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Tuesday, July 7, 2009

What is AMH?

Clearly the issue of ovarian reserve strikes many doctors and patients as "clear as mud!" Remember from our past discussions that ovarian reserve relates to the number of eggs that a patient has and the reproductive potential of those eggs. Ovarian reserve is not truly a test of egg quality as a woman's age is the final arbitrator of egg quality. As I am currently unable to make any patient younger, although I could retire if I could, we need to keep the difference between egg quantity (ovarian reserve) and egg quality (age) segregated in our mind.

So in trying to determine how a woman might respond to fertility drugs we use a variety of tests to predict her response. Day 3 FSH and estradiol, antral follicle count on sonogram and the clomid challenge test (CCCT) have been the methods used most recently. However, for the past 2 years we have also been measuring anti-mullerian hormone (AMH). This protein is made in the cells that line the follicles (the fluid filled cysts that contain a woman's eggs - 1 egg per follicle). The more follicles, the higher the AMH and the better the response to fertility drugs which resue the extra eggs that were doomed to run out of gas during the menstrual cycle.

Apparently AMH is getting some attention in periodicals outside of the medical literature as you can see in this link to the Wall Street Journal. We still rely on Day 3 FSH, estradiol and sonogram to get a complete sense of how a patient will respond to fertility drugs, BUT the AMH has proven helpful in many patients as we try to pick a stimulation protocol.

However, in doing Natural Cycle IVF, all tests of ovarian reserve may fail to predict success since by its very nature...natural cycle IVF is unstimulated. So if a patient is doing Natural Cycle IVF, whether or not they would respond to fertility shots is a moot point! What has been amazing to us is the ability of patients with high FSH, low antral follicle counts and low AMH to generate a beautiful embryo in Natural Cycle IVF. What matters is pregnancy and delivery but we have many patients whose ovarian reserve testing is poor and yet they have had success with Natural Cycle IVF. "It only takes one good embryo" as many patients are fond of saying!

So should you have an AMH level done. Yes, as long as you are working with a doctor who can interpret the results for you given the "big" picture and not lose sight of the forest for the trees.

Good luck

DrG

56 comments:

Anonymous said...

I appreciate your thoughts on AMH. I had a successful IVF at age 34 with an FSH level of 13. I responded very well to the stimulation (Estrogen > 3000, produced 13 follies, several quality embryos). They did not check AMH levels at this time. Now, at 37 I am trying to conceive again and both of my IVF cycles have been cancelled due to poor follicle development. My FSh consistently stays around 13 but oddly, my AMH is 2.4 - my Dr. said this is much higher than he typically sees. Its strange to me that I would respond so poorly given taht the FSH has not risen and the AMH is actually fairly good. My RE just thinks that age is a factor now and says that he really does not know what to make of the AMH level. Very disappointing nonetheless. We are giving it one last try. Thanks for this blog - its informative and very importantly, humorous!

DrG said...

Agree that it is weird that there is a disconnect between your AMH and FSH levels....not sure what to make of that but clearly your response is more typical of the FSH of 13 rather than the AMH of 2.4..go figure.

Hope it works out!

DrG

East Bay Fertility said...

Thanks for sharing this informative article about AMH. Keep it up!!

Anonymous said...

I'm 28 years old and all of my tests came back "normal" except my AMH (1.1) Considering my age, am I doomed? Thanks!

Anonymous said...

Im 31 trying to concieve..my doc recently got my AMH test done n the report says the level is between 13-14..is it good if i plan to go in for iui.
infact Im a case of PCOD,and my ovulation was not happening until last month.
hopin that ovulation would occur this IUI but my only concern was my AMH report.
is it alright??

DrG said...

Typical for PCOS. THat high an AMH means you have a LOT of follicles. Proceed with care if using fertility shots....

Good luck

DrG

Anonymous said...

I am 43 and trying to conceive for 6 yrs now after my first child. I was just introduced to this AMH test and it was 0.11; though the Doc cancelled the idea of an IVF. is it impossible to go with IVF with such results?

