# amh result - so confused!!!



## kare72 (Feb 26, 2010)

Hi just got result from clinic here in Ireland and I have amh of 14.7 (i think pmol/L - forgot to ask dr on the phone) and he said for my age of 38 (almost 39) I was smack in the middle of where it should be which is 8-18.  But we are doing surrogacy in India and my doctor there just emailed me that 15 is the lowest ---my antral follicle count had been 9, fsh was 3.6iu on day 2 and am just so confused!!!!  Do I go with donor egg or is it worth giving my eggs a chance?  Any help really appreciated!!!


----------



## Jumanji (Feb 13, 2008)

You are absolutely fine - very, very good for your age in fact!!!

Take a look at the attached link to CHR's age speficic AMH levels. They are in ng/ml and you need to multiple by 7.14 to get the result on pmol/l. If you are at 14.7 this is about 2.06 ng/ml - well above the 1.1 they give as age-specific for 38-39.

If you search my posts you should find some long ones on AMH which explain why there is so much confusion about what is normal and what isn't and you are in GREAT shape. Your FSH is also fantastic! Good luck!

http://www.centerforhumanreprod.com/pdf/AMH%20Update.pdf


----------



## kare72 (Feb 26, 2010)

Hi Little Jenny 
Thank you so much for your answer - I feel much better after reading your post!!!  I was feeling so down in the dumps and right after posting this question got a text from a friend that she is pregnant and needless to say it was not a good day  .  Thank you though for your response - you have given me hope


----------



## Jumanji (Feb 13, 2008)

Below is a post I did on AMH earlier. Hopefully it will show you how good your result is!!

AMH remains 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.

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


----------



## kare72 (Feb 26, 2010)

Thanks Little Jenny - God reading all that information is just more confusing!!!  It just seems there is no definitive on this amh level and age.  Thanks so much though I feel better knowing it is just not me who is confused by all these numbers  . I am going to push to at least try one with my own eggs before having to decide on donor eggs.  Thanks again


----------



## Jumanji (Feb 13, 2008)

kare72 - with your results I have no idea why anyone would have even mentioned donor eggs to you.


----------



## Yellow38 (Nov 13, 2010)

Hi All,

I just wanted to say a massive thankyou to Little Jenny for this information, I have found it to be so helpful in interpretting my results.  I have just had my AMH test back and this was 20.8 pmol/L (or 2.91ng/ml asuming I have done the conversion right) which interestingly seems to be pretty good for my age (3.  However on the ratings chart that my clinic gave me this suggested that I am in the top end of the "low" category.  Needless to say that given my age, I wasn't realistically expecting to be in the "optimal" range, but I was a bit worried about the results, however your post seems to suggest that actually I should be celebrating!  Thanks again.

Yellow


----------



## Jumanji (Feb 13, 2008)

Yellow - you should be over the moon!  It sounds as though your clinic is reading from the tdl scale which, as my post shows, is derived from a group of very young women!  Your result is truly excellent for your age.


----------



## Yellow38 (Nov 13, 2010)

Thankyou Little Jenny - yes I am pretty chuffed and optimistic now I understand the results, I really do realise how fortunate I am. 

But isn't it so frustrating that actually looking at the info the clinic has provided, I could on the face of it be feeling pretty down as their scale shows me as being low.  I think you make the point in your earlier post that clinics tend to latch on to these scales without really understanding them or applying the "intelligence" and research needed.  Surely they must know how mythered you become as an infertility patient and that this sort of info just adds to the anxiety - there are plenty of real things to worry about so unecessarily adding to these seems crazy?  

So note to Clinics out there - if you are going to offer the test, then be a little more considered with the scales you use and how your patients interpret them!!  You could all learn a lot from Little Jenny here!!


----------



## Milo73 (Jun 28, 2010)

Hi All,

LittleJenny, thanks also from me for pulling all this information into one place.  It is brilliant.

It reinforces my decision to try & ignore my recent result.  My clinic have only started using the test, and despite advising me after my 1st failed attempt that there was no need to do it as 'past cycles are the best predictors of future response', for some reason they did the test directly after my 3rd failed attempt.  It came back at <1 on the pmol scale & they sent me a standard letter stating that this was an indication that response to stimulation would be 'negligible' & my chances of a pregnancy were <1%.  I was asked to go in for a antra follicle scan.  I was pretty angry & called my consultant.  You will see from my signature that my previous responses have been far from 'negligible'.  He basically said that they had sent a standard letter & clearly my previous response was a better indicator, they shouldn't have done the test as have so much cycle information on me & not to bother going in for the antra follicle scan. The reason for this apparently was if the result of a scan backed up the AMH test result then the NHS would pull the funding for my NHS cycle (which I have waited 2 years for) in March!!

What really bothers me is if the NHS are using this test as a factor in agreeing funding.  I am lucky as I have been in a position to self fund 3 cycles.  If I was relying on the NHS I might never have got the opportunity to find out that I produce, on average, 9 eggs per cycle.  Hardly a negligible response!

Milo x


----------

