# just diagnosed with blocked tubes and low amh and feeling so sad



## catgarvie

Hi there,
In the space of about two weeks I have been diagnosed with two blocked tubes (confirmed by lap and dye) due to ruptured appendix and told I have a 'disappointingly low' AMH level (7.1) level which doesn't make me a good candidate for IVF.  I am reeling and looking for any advice/support as I try to gear myself up to begin IVF regardless next year (I've also been offered tubal surgery but it's a major op, the success rates aren't great and the consultant tells me if I'm ever going to do IVF I need to do it now before my AMH gets any lower).  I just turned 33 and I guess the AMH was the worst piece of information: I'm told this means I have really low ovarian reserve for my age (despite my low FSH, which they're now telling me might be 'suppressed by estrogen'?) and that I won't even be able to do normal IVF as I won't produce many eggs but will have to do a specialized 'short protocol'? (Excuse my ignorance on these matters; I don't know much about IVF yet and am reeling from this double whammy).  Could someone advise me as to how bad my outlook is? I'm feeling so sad and low right now and finding it hard to keep positive.
Thanks so much in advance to anyone who has the time to write back.


----------



## debsxxx

Hi there im kind of in the same boat as you. About 2 years ago i was luckily enough to fall preg with my 1st. Well untill i have the worst pain ever only to find it was ectopic. I didnt have a clue at the time i mean i wasn't even trying for a child. To cut a long story short both my tubes are very damaged which are no use to me. As i can imagine you feel awful i no i do everyday. I have just been refared for IVF at St.Marys Manchester so will see how i get on from there. But dont give up hope there should be some light at the end of the tunnel xxxx


----------



## livity k

Hi Hun, 
What a load of difficult information to get in one go,    

Your AMH is low but not awful and I know here are people that have got BFP's from that level- I'm sure there is a thread about it on here somewhere, One of the girls from our clinic with an AMH of 4 ish was told it would be difficult but not impossible and they are very realistic and would not give false hope, 

Another person from our clinic is pregnant and I think her AMH was about 8- 

The short protocol is fine, I had it as I responded oddly to long one and its easier in some ways as you don't take drugs to suppress your ovaries first, I think you take the pill, and then start the stimulating drugs, it means it feels like everything happens quite quickly which is a bonus in my eyes, 

Another thing- (and I could be wrong about this but it makes sense to me) even if you have a low ovarian reserve, the eggs you do have are relativley young at 33- so should be ok quality and its quality not quantity that counts, Another person from our clinic (whos 32) is preg with twins after her cycle was nearly cancelled due to poor response, she got 4 eggs in the end and now two babies, 

I hope this is abit reassuring for you, its a tough journey with a lot of unknowns, 

here's to 2010 and some good news! 

Livity K x


----------



## amanda_hd

Sorry to hear your news  

Just saw your post and did not want to read and run.  I am not an expert with AMH results unfortunately but i am sure someone with more of a clue will post soon enough.

Just wanted to give you    for your treatment in 2010.

It was almost 7 years ago that we were given our news and I can't properly describe how life changing and mind blowing the news was, give yourself time to digest - you are bound to be feeling sad.  Back in January 2003 i wanted to world to just open up and take me away from all that i was going through.  If only i had a crystal ball i would have seen how much in my life i had to look forward to as thankfully treatment was very kind to me and gave me my longed for family.

Arm yourself with as much information as you can and try and keep your spirits up (i know that its not an easy task).


Amanda


----------



## Ceri.

catgarvie and welcome to Fertility Friends 

    Undertaking IVF is hard enough on its own, but with the added pressure of being told that your egg reserve could be low is hard, you're not on your own though hun  You'll get masses of support and advice from ladies here going/who have gone through the same. If you tap 'AMH' into the search facility of FF you'll see a whole host of useful topics to read (and some success stories too) To narrow the search down to be a little more specific just tick the box which says 'Search in topic subjects only ' 
Please have a good look around the boards, feel free to post in any area, and make yourself at home. Fertility Friends is such a huge support. There are many who are on their TTC journey, and others who have been fortunate to have little ones with assistance. You will soon discover that our members are very encouraging of one another and offering advice or just simple hugs. There's a vast amount of information here for everyone, so start reading, posting and getting to know others. You will make some great friends too (add them to your buddy list in your profile!), lots of members often have meet ups locally too, for chats, coffee, shopping or even nights out! You can share conversations with one another freely, simply because we all understand each other. It's hard when family and friends don't fully comprehend what this journey entails and the emotions that go with it. That's where we come in!

