# 44 and low AMH



## Knockers71 (Aug 30, 2015)

Hi I'm new here, I'm 44 and have an eight year old son but have been unable to concieve since then. We have been looking into IVF abroad and going through all the pre tests. My fsh is 10 and progesterone normal showing I ovulate ( periods are like clockwork and I have signs of ovulation every month) but today I got my AMH level results- 0.8. Does this mean it's all over for me? Is there no point in going for IVF? I have been in bits today


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## Spanglyboo (May 18, 2014)

I'd speak to a clinic and see what they say. They are all different so choose and couple and see what their views are


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## Lilly83 (Jan 19, 2012)

Hello 

Sorry to here your news on your AMH 

Do you know if it was measured in pmol/l or ng/ml? UK tend to use pmol, if it is then yes it is low in afraid, but there have been ladies who have had IVF success and even natural pregnancies with similar levels but it does reduce your chances,  your FSH isn't too bad though, it's preferable to be under 10 but it can fluctuate whereas your AMH tends to stay steady/gradually decline. Do you know what your AFC is? If you are thinking of trying own egg IVF do check what levels clinics want you to be at, mine wouldn't let me cycle with AMH of 2.2 and FSH of 23, I did with AMH of 2 and FSH of 9 though. A lot say AMH has to be over 2 and FSH under 10. If you have a low AMH they usually want to aggressively stim you but with a high FSH they can't

You could also look into natural IVF where the aim is to just get the one egg? Some clinics abroad have great success rates for ladies with low reserve and are more flexible on levels 

L xx


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## Knockers71 (Aug 30, 2015)

Hi yes it is in pmol/1. I haven't had AFC done but am having a scan on Friday so may find out then. I was going to go with Gynem in Prague but don't know what their views are on AFC levels, I can't find any info on their website and they haven't got back to me. 
I might ring them tomorrow as I just want to know now! Thanks for your replies, nicola x


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## Rosalind73 (Apr 25, 2012)

Hi Knockers (great name by the way), sorry to hear you've had some bad news re your AMH. Personally I think you may well still be able to produce a couple or a few eggs, but your biggest problem will be your age and associated egg quality.

I don't mean to frighten you, but roughly 20% of the average 40 year old woman's embryos are chromosomally normal, and the data for over 42 year olds is between 5 and 8%. The latter statistic is of PGS IVF cycles which have biopsied day 3 embryos, so bear in mind it is probably from a smallish sample of women aged from around 43-44 (as not that many people do PGS and I remember reading there is little data for women over 43). Also, it's of women who have managed to get to egg collection, whose eggs have fertilised and resulting embryos have survived to day 3 - so will be a higher figure than that for IVF success rates (live births) for 44 year olds. Worth looking on the HFEA website to see what the UK stats are.

That's not to say you won't be able to find that golden egg if you can keep trying and there are many examples (including on this forum) of women who have got pregnant with OE at your age. It just depends how many IVF cycles you want to put yourself through.

Have you read these threads? They might be helpful:

http://www.fertilityfriends.co.uk/forum/index.php?topic=339945.0
http://www.fertilityfriends.co.uk/forum/index.php?topic=339620.0

Good luck with whatever you decide to do.


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## Knockers71 (Aug 30, 2015)

Hi Rosalind thanks for the links. I think we only want to have one go at IVF with my eggs, we don't have the finances to do more cycles and I don't want to put my body through it. If it fails we will rethink and either stay as a 3 person family or try and save up to use DE. At least there's no rush with that. 
Thanks for your help, nicola


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## Blondie71 (Oct 26, 2011)

Hiya have a look at tandem cycles too as that can be an option of trying with your own eggs and donor to back you up if they don't work, it would mean not having to go away and save up again if you've already got your head round the possibility of using donor eggs??


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## Knockers71 (Aug 30, 2015)

Hi blondie, I think I want to give my body a chance first before I think about donor eggs, havent got my head round that yet. Besides, the ciinic where I'm going ( Gynem in Prague) doesn't appear to do tandem cycles and we can't afford it at this stage either. Thanks, nicola


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## urbangirl (Jul 28, 2010)

I wouldn't take much notîce of the amh since you only want to do one cycle anyway, just see how many follicles there are at the scan.  Amh is more of an îssue for women just starting out and wanting a family of more than one. Some consultants presume all the eggs are 'bad' bcause they're the last ones but I don't think there's any actual evidence for that. AFC changes wildly month to month, on an amh of less than half yours I've had everything from 3 to 15.
Re Czech Republik- you're unlikely to find a clinic there willing to treat women approaching mid forties for OE. Best of luck if you go for it.