DrG said...

Well that AMH indicates to me that you are going to be a one egg/follicle per month patient regardless of whether you take thousands of dollars of fertility drugs.

However, patients can conceive with a single follicle/egg but at a lower rate. Your age of 43 is more problematic that the AMH. Options include: no treatment (hope for spontaneous pregnancy), natural cycle IVF (we have a few pregnancies in patients like you), donor egg/embryo (very successful) or adoption (extremely successful).

Good luck

DrG

vaclind said...

Hi Dr. G,
I am 27 and have an AMH of 0.5. I have read conflicting articles about AMH and IVF. Some say low AMH yeilds an increased risk of overstimulation and others say understimulation. What are your thoughts? Would you suggest a mini-IVF cyle or regular IVF cycle with all the meds?

Thanks

DrG said...

Hi Vaclind,

An AMH of 0.5 suggests to me a patient that may have a lower than average response. However, if your ultrasound demonstrates a lot of follicles (antral follicle count) then I would keep that in mind when deciding on a protocol for IVF.

Patients with a previous poor response and low AMH may consider Natural Cycle IVF in my opinion.

Good luck

DrG

Anonymous said...

Dear Dr G,
Thanks for your insight on AMH and FSH. I am 31 with AMH= 0.2 and FSH= 10-11.
I have 2 failed IVF and 2 IUI in past 2 years. So the reason I am not able to conceive is AMH or FSH?

Anonymous said...

Hi Dr. G.
I am 41, will be 42 in Dec, with 1.0 AMH and FSH 8.0, dh is 38 with low sperm count, post 1xwash tms count 3-7M with 40-53% motility.

We have used clomid with IUI, 11x and was prego 2x but didn't make it past 34 days. Clomid generally gave me 2-4 follies on each side, usually 2 between 14-21. Did not have good reaction with Bravelle, only produced 1-2 follies. Decided to do IVF, but could not as doc identified polyps, so had lap, and surgery to remove 2 uterine polyps. No endo found. One Fibroid 40x40mm outside uterus next to uterine artery rt side.

Trying to decide what is our best option. Went for scan today (day 3) have 3 follies, one 14x13 mm, 2 smaller, have not taken any meds. Should we do IUI with Gonal f or an IVF Gonal F cycle???

Your thoughts?

Anonymous said...

I'm 28 and just got my AMH Results back today. (2.55). My doctor says normal, but what is your take.. thanks.

DrG said...

Hi Anonymous #1 (10/5/11)

Well you clearly have diminished ovarian reserve but this does not preclude success especially at age 31....However, you may be a low responded to meds (you didnt say) and I think that patients like you may want to consider Natural Cycle IVF. Have seen a lot of spontaneous pregnancies in patients like you as well!

Good luck

DrG


Hi Anonymous #2 (10/11/11)

Well not a ton of good options here....May want to consider a go at stimulation with a plan to change from IUI to IVF if you stim well. Alternatives include Natural Cycle IVF, Donor Sperm IUI and donor egg/embryo or adoption...

Good luck

DrG

Hi Anonymous #3 (10/20/11)

I agree with your RE. I like AMH between 1.5-2.5.

Good luck

DrG

PragGupt said...

Hello Dr
I am 30, wil turn 31 in April. I have had 6 failed cycles of IUI and 4 failed cycle of IVF in the last 4 years. All my reports are normal, except AMH which is 1.7. Also under medication for prolactin (60 without medication and 3.9 under medication).
DH is 35, all reports normal.We have given up on all treatment and left it on God.

DrG said...

Dear PragGupt,

Sorry things have not worked out for you. But you never know and perhaps you will have success without any treatment!

Good luck

DrG

Anonymous said...

