is pg with a baby conceived through IVF while she continued BF her DS - so you don't necessarily need to wean. she had to have two stim cycles to get a healthy embryo and is now about 6, maybe more, weeks pregnant and continues to BF her one year old.

as to the results - i really have no idea, but i'm wondering if the fact your cycle hasn't returned is impacting you at all. hope you can get some answers next week hun

[Honeybee]

Thanks Marcellus and BG.

When I saw my FS last I asked whether I could have treatment and continue to BF. He said it wouldn't be ideal, but wouldn't refuse to treat me if I was still BF. I don't know how happy I'd be taking artificial hormones and BF at the same time, especially as I have a son - it would worry me that the female hormones would get into the milk, and then into him. I am very confused about the whole thing. It's breaking my heart to think about weaning him, he couldn't possibly understand why his source of love and comfort would be cut off. How could I hurt him for the sake of a baby that doesn't even exist yet?

I will look into the ABA woman's research, sounds very interesting. I'm looking up some sleep specialists in Perth, I think I've found one that sounds 'gentle', so I might give them a call and find out what they do.

I only BF to sleep, so really only twice a day. But if he's restless during the night, sometimes he can be sucking on me for ages off and on.

I do wonder whether my absent cycle would affect the AMH levels. I tried googling AMH and BF, but no results. It would be so great if that was causing the low results.

Thanks again girls.
xxx

[onthefly]

There was a thread about the ABA stuff - including link to a podcast

I think the key issue for you at this point is getting your cycles back. The next step would be cutting out night feeding, I guess, and hoping for the best.

On the hormones, it's good to remember that these are normally ocurring hormones through your cycle (though at elevated levels when doing IVF, admitedly). Also, if pregnant you would have elevated E2 and P4 levels, but it is still safe to breastfeed.
The woman in the podcast goes through the main IVF drugs and their risks etc.

[Trillian]

Honeybee, I don't have any advice, but I just wanted to give you some 's and I hope that it all works out just fine for you.

[BellyBelly]

Just a thought - have you tried acupuncture? Its brilliant for helping put the body back into balance, and great for stress too. Make sure the person is experienced in fertility work though, but its great stuff. If money is an issue, you can get cheaper acupuncture at teaching colleges too, they work under supervision of course, so it will be safe...

[Honeybee]

Thanks Trillian xxx

Marcellus - thanks for the link to the IVF thread. I will talk to FS seriously about this option when I see him on Tuesday. I actually feel that the most distressing thing about all of this is the feeling that I have to wean DS really abruptly. It's not so much weaning (although I feel sad about that), but I just don't know whether I could put DS through a really quick weaning process. Poor little mite But then the thought of him being a single child also makes me feel sad.

Kelly - I have been thinking about acupuncture a bit actually. I have a great acupuncturist whom I saw to help me conceive DS, and also to help my labour start on time. He was fantastic! I've put it off because of the $$$ factor, but it might be worth starting to see him again. Thanks for the reminder xxx

Thanks everyone
xxx

[KitKat72]

Hi Honeybee,
Just to answer your initial question, my AMH is barely better than yours -- 6.9 -- and I'm now 8 weeks pregnant. I managed to get lucky on my first round of IVF, which we were doing not really because I had any issues (other than needing to get a move on because of my low AMH!), but because of my DH's poor sperm morphology, which apparently is why we did not fall PG after 6 years of TTC naturally. I hope this gives you some hope!

KitKat72

PS. I did acupuncture during IVF and who knows -- it may well have helped ensure that the embryo "took" on the first try.

[Honeybee]

Hi KitKat72 - thank you so much for getting back to me - and big congrats on your pregnancy. Can I ask what your FS said about your AMH result? Did s/he think that it was really bad? Or just a wake up call that you had to get on with treatment? I am very nervous about what we will be told on Tuesday when we see our FS. But the fact that you got pg with an AMH of 6.9 is very reassuring to me. I am hoping we might do a couple of cycle of IUI with ov induction (which is what we did to get DS), and then go into IVF with all guns blazing.

Would be very interested to hear you experience.

Thanks again

ETA - I would definitely do acupuncture in conjunction with any fertility treatment, I started acupuncture the IUI cycle I conceived DS and I'm sure it contributed.