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## Knockers71 (Aug 30, 2015)

Hi urban girl thanks so much for your reassurance. I haven't had a scan to see the follicle count yet so that's the next hurdle. We're going to gynem in Prague so hopefully they will be ok with going ahead. 
Thanks, Nic


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## Sunny002 (Oct 31, 2015)

Hi Knockers71,
Did the doctor not give you an option to take DHEA to increase your AMH?
2 months ago mine was 0.6 it's now 1.3 and climbing with taking the DHEA & CQ10.
I'm 43 I've had 5 miscarriages all with heart beats within 2 yrs then since the last one 12 months ago I haven't been able to get pregnant at all so here my IVF journey begins.


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## Rosalind73 (Apr 25, 2012)

Hi Knockers, I'm afraid there is considerable evidence that egg quality declines with age - sharply after 35 and rapidly after 40 - although that's not to say you won't find that golden egg if you're willing to keep on trying (or you never know you might just get lucky).
Also I was told by the Lister that the latest evidence shows that DHEA does not increase AMH (and there has been pretty poor quality evidence up until now anyway), but there's probably no harm in trying it (although I think there is some concern about it and seem to remember the doc mentioning that also, so I would double check). Along with CoQ10 which I think is completely benign.


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## Blondie71 (Oct 26, 2011)

What about melatonin for egg quality Rosalind, any thoughts? I keep seeing it mentioned lately.


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## Knockers71 (Aug 30, 2015)

Hi Sunny I'm taking DHEA on the advice of the doctor, fir two months and aspirin. He wanted me to delay IVF until I've taken them for 2 months. I take co enzyme q10 too already. That's great to hear your AMH has increased! Sorry about your miscarriages x and thanks for the advice x


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## Sunny002 (Oct 31, 2015)

Hi Knockers71,

It looks like we're in the same boat, my clinic also told me to continue with all these meds (including asprin)for 3 months prior to starting IVF. Apparently that's how long the DHEA takes to increase to a level of which they will start (2.0) Out of interest do you get your testosterone tested monthly? 
I'm actually feeling very positive now & have my fingers crossed for a BFP in time for Christmas. 
Lots of luck & wishes to us all xx


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## Rosalind73 (Apr 25, 2012)

Hi Blondie, I haven't really heard anything about melatonin. 

To be honest I don't think we can do much about whether our eggs are chromosomally normal or not - that is pre-determined, and is our greatest problem as we get older. However maybe there is some way of improving our reserve each month, making our eggs more likely to fertilise or our embryos less fragile (better morphology). But as of yet there doesn't seem to much evidence of anything working - not that I know of anyway.

Having said that I took CoQ10 before my last few IVF cycles - just in case there was any benefit and because it's harmless.


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## urbangirl (Jul 28, 2010)

I don't think DHEA is expected to increase amh, one of the things it is said to do is reduce the number of follicles going into atresia so you end up with more usable ones. As for 'old eggs' I don't entirely agree with Rosalind on this, the eggs are in arrest for, say 40 years since this is an over-40's thread, doing absolutely nothing. Suddenly they get the signal to come to life and unfortunately the ovary is not the perfect organ it was 20 years earlier. Hence the eggs are much more prone to aneuploidy.  There are things that can be done to improve ovarian environment, avoiding chemicals known to have negative effects such as hormone disrupters etc. I'm not saying all our eggs would otherwise be fine, but more of them.


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## Rosalind73 (Apr 25, 2012)

It's true that it's a bit more complicated than I originally stated, but there doesn't seem to be any evidence for environmental factors causing aneuploidy i.e. chromosomal abnormalities in our embryos. From this paper: http://hmg.oxfordjournals.org/content/16/R2/R203.full

"Are there predisposing factors to human non-disjunction {aneuploidy}?
Since the identification of the first human aneuploidies, investigators have been interested in identifying predisposing factors. This has led to tests of a wide variety of possible associations, including occupational exposures (e.g. pesticide applicators), medical treatments (e.g. radiation therapy), reproduction-related products (e.g. oral contraceptives), habituating agents (e.g. cigarettes), miscellaneous environmental exposures (e.g. toxic waste sites) and intrinsic factors (e.g. polymorphisms in folate pathway genes). However, these efforts have been remarkably unsuccessful, and maternal age, aberrant recombination and the occurrence of a previous trisomy (26) remain the only three factors incontrovertibly linked to human aneuploidy."