Dr. G

I am 36 and have been dealing with infertility for the past 16 years. I have had several pregnancies that ended in miscarriage prior to my second trimester. All my tests are negative, my highest FSH was 18 and 0.1 AMH, Dx: POR. I have been doing alot of reading about successful results with the use of DHEA. What are your thoughts?

DrG said...

Hi Anonymous (3/28/12)

Good question. THere has been a lot of interest about the use of DHEA for poor ovarian reserve. Has used it in one patient. She hated it. Bad acne etc and ultimnately conceived with NC IVF.

Hope it works for you if you try it...

Good luck

DrG

Anonymous said...

Hi there,
I just got my AMH results which are 7.6 pmol/l. I'm 32 and otherwise healthy.
My doc said if I were at 10 I would be travelling well. I haven't been trying for a baby, quite the opposite actually.
My AMH result has me worried though as it is in the low range. Does my AMH mean I will struggle to get pregnant? Do I need to start trying now?
Thanks

vhmp said...

Hi, I'm 34 (almost 35) and my AMH has dropped significantly in the last year to 0.7. I've had a failed IUI and am planning on doing stimulated IVF. Until I read your blog, I had never heard of natural IVF. Is this something you'd recommend to someone with my age and AMH level? Are natural IVFs done by most Reproductive Endocrinologists?

DrG said...

Hi VHMP and Anonymous,

Remember that AMH predicts response to gonadotropins for IVF. It does not predict spontaneous preg rate or natural cycle IVF pregnancy rates. There is no doubt that trying to conceive when younger is better...but there is no way to maintain your eggs (except don't smoke!)...so you just need to consider your particular situation when planning for the future...If no time is a good time to have a baby then every time is a good time to have a baby!

Good luck

DrG

Anonymous said...

I understand the way you feel.My dr said that my AMH was low and that I was running out of time.I cried and prayed so hard..I left it to the Lord.Now I'm pregnant,and it was w/o help from any dr.Pls stay prayerful.God Bless.

Anonymous said...

Hello DrG,

What an awesome blog. My AMH last august was 0.80 and when i got it tested again in May its 1.35 due you think we can improve amh naturally? Does micronized DHEA help? Please let me know.

Thanks,
Babycatcher

DrG said...

Hi Babycatcher

Well not sure about the impact of DHEA on AMH levels. There is some variability in AMH testing and I have seen numbers jump a bit like yours....not sure how to explain it....

Good luck

DrG

Anonymous said...

HI Dr,
I am 35 with AMH <1.1 and FSH 22. My dr has suggested trying IUI. Can I still try stimulated IVF if this is unsuccessful?

Anonymous said...

Hello DrG,

I'm 33 and just heared that my AMH is 0,33, my FSH is constantly changing from 3.2 to 14 to 2.8..... My E2 is between 950 and 1500. I have no idea what this means, because everybody has high FSH results, but mine are low? My docter said that i would need the highest doses of hormoons when i start with IVF, but I have no idea if with these results its possible? The last egg count I in natural cycle I had 3 eggs :( and one side was empty :(

Can you tell me more about how i need to set my expectations/ what my results mean??

Thank you, Bloggie

DrG said...

Hi Anonymous (7/26/12),

Clearly you have diminished ovarian reserve (AMH low, FSH high). THat means that you are basically a one egg a month type of person. So with your one egg a month you can have sex, do an IUI or do NAtural Cycle IVF. Stimulated IVF will likely result in a single egg. You can try but if you get one egg for free and one egg for $4000 worth of fertility meds….

Good luck

DrG

Hi Bloggie (8/16/12),

Well AMH is best test for ovarian reserve as it is more consistent month to month….If you have a high estrogen then it can suppress your FSH …kinda like a see-saw on the playground. That is why your doc is suggested high doses of stim…hope it works out.

Good luck

DrG

Anonymous said...