Here are some links which you should find really useful at the moment&#8230;&#8230;

*What Every New Member Needs To Know (includes a list of common abbreviations) ~ *   CLICK HERE

*FERTILITY GUIDES ~ *CLICK HERE

*Investigations & Immunology ~ *CLICK HERE

*What can improve egg quality and quantity ~ * CLICK HERE

*Tubal Factors ~ *CLICK HERE

*Questions for your first cycle consultation ~ (use the ones that apply) *CLICK HERE

*A Rough Guide To IVF ~*   CLICK HERE

*IVF General ~ *CLICK HERE

It _may _ be discussed about the option of donor eggs at some point. IF this is the case it might help to have a read on this thread  
*Donor sperm/eggs ~ *CLICK HERE

Its not all just serious stuff here, you can also have a bit of fun or just gossip while you are on FF too so check out the general chit chat / jokes / hobbies area:

*Girl & Boy talk - Community & Fun Board ~ *CLICK HERE

You can also chat live in our excellent chat room. We have a newbie day in the chat room every Wednesday where you can meet one of our mods for support, meet other new members and get technical support with navigating the site and using all the functions available here.  CLICK HERE FOR INFO ON NEWBIE CHAT 

You can also "meet" and chat with people in your local area through the *Location boards*. This is especially useful to find people who may be using the same clinic and or in the same PCT area. It's a small world!

Wishing you lots of luck    and 
Keep in touch
Ceri xx


----------



## catgarvie

Wow - thanks so much to all for the swift responses.  I wasn't even sure I'd get a response so I'm amazed how kind you've all been to reply like that.  I guess I'm not as alone as I feel (it's just everyone I know seems to have got pregnant the month they came off the pill!).  Livity, thanks so much for the encouragement about the twins with only four eggs - I will definitely try to keep that at the forefront of my mind.  I have also only just turned 33 (in fact, I got all of this awful news on my birthday - great present!) so maybe the quality over quantity thing is something I can try to hold onto!
Thanks again
CG x


----------



## Momito

Hello Catgarvie

I´m sorry to hear of your double whammy...but don´t despair...my AMH is much worse than yours...at its highest 5.7 and at its lowest 0.99...so it can fluctuate.

Us poor responders are not the best candidates for IVF it is true, but as someone else has pointed out, you are still young and so probably your eggs are in good condition.  As a serial patient with lots of failures behind her, I´ve been lookinig into something called Mini-IVF or minimal stimulation IVF.  The approach is different: instead of trying to force women with low ovarian reserve to produce eggs that aren´t really there by pumping us with drugs, they look for quality over quantity and offer low levels of stimulation over a period of say 2 or 3 sessions  (less drugs = less expensive treatment too).  They harvest and freeze as they go along in order to build up a bank.  I´ve looked into a few clinics: there is one in London called Create, but they are quite expensive for 3 sessions (although being a lot younger than me you may not need so many).  I´ve been most impressed with the feedback and info offered by a clinic in New York, the New Hope Fertility Center, where they seem to have pioneered the process.  It is much cheaper, but of course one has to take into account the cost of flights, accommodation and time spent away from home.

I hope that this gives you some cause for feeling a little bit more optimistic about your situation.  There are new treatments out there and pioneering approaches as doctors find themselves facing the same problems which force them to look for different solutions.  We´ve found that we have had to educated ourselves as we go along and if you feel doubtful about some advice given to you, keep looking for answers.

Lots of luck to you

Momito
xxx


----------



## Mazza1971

Hi Cat.

Well that wasn't the best birthday present was it!

My AMH is also low at 6.1 and although I haven't acheived a pregnancy yet through IVF, it has been acheived by several people with much lower AMH results on FF. The problem is with people like us is that we don't produce enough eggs to play around with!

