# Gutted to say the last :(



## jennewstart (Nov 25, 2010)

Hi Ladies,
I went to my gynae today for some results and was told that my AMH level, at 5.86 is low, and that I am looking at a 1 in 40 chance of getting pregnant each month.... I am gutted but trying to be strong. He said I could go on Clomid (at my expense) but this would only raise my chances from 2.5% each month to just 5%. I asked about IVF and he said that theres not really much point putting myself through that either   

I went there, full of positivity and came out as if someone had hit me over the head... I was totally in shock. Do I resign myself to belive that its no more children now? Has anyone else been through this heartbreaking news and if so, how did you cope?
Thank yu
xx


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## 69chick (Feb 15, 2005)

jennewstart - don't give up yet. Yes, your amh maybe on the lower side, but not time to give up yet!
Who/where is your consultant? What tx have you had to date/results?


chick x


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## jennewstart (Nov 25, 2010)

Hi, Thanks for your reply huni. As far as tests go, Ive had dye put into my tubes to see if they are blocked - they are fine. Hubby has had his sperm count done and thats normal. I had blood taken right at the beginning (last October time) and the gynae said that I wasnt ovulating that month, but he said that doesnt mean Im not producing the eggs, just that they couldve taken the blood at the wrong time of the month, and thats it
Oh yeah and the AMH blood test which I had to pay £90 for
xx


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## Lou F ❁ (Feb 28, 2003)

*WELCOME TO FF*

*Wanted to say Hello and welcome you to FF, my role here of FF as a MOD is to make sure you find your way as easy as possible, hopefully this message will do that  Am so glad that you have found us, hopefully you will meet like minded people that will help and support you through what can be a very hard stressful journey. There are many members here on FF with a true understanding of what you are going through at all stages that infertility throws at you  FF has brought so many people together and helps form many new friendships that may last many years, I certainly have and my life is richer for it. It's hard when family and friends dont fully comprehend what the IF journey entails and the emotions that go with it, Thats where FF comes in to play. *
*I hope that you will find the links i have left you helpful and direct you where you need to be until you find your feet, which wont be long i can assure you. If there is anything that you still need to find give me or any MOD a shout and we will be happy to help you  *
*Links to follow..........................................*

*What Every New Member Needs to Know*
CLICK HERE

*Fertility Guides *
CLICK HERE

*POF / Early Menopause ~ * CLICK HERE

While undergoing treatment, you might find it useful to join other ladies having treatment at the same time. 
The *Cycle Buddies* threads are just for that.
Just pop along to the appropriate month and say "Hi" when you are ready to start treatment

*Cycle buddies *
CLICK HERE

*Girl & Boy talk  Community & Fun Board *
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:
You can also chat live in our 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.

Wishing you lots of luck    and  
Keep in touch
Lou


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## 69chick (Feb 15, 2005)

OK, well not knowing where you have tx, I'd say they are not very experienced in people with your 'problems'.


Which clinic are you at, and why did you have to pay for a blood test? (Do you already have children?)


If your DH has normal results, thats one hurdle out of the way, and another that your tubes are latent.


There is a thread on the poor responder thread - many of those girls have lower AMH than yours.


I'm guessing that your clinic could be NHS? (They have to work to 'rules and guidelines').


You must NOT give up yet - way way too early in the scheme of things x


Keep in touch.


chick x


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## Jumanji (Feb 13, 2008)

I have now idea how on earth your gynae can be so dogmatic. There are absolutely NO STUDIES out there which give any data on AMH levels and chances of natural pregnancy per month. In fact, there are very few studies on AMH in the general population at all. Try asking him for the studies upon which his chances per cycle are based!!

Below is my standard post on AMH; as you can see, there is some disagreement and according to some scales you are entirely normal. Furthermore, remember that if you are over 35 AMH levels fall naturally anyway without meaning there is little hope! One thing I would add to the below is that I am reading more and more about ladies whose AMH has fluctuated. This belies what we are told about its stability - we need to remember that FSH, at first, was described as having minimal flcutuation!

As others have said, it doesn't sound as though you have seen the most experienced people. I would try a different clinic.

AMH reamins a fairly new test and 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 test. However, a lot of less experienced doctors now place a lot of reliance on this test and will be very "doom and gloom" if yours is anything less than perfect.

The first thing anyone should find out is what scale their AMH result is on. The pmol scale has higher numbers than the ng/ml scale 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 pmol/l scale is more commonly used in the UK and Australia but elsewhere, notably the US, the ng/ml scale is the one used.

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 link for details of this scale - http://www.tdlpathology.com/index.php?option=com_content&task=view&id=201&Itemid=73. This sample also gave a mean AMH of 4.

However, take a look at the next link which details 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 first 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, the Glasgow Centre from Reproductive Medicine and some other clinics now regard 5-15pmol/l as normal and 15 and above as high. This fits in with the Repromedix scale. 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!!

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

Note also that in 2009 on the poor responder thread there were 3 pregnancies in ladies with AMH of 0.1ng/ml. One of these was straight after an IVF cycle in which no eggs were collected and another was in a lady who had not seen AF for a few months.

Whatever your doctors say, AMH is not the be all and end all. If you have low AMH it is not "the end". Plus make sure it is really low - many women here are told they have "low" AMH based on the very early scale when subsequent studies have shown it is really fine.

/links


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## birba (Feb 7, 2011)

Hi Jenne,
I get mad when I read about doctors being so dogmatic and cold - this is the reason why we get depressed AND we put in our brain that we cannot conceive HENCE we don't!
My AMH is lower than yours and I am trying now with Clomid for 6 months, tubes damaged but open and my consultant told me that I CAN conceive naturally without giving me any percentages. Clomid enhances the ovulation and it's indicated with lower ovarian reserve so that the ovaries produce more follicles.
I don't think I can add much to LittleJenny's post other than it's so refreshing to read all of this explaining that those percentages are c**p and NOT proven!
Plus your tubes are perfect, your hubby's fine you are going to be OK!
There are ladies here with "undetectable" AHM and have conceived and carried to full term.
I'd change consultant and get one with a heart, where are you based?
Sorry really gets me, I've been there, still am, and crushing somebody's like this I don't get it as I know it's a rollecoaster of emotions and disappointments
NB Clomid is not very expensive (I think I paid 12 pounds for tablets for 6 months)

DO NOT GIVE UP! enjoy baby making sex, get an ovulation kit and carry on!
Please please let us know how you get on!


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## Jumanji (Feb 13, 2008)

I have to say that I approach any "chances per month" statistics with great caution!  How on earth can they possibly measure these things discounting all other relevant factors.  It is just impossible and yet many doctors seem to gaily trot them out based on NOTHING!


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