Hi Dr.G,
Im 28 and I had an ectopic pregnancy early last year, and DH and I have started ttc for the last 8 months.
I have undergone HSG twice, a simple HSG the first time around and an HSG with FTC the second time around. Normal result after the second test. Ive had 2 cycles of clomid and both times produced eggs around 22 - 24mm, but have been unable to conceive. Uterus lining was satisfactory.
My gynec has referred me to a fertility expert, who prescribed an insulin resistance test, AMH testing and a transvaginal scan during our first appointment. He kept asking me if I had PCOS and was surprised that it did not show up on the scan. I am overweight, but have regular cycles, no acne, no facial hair. My insulin resistance test shows high levels of insulin, and based on that finding, he has confirmed PCOS. The AMH levels have been reported as low, around 0.3. I would appreciate it if you could share your thoughts as to what is really going on with me, what should I be looking out for, and what would be the next possible step. My husbands results have all come back normal. Thanks

Anonymous said...

Hi Dr. G,
I'm 42 and have an FSH of 34 and AMH of 0.16. My period has become very irregular. I had a very early miscarriage 4 months ago, and haven't had a period since. . What do you mean by one egg a month? Do you think that natural cycle IVF would be a possibility for me?

Anonymous said...

Hi,

I am 36, single and recently had a AMH test done with a result of 10.33. I understand this is low fertility. I was wondering whether this is a score low enough for me to consider getting my eggs frozen in case Mr Right doesn't come along any time soon - or I decide to go it alone?

DrG said...

Hi Anonymous (10/10/12)

At age 42 with an FSH of 34 and AMH of 0.16 you clearly have decreased ovarian reserve. Hopefully you will still have a few normal cycles and although one could consider NC IVF the chance of success will be very low (<2%)and may not be any better than the spontaneous pregnancy rate given your recent pregnancy. Donor egg/embryo or adoption clearly more successful.

good luck

DrG

Hi Anonymous (1/1/13)

Hmmmm. Well in our lab an AMH > 2.5 indicates a lot of eggs. Maybe the 10.33 is using different units????

Good luck

DrG

Anonymous said...

I am 28yrs old, and have started experiencing period pains that are excrutiating since my 27th birthday. In May 2012 I was told I have a very low AMH after the test was done. Does this mean I will not be able to naturaly concieve?

melissa said...

I am 34, I have an AMH of 0.58 and an FSH of 6.8. The doctor said I only have a 25% chance of having a baby and that he thinks I will need IVF to do this. What are your thoughts, am i doomed or do you think i might be able to have a baby using meds like clomid?

DrG said...

Hi Anonymous (3/6/13)

AMH levels predict how a patient will respond to fertility drugs….it cannot predict spontaneous conception odds. I would see an RE specialist to investigate the terrible periods and explore the AMH results.

Good luck

DrG


Hi Melissa (3/14/13)

Not enough info to comment in a meaningful way except to say that I have seem a lot of pregnancies in your age group in spite of AMH levels that are not so great. Remember that age predicts egg quality and AMH predicts egg number….

Can't argue that IVF works better than clomid but worth asking your RE about the possible option of doing some CC/IUI cycles….

Good luck

DrG

Anonymous said...

I am 39 years old next month. My AMH is 0.16 and my FSH is 5.9. I had an ectopic 2/24/12 on the right side. I had surgery without cutting tube. Then a clear HSG in October.I had another ectopic on left side on 11/27/12. Has MTX. Both tubes are intact. I have been told I have s 60% chance of another ectopic if I can get pregnant.Also told<25% chance of successful IVF with my eggs. Dr. Suggested egg donor.I take co q-10, selenium, vit. D&e. Prenatal, nettle, red raspberry leaf , and acupuncture. Do you think I have a chance using my own eggs?

Anonymous said...

I am 25 and have 'unexplained infertility' which is very rare for women my age. My partners sperm is excellent 97 mil/ml and high motility. And I ovulate every month, and have an amh level of 4.06 ng/ml which is above average for my age. What on earth can be wrong??? I have no evidence of pcos or endometriosis and had a normal hsg.

DrG said...