On my first attempt at IVF I only produced 2 follicles so it was converted to IUI which wouldn't be an option for you due to your blocked tubes (but really it was like putting £1,500.00 down the drain!) On my second attempt I produced 3 follicles but on my scan 2 days before egg collection we only thought there was 2. Obviously it is nerve racking as even if you produce the follicles you don't even know if there are any eggs in them! Fortunately for me they retrieved 3 eggs and 2 fertilised and 2 were transferred on day 2. Unfortunately it didn't result in a pregnancy but I did feel quite pleased that I had at least got that far!

I am about to embark on another short protocol in January and am currently taking the contraceptive pill (ironic isn't it) so that they rest my follicles for a month and then hopefully they will get a better result when I stimulate me. I will also be on the maximum stims. As I only have 6 antral follicles, the maximum number of eggs if all follicles grow will be 6!

It is really difficult when everyone around you is getting pregnant (especially when it all seems to easy for them) but you do realise when you trawl this site that you are not alone and there are lots of people with very sad stories to tell and loads that have triumphed when they thought it was all over for them.

I wish you well on your journey and hope 2010 is the year that you get a BFP!!! and your 34th birthday is one where you are a Mummy!

Love Mary xx


----------



## Jumanji

Don't want to gatecrash your thread but I honstly do not think your AMH is too dreadful AT ALL!!

Please see my post below which is essentially one I have posted before. A lot of labs and clinics, especially in the US, would regard your AMH as entirely normal! Note that your result is in pmol/l - some of my post refers to the ng/ml scale, more commonly used in the US. You have to divide your result by 7.14 to get it on the ng/ml scale so you are pretty much spot on 1!!

Also, please do not think that AMH or FSH tell the whole story. My sister had terrible FSH and her clinic told her not to even bother getting her AMH done since with FSH that high it was bound to be atrocious. But she ended up with 5 eggs (not a vast haul but not bad), 100% fertilisation, 5 Grade 1 embies, twins and a couple of frosties! That's a result that anyone would be thrilled with, even those with stellar hormone results!

There are LOADS of success stories out there with much lower AMH than yours. One lady on this site has triplets and her AMH level was 2 point something on the same scale as yours so much lower than you.

I know all this is a shock and upsetting but I don't think your clinic is correct if they are implying that your AMH is somehow disastrous. It really isn't! 

Here is my post...

Bascially, I think there is still a LOT of confusion about AMH and what is "normal" and, to be honest, I don't think even the best in the medical profession have enough data yet to know what it all means. Hence I really do not think anyone should panic over the results of one tests.

The first thing anyone should find out is what scale their AMH result is on. The pmol scale has higher numbers and the conversion factor is 7.14. Hence, if your result is 1 ng/ml that is 7.14 on the pmol/ml scale.

The assay kit link (next but one link below) is the source of the "original" AMH ranges which everyone jumped on as representing the "norms". They are 2-6.8 on the ng/ml scale and 14.28 - 48.55 on the pmol/l. This is the scale which had people with AMH of say 1 (or 7.14) being told they had "low ovarian reserve". It was also the source of the statement that "optimal fertility" is about 28-48.55 pmol/l (3.92-6.8 ng/ml), while "satisfactory" fertility is 15.7-28 pmol/l (2.2-3.92) - see this scary link if you want to be really depressed http://www.tdlpathology.com/index.php?option=com_content&task=view&id=201&Itemid=73. This sample also gave a mean AMH of 4. But look at the sample they got this from. First, the size is small (335) and ALL the women are under 38 so chances are we know they probably mostly in their 20s! (I remember reading elsewhere that a lot were college students and thus 18-23 or so but I can't find the link now!). To be fair on the assay manufacturers, they clearly never intended their results to be taken as "norms". They do point out that AMH decreases with age and that suggest labs should find their own ranges. The trouble is many have not done that and simply trot out this reference range, with no idea where it comes from!!

http://www.mbl.co.jp/diagnostic/products/amh/AMH_nousho.pdf

Other research has found that in women of 37 the average AMH was 10 pmol/l (1.4ng/ml). This has 238 subjects but I don't know the numbers in age ranges. Anyway, it did find that AMH remained at about 20-25 pmol/l from age 18-29 (so satisfactory but not optimal according to the frist link above!!) and then started to drop. Again, this is beginning to show lower AMH is still ok, especially for those over 30 and that even in those in their 20s, the average still looks lower than first thought. See the next link.