To look at it in more detail, women's eggs undergo a number of stages in their development, including meiosis, a type of cell division. I quote from this website: http://biology.stackexchange.com/questions/954/does-human-female-meiosis-ii-occur-after-fertilization-with-sperm

"Primary oocytes are formed prenatally and remain suspended in prophase of meiosis I for years until the onset of puberty. An oocyte completes meiosis I as its follicle matures (during ovulation) resulting in a secondary oocyte and the FIRST polar body. After ovulation, each oocyte continues to metaphase of meiosis II. Meiosis II is completed only if fertilization occurs, resulting in a fertilized mature ovum and the second polar body. So in short, the egg is stuck in metaphase II until fertilization."

Again from the Human Molecular Genetics paper: "We know that most aneuploidy derives from errors in maternal meiosis I, that maternal age is a risk factor for most, if not all, human trisomies".

They continue: "Beginning in the 1980s, several groups initiated DNA polymorphism studies to determine the origin of human aneuploidy...three general 'rules' of human non-disjunction emerged: first, regardless of the specific chromosome, most trisomies originate during oogenesis {the creation of an egg}; second, for most chromosomes, maternal meiosis I (MI) errors are more common than maternal meiosis II (MII) errors; and third, the proportion of cases of maternal origin increases with maternal age (3). However, against this background, chromosome-specific differences in non-disjunction have become apparent. For example, maternal MI errors predominate in trisomy 21, while trisomy 18 typically involves maternal MII errors"

From what I've read, it seems that an abnormal spindle (a component of eggs involved with organising the chromosome pairs so that proper division of the pairs can take place) in an older egg - rather than an older ovarian environment - is what predisposes development of errors in maternal meiosis and thus chromosomally abnormal eggs. Have a look at this: http://www.advancedfertility.com/age-eggs-chromosomes.htm

"17% of the eggs studied from women 20-25 years old were found to have an abnormal spindle appearance and at least one chromosome displaced from proper alignment.
79% of the eggs studied from women 40-45 years old were found to have an abnormal spindle appearance and at least one chromosome displaced from proper alignment."

This post contains an unconfirmed link/information and readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites


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## Blondie71 (Oct 26, 2011)

Interesting stuff Rosalind!! I'll be able to tell you in a month or so if my old eggs (40 at conception) have led to any chromosome issues with my boys as they have just taken lots of blood from them for genetic testing, I'm a bit nervous about it all as think I'll be on a guilt trip forever


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## Rosalind73 (Apr 25, 2012)

Hi Blondie,

I can just imagine your nerves - what are your boys being tested for? Are they having their karotype done i.e their chromosomes checked? Or are they being tested for a particular genetic condition?

There are many genetic diseases/conditions that are not caused by chromosomal abnormalities, rather mutations on specific genes. And even if they are being tested for a chromosomal abnormality, aneuploidies are not the the only type of chromosomal mutation, and maternal age is not the only factor (although a significant one) in predisposing someone to producing embyros with aneuploidies.

In other words there are lots of other genetic problems that are nothing to do with a mother's maternal age. Besides, most aneuploidies are incompatible with life and result in miscarriage so I imagine your boys are probably being tested for something else.

So I'm sure you won't need to feel guilty.


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## Blondie71 (Oct 26, 2011)

They have had some delays to do with speech & gross motor skills (motor skills are excellent now though) and autism has also been mentioned as a possibility though too young yet to determine, so they are going to check all chromosomes, thyroid and also metabolics test, I'm not really that clued up on all of this tbh so I just hope everything checks out ok x


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## Rosalind73 (Apr 25, 2012)

I know very little about is as well, but again I doubt it's anything to do with your age. 
Fingers crossed all will be okay.
xxx


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## Knockers71 (Aug 30, 2015)

Do any of you guys recommend any clinic in particular? I've been in contact with gynem in Prague but they haven't got back to me in weeks. I sent them details of a scan which showed one of my ovaries is Polycystic, I don't know whether they think I'm just a lost cause now!