Hi Anonymous (4/2/13)

Clearly you could conceive with IVF. However, your response to stimulation may be suboptimal. I would still give a try or consider Natural Cycle IVF. Can't argue that donor ova IVF or adoption are more successful but i would not give up on your own eggs yet….

Good luck

DrG


Hi Anonymous (4/6/13)

Well unexplained is about 20% of our practice and I would probably see more 25 year olds with unexplained if I didn't practice here in Washington where delayed childbearing is the norm….

I would suggest seeing an RE. Options include CC/IUI, Natural Cycle IVF or stim cycle IVF. Spontaneous pregnancy could still happen!

Good luck

DrG

Anonymous said...

Hi Dr.,

I am 31 years old and when I decided that I wanted to stop birth control and try to have a baby, I went to see a gyn. She asks for blood tests and told me that my amh was low (0.8 ng/ml) for my age. What does that mean exactly? That my chances to conceive by just having sex are low? I just stopped my birth control and did not even TTC yet! I am healthy and do exercise...Thanks for your help!

Anonymous said...

Hi I am 36 nearer 37 and have an AMH of 10.63 and FSH 8.5 do know will it be possible for me to conceive?

DrG said...

Hi Anonymous (4/22/13)

AMH predicts response to fertility drugs. Its ability to predict your fertility is limited given you have never tried!

Good luck

DrG

Hi Anonymous (5/2/13)

Remember AMH predicts response to fertility drugs. I would review your values with your RE. AMH level of >10 ng/mL is suggestive of a lot of eggs. Not sure if your AMH was reported as ng/mL or not….

Good luck

DrG

Priya Khedekar said...

Hello Doc,
I have irregular menstrual cycle problem due to which my doctor advised me to test my AMH level.

Following are my details.
Age: 28 yrs
TSH:2.77
AMH: 0.5 ng/mL

My doc has told me that I have low AMH level which could cause problem in conceiving.I have not planned pregnancy yet for 6 months atleast.
Can you please tell me , whether I will be able to conceive naturally ?

DrG said...

Hi Priya

Well that AMH is a bit low for your age. Unfortunately there is no test to determine if you have a good egg except pregnancy and delivery! I would consider a proactive approach but certainly have seen spontaneous pregnancies in cases like yours!

Good luck

DrG

Anonymous said...

I am 25 and have been ttc for ages with "unexplained" infertility. Recently I had a scan which showed I had only 4-5 follicles on each ovary measuring around 4mm. But my amh came back very high at 4.1ng/ml. I have always had regular periods since I was 12 and I ovulate every month. I am starting IVF soon, and I want to know why is my amh high but my afc low?? I thought the amh and afc are supposed to correlate. Now I have no idea know what to expect... or what my real "ovarian reserve" is?

Anonymous said...

Hi Dr. G,

I am 35 years old and was just told that I have an AMH of .08. I also stopped getting regular monthly periods last September, which have become sporadic (every 3 months or so). My husband and I have been trying for two years but without getting regular periods, it is impossible to figure out when I'm ovulating. I just started seeing a RE and she suggested Clomid. What are my chances of getting pregnant and is Clomid the right way to go or should I start with IVF since my AMH is very low?

Anonymous said...

Hi Dr. G,

I will be 36 yrs old next month. My AMH is .08 and FSH is 19.5, basically not very good numbers to say the least. What are my chances of IUI or IVF working? My RE states that if I have less than 3 eggs, we should pursue IUI and more than 3, IVF. Is it worth it to take Clomid along with all the injectables if my chances are so bad?

Thanks.

SHS said...

Hello doctor,

I am 34 years old, will be 35 in Feb. My husband's(36 years) reports came in as sub-fertile, however I was disagonised of Diminished Overian reserve. My AMH is 1 and FSH is 10.9. My doctor suggested I go for IVF and that I shouln't wait too long. I am currently on DHEA for a month and scheduled for a few test prior to proceeding to IVF. My questions are
- What are my chances of pregnancy via an IVF?
-Also does high FSH/low AMH at 34 years, means I have bad quality eggs?