http://www.ingentaconnect.com/content/bsc/ajo/2005/00000045/00000001/art00006;jsessionid=o9h2pdwmbk56.alice?format=print

This next study was small (only 20) but the mean age was 26 and the mean AMH was 2.4 ng/ml - this again suggests that even in young women typical AMH levels may not be as high as first suggested. The study also specifically notes that two women aged 33 and 35 had much lower AMH results (1.2 and 0.39) than the rest. Note that this study was not in infertility populations - just individuals with normal hormones in all other respects, normal menstrual cycle, BMI etc. See the link below.

http://humrep.oxfordjournals.org/cgi/content/full/dem101v1

The next one was bascially showing that ladies with PCOS have higher AMH which declines more slowly than in control groups, but look at the control stats. Again, it's only a small number (41) but the study looked at the decline in AMH over time and consisted of 2 visits. The mean age at visit 1 was 29.9 and the mean AMH was then 2.1 ng/ml (written as ug/l here but it is the same). At visit 2 the mean age was 32.9 and the mean AMH was 1.3ng/ml. So these "control" ladies would have, on average, had low ovarian reserve by their second visit according to the first stats. Even in their first visit, they are only just "satisfactory" on average!! See below link.

http://humrep.oxfordjournals.org/cgi/content/full/19/9/2036

Repromedix is a bis US lab and was the original supplier of the "mail order" AMH test to women in the US wanting to see how much time they had!! It was marketed as the "plan ahead" test or something similar. Personally I think it is very misleading to suggest a blood test can possibly tell anyone how much "time" they have left!! But, moving on from that, Repromedix will have got a lot of data from having supplied this. Take a look at what they consider normal!! It's right down - bascially from 0.7-3.5 on the ng/ml scale, which is 5-25 on the pmol/l scale is to them "normal" with 0.3-0.7ng/ml (2.14-5 pmol/l) being "borderline low" and 3.5-5 ng/ml (25-35.7 pmol/l) being "borderline high". This has shifted the goalposts considerably!!! In this regard, I know that the Glasgow Centre from Reproductive Medicine regards 5-15pmol/l as normal and 15 and above as high. This fits in with the Repromedix scale. Clearly things are shifting here!!! I think this demonstrates how experience of AMH ranges (not just reading a supposed "norm" off a sheet with no understanding of its source) is all important.

http://www.repromedix.com/pdf/AMHbL17CF181.pdf

More recently, CHR in New York has introduced "age specific" AMH levels. As I noted above, the scale that much of the UK uses is dervied from a very young sample population so women over 35 are judged on a wholly inapplicable scale. Plus, research clearly suggests AMH declines with age and yet most women are still fertile at 40 so a certain amount of lowering must be entirely normal. If you see the link you will note that for women under 30 the level should, according to CHR, be 2.1ng/ml or more (14.99 pmol/l or more); for women 31-35 the level should be 1.7 ng/ml or more (12.14 pmol/l or more); for women 36-40 the level should be 1.1 ng/ml or more (7.85 pmol/l or more) and for women 41 or more the level should be 0.5 ng/ml of more (3.57 pmol/l or more).

http://www.centerforhumanreprod.com/about_newsletter.html

This link is from the advanced fertility centre in Chicago and, as you can see, they regard AMH of 0.7-3 ng/ml as being normal (although 0.7-0.9 is low normal). Plus, it is only below 0.3 ng/ml that they regard AMH as very low (about 2 pmol/l). This site also makes it clear that AMH probably does not reflect egg quality.

http://www.advancedfertility.com/amh-fertility-test.htm

This lab from Germany regards 1-5 ng/ml as normal and 0.8-1 as redisidual. However it regards below 0.4 as "menopausal" which we know cannot possibly be correct since loads of women with lower AMH that that have got pregnant!! In the past 3 months the poor responder thread has seen 2 women with AMH below 0.4 ng/ml get pregnant naturally - one lady got pregnant the month after an IVF cycle in which no eggs were collected.

http://www.labmed.de/en/uploads/labmed_letters/amh-engl.pdf

Personally, I think the main message is that it is all too up in the air for anyone to base too much on this one test!! The goalposts are clearly moving and plenty of clinics are surprised all the time. Plus the scales in America seem consistently lower than those in Europe so that a lot of women who are told they are "low" here would be fine there, which is ridiculous!