HB
xxx

[Trillian]

Honeybee, I was just about to toss out an old Cosmo mag I had here and there was an article about 3 women who had the AMH test done and one of them, a 21yo, got a result of 11.3, which is higher than yours, but they went on to talk about that result further and what it meant and the FS they consulted for the story said that the test result could just be faulty and to have it done again, and if the second one came back the same/similar then to investigate with a scan to look at the follicles and test hormone levels - which considering you are still BF could have altered the result (fingers crossed that is all it is). He actually did comment that a result of 11.3 for this 21yo was not really that low when considering that women in their 40's can have levels of 1.0 - 2.0 down to 0.4 and some with even less than 0.4. So maybe this is one of those situations where you should be alert, not alarmed and that when you have it investigated further, things might be OK

[drbeee]

HB, just to let you know that my most recent AMH was 0.5 (I am 42) and I just had a fresh collection where we got three good embies from three eggs. Not huge numbers of course, and we dont know whether I will be pregnant, but my point is that even at 0.5 there appears to be SOME ovarian activity!

Good luck

[Honeybee]

Trillian - that's very interesting! I was wondering if it would be worth having the test repeated. I think I read somewhere that the levels can vary a bit. It sounds like a very new thing, and there is still a bit of uncertainty about what it all means. I am certainly not as alarmed as I initially was, this thread has been quite reassuring. Now I think on Tuesday FS will say that it is best to take action sooner rather than later, but there is still a good chance for another baby. I think I might ask him if it might be an idea to do a scan and see if my ovaries are doing anything. Thanks hun xxx

drbee - thanks for letting me know your story, it's great that you got three good embies with a low AMH. Wishing you all the best for the rest of your TWW, and hoping you get a BFP

Thanks so much everyone for all the support, I'm feeling a lot more hopeful now.

HB
xxx

[KitKat72]

Hi Honeybee,

Just to answer your question, my FS's response was that 6.9 wasn't great -- it does mean lower fertility than a "normal" woman -- but that he wouldn't start to really worry until it got to 3. He said that in his experience, an AMH of 3 seems to be the cut-off where it starts getting a lot harder to get a positive result with the IVF drugs. He did agree, though, that time was of the essence and that at this point we shouldn't dilly-dally around too much longer. We ended up starting our IVF cycle literally days after getting the AMH result, and, as I already said, our cycle ended up with a BFP, so clearly lower fertility doesn't mean NO fertility! And, according to his theory, it would also mean that you have some cause for optimism even with an AMH of 5.9.

Oh yeah, as far as AMH numbers fluctuating, what I've been told was that the reason doctors are switching to AMH testing from FSH testing (my doc doesn't even bother testing FSH anymore) is because FSH can fluctuate, giving women an overly optimistic idea of their fertility if they happen to test it on a "good" month, whereas AMH is supposed to be much more stable. As I understand it, AMH testing is founded on the fact that you are born with a certain number of eggs, and, when those eggs run out, you hit menopause. The eggs that are resting in your ovaries emit the hormone AMH. So the current thinking is that the level of AMH measured in your blood stream is an indicator of how many eggs you have left: supposedly the more AMH measured in your bloodstream, the more eggs you have still hanging out in our ovaries. Low AMH is supposed to therefore indicate that your eggs are running out. As someone else wrote, it just tests quantity; there's no indication that it can tell the QUALITY of the remaining eggs. But because the number of eggs remains stable all month, the AMH number does NOT fluctuate (theoretically, at least), and is accordingly more accurate than FSH testing. (FSH levels rise and fall over the course of the month and can fluctuate from month to month, making any one FSH test less accurate as an indicator of fertility.) Instead, the thinking is that AMH steadily declines as you release your eggs. So why don't we all have similar AMH levels when we're the same age? What I have read is that some women are born with fewer eggs or simply go through more eggs each month as their ovaries get ready to ovulate; those women lose their eggs quicker and will have a lower AMH earlier (and theoretically will hit menopause earlier). I think the bottom line is that IF the current understanding on what AMH signifies is true, then you can't just assume that if you re-test AMH you'll get a better number, because the numbers should only go in one direction -- down.