Thank you and I would much appreciate your response. IVF is a very expensive procedure, so want to make sure it the right decison for us.

Ginger Sauce said...

DrG,

I am 34 and recently had an OAR assessment on Day 3 of my regular cycle. I also had a Day 3 US in which the Dr. observed 5 'cysts' under the size of 1cm on my left ovary.

Below are the OAR results (total score of 9):
AMH 0.54 ng/ml,
estradiol 58.1pg/lml,
lnhibin B 109.2 pg/ml,
FSH 4.96 mIU/ml
LH 4.73mIU/ml

My dr. basically told me that my egg quality AND quantity are impaired and that I am not a good candidate for IVF or IUI. I am confused since all results except AMH are in the normal to good range. I had a 6.5 week miscarriage on March 08, 2013, so I know I can get pregnant.

My question... Does the low AMH suggest I will have a problem with successful pregnancy naturally, or does it just suggest that I am not a good IVF candidate?

Thank you so much for your advice.

Jacquelyn

Anonymous said...

I am 43 with an fsh of 10 and amh of 0.42. never been pregnant. what are my options and chance for success?

DrG said...

Well, better late than never….been a tough summer but trying to catch up…

Hi Anonymous (6/26/13),

Have occasionally seen AMH levels that were seemingly too high or too low given the sonogram. In these cases I usually repeat the AMH. In general, I would agree that the AMH and AFC correlate very well so repeating the AMH and or the sono makes sense…

Good luck.

DrG


Hi Anonymous (7/23/13),

Agree with your RE. Clearly adoption or donor egg are more likely to be successful. In a stim IVF situation we usually will cancel for < 3 mature follicles. However, such patients may go on to have success with Natural Cycle IVF. Pregnancy rates are probably going to be <10% per initiated cycle…But if you make it all the way to ET then you will have much higher odds...

Hang in there.

DrG

Hi SHS (8/1/13),

AMH does not correlate well with egg quality but is good at predicting egg quantity. Your numbers are pretty typical for our clinic as we have a large population with diminished ovarian reserve. Agree with your RE that now is the time to throw down the gauntlet and be proactive!

Good luck

DrG

Hi Ginger Sauce - Jacquelyn (8/6/13),

As you can see from the above responses AMH predicts egg number but is not good at predicting egg quantity. It is reassuring that you had a near miss in March. Options for you include no treatment, FSH/IUI, stim or NC IVF. I would support FSH/IUI if you were 100% sure that you would never try stim IVF. Otherwise I would try stim IVF as first line treatment all other things being equal.

Good luck

DrG

Hi Anonymous (8/8/13),

Clearly donor egg/embryo or adoption are best options. With your own eggs the odds are not so great but you could consider FSH/IUI, stim or NC IVF, With your eggs you are unfortunately looking at odds that may be <10% per cycle no matter what treatment except donor egg which should be 50-75% success per ET.

Good luck

DrG

Anonymous said...

Dr. G,

I'm 23 and my husband is 26. We have been TTC for going on 13 months. A few weeks ago, I had my first appt with an RE. He pretty much said he wanted to start with labs and go from there. When I start my next period (in Oct.), he wants me to make an appt for my husband to have a sperm analysis and then we will see him the same day when the results are ready. I'm also supposed to try BBT for a month. When I was there, he ordered labs. I'm an RN and work at the hospital where I was seen. Shame on me.. but I looked up my lab results. My AMH was 14 ng/mL. I'm not familiar with it at all.. I had never actually even heard of it. Unfortunately, I won't get to talk to the RE about it until next month. :(

In April, I decided to see my family doctor to see if she could help me any with TTC. My TSH was 9.5. She started me on Synthroid. (The RE increased my dose to 75mcg). My family doctor also ordered an ultrasound back in April. It was normal. My cycles range anywhere from 28 to 39 days. I never miss/skip periods. I'm 5'5 and 130 lbs. My only other health problems are gastroparesis and GERD.