My last link is from a Swiss clinic warning that AMH use has its limits and advising of natural pregnancies in 2 women with completely undetectable AMH!!

http://www.ncbi.nlm.nih.gov/pubmed/17562340

I hope I haven't bored you too much! I just get so fed up with seeing women get contradictory information about their AMH results. Some ladies have got into a real panic for now reason. It might help if the doctors could just say "we don't know" every so often!!!

**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**


----------



## catgarvie

Hi ladies,
LittleJenny, thanks so much for your post.  Goodness, it does really seem as if nobody agrees as to what's 'normal'.  That's so encouraging - and also so frustrating if they're winding people up for no reason (admittedly I don't need much winding at the moment).  Thanks for taking the time to research all that information and to reply.
Mary, I really hope your next cycle will be a successful one.  Looks like we might be going through it at the same time.
Momito, thanks for the info re Create.  I hope it works out for you there.
CG x


----------



## Momito

This is very interesting information regarding the criteria used for AMH and what it means.

Thanks so much for posting it Little Jenny.  

A Very Merry Christmas to you all and let´s hope that the new year brings us less heartache and more lovely surprises in the shape of wailing babies!

Love
Momito
xxx


----------



## nikkistar

hi i am 26 years old and have been ttc for 3 years and i have a five year old son .i found out in jan 2010 that i had two blocked fallopian tubes so i was referred to bourn hall in cambridge i was looking in to doing the egg sharing scheme so i went to bourn for a blood test to test my amh levels it came back as 2.92pmol/l not to sure what that means but is very low i was just wondering if anyone had any success with levels this low feel gutted will there be anything they can do to help me with that or will they advise me not to go through with ivf.


----------



## TaraAbel

Hi, 
 Just wanted to send you big hugs. 
I had HSG last week which came back saying i have Hydrosalpinx in tubes  , my partner had his SA yesterday got appointment in 2 week to discuss both resuylts and mine in more detail.
I had peritonitus at the beginning of this year and was lucky to pull through had 3 ops to wash my internal organs and blood and now i am unable to eat solids and being sick everyday, got appointment with surgeons today to see what and when they are goint to do something about it as it is there faults, was in hospital for  nearly 2 months in all. Also have Severe endo which has now spread to bowel and PCOS, not ovulatinga and have no periods.
I am 23 years old, people have said i need tubes removed before i have IVF and then some say they can block them off i will have to wait and see what is said when i got. I did not realise peritonitus/appendicitus cause soo much hassle and fertility doctors really dont like it if you have suffered with it.
Soo I know how you are feeling, but we have to try and stay positive easier said than done. I hope you get some answer and decide the best treatment for you. 
How long have you been with you partner? where abouts do you live? I live in staffs, been with partner for 9 years this year and he is very supportive offers me lots of hugs. 
Soo many of our friend are having babies, and that upsets me alot, but i  our time will come. Are you family and friend supportive?

Wishing you lots of luck    and baby dust  

Tara x x


----------



## nikkistar

hi tara are you poor thing you are really going through it i hope they get to the bottom of it all for you soon your have to keep in touch to let me know how youre getting on i have been with my dh for 9 years yes he is as supportive as he can be its hard because as much as there sad when the problem actually falls with you it feels like you feel so empty and its hard to explain to him he has been so there for me so much though and puts up with lots of tears etc and family have been brill to have not really told any friends though we are in hertfordshire. how about you has everything been supportive to you


----------



## TaraAbel

Hi Nikki,
              Hows you today? yes my family have been very supportive and a couple of close friends are there when I need someone to talk to, they have babies though already soo don't properly understand. Steven is very supportive I just hope his SA comes back ok and that it is just me, I seem to cope better with things than he does, waiting for an appointment in 2 wks for results.   


Tara x x


----------



## nikkistar

ah hopefully it does et me know how it goes keep smiling x


----------

