Low AMH and the depressing news

You got the news your amh is low.  Maybe you heard some stats that sounded awfully bad. Maybe you weren’t following everything that was said, but words stood out. Words like donor. Titles like DOR, or diminished ovarian reserve.  It’s one of those conversations no one ever wants to have and be sure, whoever is delivering the news isn’t happy to do so either. 

What happens next is typically a period of despair and depression until we finally get the strength to fight back.  It’s now when you need to focus more than ever.  
AMH levels are thought to correlate to how many follicles you have left. Some women take this so seriously that they believe that means it’s only going to go down, and in theory it should. The fact is, if you hang out in infertility groups long enough you’ll see women whose  AMH fluctuates, some even from low back to normal.  
In the fertility world low amh truly only means you are less likely to respond well to fertility meds.  It means the tools the doctors’ use to get women pregnant are likely going to be less effective.  Low amh makes the doctor’s chances of giving you success lower.  It does not mean you can’t get pregnant the old fashioned way. 

Think of it like this. IVF works to overcome infertility caused by male issues or no tubes.  It works by pulling out a lot of eggs, say 15, giving them the best shot at fertilizing by leaving them in a dish with a ton of good sperm or injecting with ICSI, putting a sperm directly into the egg.  Some will fertilize and some will not, some will grow and divide as expected.  Some will make it to day 5 and turn into beautiful blastocysts, a ball of cells of hope.  Maybe out of 15 eggs, the woman gets 2 or 3 blasts and the rest die off.  She has one of her blasts transferred or goes on to test them with PGS.

For women with DOR, that very same process can happen, but due to low response to meds, maybe they need to retrieve eggs 4 times to get the same 15 eggs.  It may take even more.  On all different types of protocols, I can make a maximum of 3 follicles.  Going through 5 cycles to get the 15 eggs for me would be too expensive.  And of course, even after all of that there is a chance it won’t work.  Overall, the first cycle works for all women only 35% of the time. 

For this reason, doctors often offer donor eggs.  Donor eggs are a tool to fix the issue of not being able to get the 15 eggs in one cycle.  It is a tool in their arsenal, the same as stimulation meds, or ultrasound machines, or embryo labs are tools.  When they offer them, they are not saying you can’t get pregnant with your own eggs, naturally or with assistance.  They are saying that there is a tool available that can overcome a hurdle.

The good news is that AMH does not speak to quality.  Everything I can find and all my years in my groups points to age as the best correlation of quality.  If you are 25 and have low amh, the eggs you do have should be as good as a 25 year old with good amh.   Low AMH itself is usually not a cause of infertility.  IVF is typically not the answer to low AMH. 

If your tubes and sperm are good and you aren’t getting pregnant, I always suggest people consider having a natural cycle monitored.  This means getting bloodwork and ultrasounds throughout your cycle and looking for anything abnormal.  I did this once and I surged to ovulate with a small follicle and just barely ok lining, and I already knew my luteal phase was 5 to 8 days.  Would IVF fix that? Sure, but it’s overkill. Like getting IV antibiotics for a sinus infection. 

My main point with this post is that low amh is not the end.  I have met a ton of women who have had babies with low AMH, many naturally, many with help of some sort.  It feels devastating but it isn’t the end.  Remember, women over 40 have been having babies forever and their AMH is low naturally.  

Take the amh value for what it is, one indicator of how you are likely to respond to stimulation meds.   Still, if you need IVF due to your partners sperm or bad tubes, remember it is just an indicator. Some women with low AMH respond well, some women with normal AMH have poor response.  

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