My question is: What does an AMH of 14 mean? Everything I read on the Internet says that it indicates PCOS. If my ultrasound was normal, can it still be PCOS? If not, how abnormal are my results?


Thanks!! :)

Anonymous said...

Hi - I am 30. Trying to get pregnant for 13 months. Amh is 1.83, fsh in June was 10.1 cd3 and tsh in June was 4.06. I am now on meds for thyroid. Any insight on why amh is normal and fsh is high? Could it be my thyroid? If tested when tsh is good would fsh be better? I am torn on moving forward with a clomid iui cycle. Part of me wants to try naturally longer but I don't want to waste any more time. All other tests and husband are normal. Any advice?

Anonymous said...

have a few questions that I cannot research the answers for nor can anyone give me.
I am 29. My fsh has been 10.1 and most recently 9.7. My amh is 3.97 my afc is 15+ on one ovary and 8-9 on the other.my estradiol level was 45
my prolactin was 10.9
my LH was 11.1

My husband and I unsuccessfully tried for a year to inseminate ourselves due to his inability to ejaculate during intercourse. Our first IUI in march was successful, however it ended at 10 weeks with a d&c due to a blighted ovum.
I have done 3 unmedicated iuis and one with clomid after my miscarriage and they were all unsuccessful. I believe that most were bad timing. Can you tell me if I move to IVF, if my borderline FSH will be troublesome? I used to smoke when I was younger, about 6 cigarettes per day. The past few years, I smoked maybe one per day until the past few months when I quit. Do you think that could be the cause of my fsh being high and possibly indicating that I have poor quality eggs even though I have a lot? My husband and I are looking into ivf in January if our next 2 iuis are unsuccessful.

Anonymous said...

am so confused as to why my results don't add up.
I am 29. My fsh has been 10.1 and most recently 9.7. My amh is 3.97 ng/ml, my afc is 15+ on one ovary and 8-9 on the other.my estradiol level was 45
my prolactin was 10.9
my LH was 11.1

My husband and I unsuccessfully tried for a year to inseminate ourselves due to his inability to ejaculate during intercourse. Our first IUI in march was successful, however it ended at 10 weeks with a d&c due to a blighted ovum.
I have done 3 unmedicated iuis and one with clomid after my miscarriage and they were all unsuccessful. I believe that most were bad timing. I used to smoke when I was younger, about 6 cigarettes per day. The past few years, I smoked maybe one per day until the past few months when I quit. Do you think that could be the cause of my fsh being high and possibly indicating that I have poor quality eggs even though I have a lot? My husband and I are looking into ivf in January if our next 2 iuis are unsuccessful. I read research all day about high fsh and good amh but I just don't understand why it happens and if it's possible for all of my eggs to be of bad quality.

DrG said...

Hi Anonymous (9/4/13)

Seems possible that you have PCOS like tendencies but this is not a show stopper.

PCOS is a clinical diagnosis (not a lab one) and requires 2 of the following 3:

1. Irregular cycles (you have cycles as long as 39 days so seems possible)
2. Increased male hormones by blood test or examine (acne, facial hair etc)
3. PCOS looking ovaries on sonogram.

Good luck

DrG

DrG said...

Hi Anonymous (10/24/13)

Agree with thyroid getting treated. I am not impressed by FSH of 10.1 given AMH in normal range. I see no problem with any course of action (assuming normal tubes, sperm etc). I see options as:

1. Keep trying
2. Clomid/IUI
3. NC IVF
4. Stim IVF

Good luck

DrG

DrG said...

Hi Anonymous (12/2/13)

I assume that you rechecked HSG following miscarriage and recent failed IUIs? I go with AMH and soon as being very reassuring. Would not get too hung up on FSH as it is less reliable compared with the other 2 tests of ovarian reserve.

Good luck

DrG