Now, not everyone believes that the current thinking on AMH/low fertility is correct. There is a fertility clinic out of New York City called the Center for Human Reproduction (you can Google them) that has been experimenting with prescribing the hormone DHEA, which is available over the counter in the US but only by prescription from a compounding chemist here in Oz. Based on their observations with patients who have taken DHEA, the doctors at this clinic believe that DHEA can help increase fertility in women who test as having impaired fertiity. The doctors there have posted a number of journal articles and other literature that they have published based on their success with DHEA supporting their view that women with low fertility may have greater success conceiving if they take DHEA for 3-4 months in advance of TTC. Based on their observations, these doctors state that they now think that the current thinking on the cause of lowered fertility is WRONG. They have come up with a new theory that declining fertility is not primarily a matter of the eggs running out or essentially going "stale", but of the ovarian environment itself becoming less friendly to the eggs as we age, based on declining hormones (sorry if I'm not getting the details quite right -- I read these articles a couple of months ago, but, from memory, this is the gist of what their new theory says). The poor environment around the eggs, according to their theory, is what causes the eggs to age. So, their current theory is that DHEA helps keep the ovarian environment young by maintaining hormone levels where they should be, leading to better egg quality and, accordingly, enhanced fertility. So even with fewer eggs, you get better results.

Note that their theory is currently only that -- a theory. And their theory contradicts the current consensus in the medical establishment, although, as they point out, the fact that the medical establishment thinks a certain view is right does not mean that it IS right: for example, the medical community thought that ulcers were caused by stress and laughed at the theory that they were caused by viruses (or bacteria -- I forget which, sorry) until those Australian researchers proved that ulcers were caused by a bug and could be treated with medicine a few years ago. So the fact that the CHR's view contradicts "normal" thinking on fertility does not necessarily mean they are wrong. The big flaw is that, as this clinic itself states, they have not been able to do double-blind studies because, with their reputation for getting sub-fertile women pregnant, none of their patients want to risk being in the group that doesn't get DHEA. So their pregnancy success rates on DHEA do not have a comparable non-DHEA measure for a similar patient population to show that the DHEA is what caused the result. That said, in the US it sounds like a number of doctors now are prescribing DHEA to maximize the chances of success in women like us. In Australia, however, the use of DHEA to increase fertility remains highly controversial. Some doctors are willing to let patients who ask for it try it (remember, here in Oz you need a prescription for it), but many other doctors absolutely refuse to prescribe it since its utility has not been proven in the traditional double-blind study. As far as side effects, my understanding is that there is no evidence that DHEA can cause major harm, but, in large doses (larger than the amounts used in the CHR's regimen of 3x25 mg per day), DHEA can cause women to have increased testosterone levels, causing them to develop pimples and masculinizing characteristics like a lowered voice, increased hair growth, etc. If you are interested exploring this treatment further, you can go onto the CHR website and read some of their literature. Maybe you can print out some articles and ask your doctor about them.

As for me, I asked my FS about it after learning about DHEA and he said that he had heard the anecdotal evidence that it could help but had never tried it on a patient before himself. He told me that it wasn't part of his or my clinic's standard fertility treatment regimen, but that he wasn't against letting me try it if I wanted to. He said that no previous patient had wanted it badly enough for him to write a prescription, but that he would give me one if I wanted. So we decided that, if my first IVF cycle didn't work out, I would try it. However, since I did get pregnant from my first IVF cycle, I didn't need it. I do plan on trying it though before we try for #2 (assuming that my current pregnancy continues to term successfully). Since I'm American, it will be a little easier for me to give this a shot since I can pick some up next time I'm in America (although I think it's illegal to bring it into Australia without a permit -- hmm). But it's only about $12 for a bottle in the US, whereas here on the Gold Coast I'm told that the local compounding chemist charges something like $75 for a month's supply, so we shall see . . . Note that in the US DHEA is considered as something of a "fountain of youth" pill since it also supposedly helps maintain muscle tone, helps lower the body-fat percentage, and supposedly keeps the brain alert. It's been getting a lot of press in the US now for a couple of years. I don't know if this is just a fad that will die out eventually or not, but at least the fact that a lot people are using it without news emerging of any serious adverse reactions provides some reassurance that it is relatively safe.

By the way, I think there are some threads on here where women who have tried DHEA have written about their results with it. Some people found it useful, and some women say that it did absolutely nothing for them. So I'm certainly not saying that it's a miracle drug or will definitely help you, but it might be something that you might want to look into since you are obviously concerned about your AMH level and fertility. BTW, I have no idea how DHEA would interact with breast feeding. Since it is an androgen -- a hormone precursor that is broken down into other hormones like testosterone by the body -- I would theorize that the DHEA itself wouldn't get into the breast milk at all, but I really have no idea so you'll have to ask your doctor about that.

Good luck, whatever you decide to do!

KitKat72