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## Altai (Aug 18, 2013)

Knockers- I think you have to be persistent with the clinics. I got the same attitude from most clinics tbh apart from Serum. Cz especially as they are very much de oriented and as for the rest probably the same and also none wants to spoil their stats as chances like you said are really low.  
But as I understand they can't say no, so if you happy with the clinic  worth pushing. I did. 
I already posted on the other thread - worth trying Serum in Greece as customer care is excellent. I was following their clomid banking cycles thread as was doing embryo banking as well. as I could see only over 40 women have got preganant after that. So looks  very promising. 
But think Cz clinics are good as well. 

Blonde - sorry to read your new. Hopefully all turned out to be ok after all. But good thing it's been noticed early on. I am harbouring some similar thoughts what if something will  not be right because of my age ever since I got news from my uni friend. Her daughter's been diagnosed with autism but she realised it quite late. 

Rosalind - how are you? Hope all goes well. 

Hugs

A.


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## Knockers71 (Aug 30, 2015)

Hi Altai thanks for your reply. 
What sort of cost is IVF at serum? I can't find any into on their website. 

Thanks, nicola


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## Altai (Aug 18, 2013)

Knockers - it was € 3k for one cycle and € 4k for the package of 2, exc medication.  I don't think prices have changed since then. But I was cycling with them a year ago, so worth checking. If you pop into serum thread  under international section board, somebody will be able to help you. 

Best of luck.

A.


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## Rosalind73 (Apr 25, 2012)

Hi Knockers,

If you're having treatment in London I would recommend the Lister. If abroad, I would recommend Embryogenesis in Greece. I'm recently back from there after having done a CGH (PGS) cycle. Luckily it worked out well for me and I'm now pregnant. Prices are similar or perhaps a bit lower than Serum. Just PM me if you want more info.

Altai - I'm good,  thanks for asking. Am now 18 weeks pregnant, but still can't really believe it or get my head around it be honest. Congrats again on your continuing pregnancy - you're just a few weeks ahead of me!

I meant to get in touch with you anyway as am planning to try and organise another single ladies meet up in London if you fancy joining us? I'll put a post about it on the singles board.


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## daisyg (Jan 7, 2004)

Hi Blondie,

Just wanted to let you know that you can PM me for a chat off board if you like.  I have congenital issues and autism with my twins.
I would be happy to chat if you ever need to.

Hang in there,
D xxxx


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## Altai (Aug 18, 2013)

Rosalind-- congratulations. What a great news! Yea, I know what you mean - I was even scared to post too much in case something goes wrong. I only told couple  of my friends that I got pregnant at around 12 weeks.  All other I told last week. 

I will respond on the singles board.

Hugs

A.


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## Rosalind73 (Apr 25, 2012)

Thanks Altai. And ditto about telling people. I've only really just started mentioning it in any posts on here, and like you only told a few of my friends initially. Still haven't really told most of the rest of them yet (but am just starting to now).

Hugs to you too

P.s. Knockers - sorry to have diverted the thread a little. How are you getting on with clinics?


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## Knockers71 (Aug 30, 2015)

Hi Rosalind that's fine don't worry! 
I heard back in the end from gynem and they said my protocol would stay the same despite the cysts. But I have another issue now, I will come into a little bit of money next year as my grandpa just died, so I am considering whether to do a tandem cycle somewhere instead of cycling once with my eggs which is unlikely to work, then having to do it again with donor eggs. We won't have money to do more than one cycle so we want to give ourselves the best chance of one cycle work. So now I'm looking into clinics which do tandem cycles as gynem don't do them!
Back to square one really!


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## Altai (Aug 18, 2013)

Knockers  - I think there is a clinic in Cyprus that does tandem cycles. But most clinics don't do. Probably there is a reason for this as success rates with tandems are lower. it's  almost impossible to synchronise recipient' and donor cycles and  one of you likely end up responding quicker to stimms  than the other, thus potentially leading to defective embryology/ transfer. You need to maximise your chances by every little you could get, not to minimise given that you might only have one go. Donor cycles don't have 100% success rate unfortunately.

But I think most clinics do combo de/oe cycles where you & your donor stimm separately. For example, your donor stimms  first & freeze all embryos. Next month you start your IVF and transfer your embryo & donors. 

That's what im planning for a sibling as have 2 frozen oe  blasts. I don't want to destroy my embryos (given all the effort & money spent on creating them). But will go directly to combo to maximise the outcome and give my embryos chance( not that I have high hopes but who knows)....

Good luck

A.


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