# Any success stories with low AMH



## Illy

Hello there,

I recently had an IUI which BFN.  I spoke to the consultant last week and because of DH spermcount (only 2million after the wash) they want to go forward with the IVF.  I had the blood test and the upsetting thing was that my AMH levels dropped even more after the IUI. It is now 7.9!!

What does the AMH really say? and has anyone had a BFP with low AMH?

elona


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## Jumanji

Your AMH, I assume, is measure on the pmol/l scale which converts to 1.1 on the ng/ml scale (conversion factor is 7.14).

This is NOT bad. Below is my "standard" post on AMH and I would like to also add the following link to age specfic AMH levels released by CHR in New York.

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

here is my "standard 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.

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. I also found it interesting that the Lister told Ali they now, ideally, look for 0.7 as a minimum - that is a BIG jump down from 2. 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

This is from Advanced Fertility in chicago and also shows that their findings indicate lower AMH is perfectly ok.

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

Other labs are of course making their own rules. This one 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. 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


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## Griselda

Hi Elona

Sorry for a late response.  But, yes, it is possible.  My AMH came back as 5.5 on the on the 0-50 (pmol/l) scale so pretty rubbish.  

I had success first time with DIUI.  The sample was from abroad and had 9 million swimmers.

Good luck!

Jenny, many thanks for the very informative post too.

G x


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## Miranda7

Check out the Poor Responders Bumps and babies thread. Two sets of triplets, lots of babies... and with FAR lower AMH than yours. SchmAMH!


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## kateyl

Hi

At 35 years I got the fab amh of 3.5 (yikes)! I did IVF the following month and my 2 year old is now running around the garden playing! Reproduction is not an exact science!!

Good luck!


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## kandyfloss808

LittleJenny said:


> Your AMH, I assume, is measure on the pmol/l scale which converts to 1.1 on the ng/ml scale (conversion factor is 7.14).
> 
> This is NOT bad. Below is my "standard" post on AMH and I would like to also add the following link to age specfic AMH levels released by CHR in New York.
> 
> http://www.centerforhumanreprod.com/about_newsletter.html
> 
> here is my "standard 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.
> 
> 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. I also found it interesting that the Lister told Ali they now, ideally, look for 0.7 as a minimum - that is a BIG jump down from 2. 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
> 
> This is from Advanced Fertility in chicago and also shows that their findings indicate lower AMH is perfectly ok.
> 
> http://www.advancedfertility.com/amh-fertility-test.htm
> 
> Other labs are of course making their own rules. This one 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. 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


wow little jenny your info is fab, thanks so much for taking the time to post.

i hope you don't mind me asking but i've just had my AMH results pmol/L was 5.20 which on the reference below say i am normal, do you think the hospital would change the reference chart so it would make me look normal as from other readings my results don't look good? i had them done at the portland womans hospital in london:

< 0.1 - negligble
1.0-4.9 - reduced
5.0-14.9 - normal
>14.9 - excessive

my fsh is 10.6

any thoughts would be very welcomed, thanks!


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## Jumanji

Kandy - I definitely do not think the hospital would change the reference chart to make you look normal!  the scales they have given tie in much better with the data from the US which would, as I say in my main post, also indicate your AMH is normal.


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