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Our RE just made me feel like we are "barren"...completely shocked and a little lost
- Thread starter deojames
- Start date
ahcadvocacy
New member
@deojames Out of interest, you mentioned your husbands morphology- how low is low, and what are the other parameters like? I'm an embryologist at a fertility clinic and do a lot of semen analysis. We usually worry about morphology the least out of everything. It's a point of contention among professionals, and it's relevance is hotly debated. There is a lot of research out there showing positive outcomes for people with low morphology who try naturally.
Your AMH is low for your age, and could explain your irregular periods. But if you are confirming ovulation each cycle, there is nothing to preclude you from conceiving naturally when you do ovulate.
A good analogy I saw on here from someone else was, when most people try to concieve, they're rolling a standard 6 faced dice each month (a d6). They have to roll a 1 to concieve. Its a game of luck. When you add in additional factors, the number of faces on your dice increase. So, add in your husbands low morphology and you're rolling a d9. Add in your low AMH and you're adding a d12. Your odds of rolling a 1 are lower now, but it's still possible.
You should be monitored regularly for signs of early menopause though (FSH and LH and estrogen predominantly). You will definitely want to move into something like IUI or IVF before you hit menopause. With a low AMH, earlier menopause is possible.
I think your RE is taking all that into consideration and making the recommendation he thinks is best, but just being very blunt about it, which isn't fair. He should be more Compassionate about it and progress at a pace you feel comfortable with. IVF can be tough to consider.
Getting a second opinion doesn't hurt at all and is definitely what I would do. It can help to hear the same thing from multiple people, or to hear a different perspective and know your options.
Your AMH is low for your age, and could explain your irregular periods. But if you are confirming ovulation each cycle, there is nothing to preclude you from conceiving naturally when you do ovulate.
A good analogy I saw on here from someone else was, when most people try to concieve, they're rolling a standard 6 faced dice each month (a d6). They have to roll a 1 to concieve. Its a game of luck. When you add in additional factors, the number of faces on your dice increase. So, add in your husbands low morphology and you're rolling a d9. Add in your low AMH and you're adding a d12. Your odds of rolling a 1 are lower now, but it's still possible.
You should be monitored regularly for signs of early menopause though (FSH and LH and estrogen predominantly). You will definitely want to move into something like IUI or IVF before you hit menopause. With a low AMH, earlier menopause is possible.
I think your RE is taking all that into consideration and making the recommendation he thinks is best, but just being very blunt about it, which isn't fair. He should be more Compassionate about it and progress at a pace you feel comfortable with. IVF can be tough to consider.
Getting a second opinion doesn't hurt at all and is definitely what I would do. It can help to hear the same thing from multiple people, or to hear a different perspective and know your options.
s3anreilly
New member
@krython AMH does as far as I've read not actually impact the chance per cycle. Age does and those are obviously related. But not AMH itself for the same age.
Plus the numbers OP said don't actually predict menopause before 48. And I've not seen a medical guideline suggest monitoring for lowish AMH before. (https://academic.oup.com/jcem/article/93/6/2129/2598432 & https://www.asrm.org/globalassets/a..._interpreting_measures_of_ovarian_reserve.pdf)
@deojames
Plus the numbers OP said don't actually predict menopause before 48. And I've not seen a medical guideline suggest monitoring for lowish AMH before. (https://academic.oup.com/jcem/article/93/6/2129/2598432 & https://www.asrm.org/globalassets/a..._interpreting_measures_of_ovarian_reserve.pdf)
@deojames
nathanbarber
New member
@s3anreilly You can predict how many years you have before menopause based on amh???? I've never heard of this before!
I'm 41 with an AMH of 0.42 ng/mL. How long do I have until menopause? (Sorry if im derailing the thread but I'm genuinely intrigued by this!)
I'm 41 with an AMH of 0.42 ng/mL. How long do I have until menopause? (Sorry if im derailing the thread but I'm genuinely intrigued by this!)
s3anreilly
New member
@nathanbarber It's in the first link. Yours seems to unfortunately be 5th percentile which means somewhere between 41-44prediction if I read this correctly maybe @mcg1102 wants to check me.
@s3anreilly
That's true, I was working on the assumption OPs irregular periods are linked to the low AMH, and being irregular can make it harder to concieve/increase time to conception obviously.
If the AMH result described was standalone, then at my clinic we would be recommending ancillary testing to rule out POF, especially with the recent change to menstrual regularity.
FSH/LH are usually routinely done with AMH anyway though, so no doubt the clinic have already done this and would have raised it with OP already if it was a concern.
It's not to scare OP or cause concern, I'm just working through why the RE may have said what he did, based on our own protocol. Other clinics may be different especially in different countries (I'm UK based).
Another possibility is that - since AMH does predict response to hormonal stimulation and egg quality at retrieval, at any age - the RE assumed anything below IVF (in terms of intervention) is a waste of time. This is up for debate and is partly why I would recommend a second opinion.
AMH does as far as I've read the evidence not actually impact the chance per cycle.
That's true, I was working on the assumption OPs irregular periods are linked to the low AMH, and being irregular can make it harder to concieve/increase time to conception obviously.
Plus the numbers OP said don't actually predict menopause before 40.
If the AMH result described was standalone, then at my clinic we would be recommending ancillary testing to rule out POF, especially with the recent change to menstrual regularity.
FSH/LH are usually routinely done with AMH anyway though, so no doubt the clinic have already done this and would have raised it with OP already if it was a concern.
It's not to scare OP or cause concern, I'm just working through why the RE may have said what he did, based on our own protocol. Other clinics may be different especially in different countries (I'm UK based).
Another possibility is that - since AMH does predict response to hormonal stimulation and egg quality at retrieval, at any age - the RE assumed anything below IVF (in terms of intervention) is a waste of time. This is up for debate and is partly why I would recommend a second opinion.
s3anreilly
New member
@krython How would AMH be linked to irregular cycles? I've never heard of that before. The only link I can think of is that people with PCOS often tend to have a high AMH (like 10) and tend to have irregular cycles. Not the other way round. But it's not really a casual link.
1.7 AMH isn't anywhere near POF territory (assuming the typical US unit ug/L)?
ETA: I don't think in the UK a non private clinic would even test anything after 4 month of trying. @isht without major red flags of anything amiss.
I don't think the cycles can be that irregular if it's 4-5 cycles trying in 4 month.
1.7 AMH isn't anywhere near POF territory (assuming the typical US unit ug/L)?
ETA: I don't think in the UK a non private clinic would even test anything after 4 month of trying. @isht without major red flags of anything amiss.
I don't think the cycles can be that irregular if it's 4-5 cycles trying in 4 month.
@s3anreilly
This could be the source of our disagreement. I've been assuming typical UK units, and forgot the USA is weird (joke).
In the UK anything below 5 is low for anyone under 39. If a patients AMH is below 1 most clinics, including where I work, won't offer treatment with own eggs.
Here's a link to how the UK interprets AMH. This isn't where I work, BTW!
1.7 at 33 in the UK would be classed probably as POI rather than POF, but still of concern.
As AMH falls and people start approaching perimenopause or premenopause - either with age, or due to POI/POF which can be diagnosed through AMH in conjunction with FSH/LH, hence my initial recommendation for ancillary tests - it's typical to see a level of dysregulation.
Not saying that's the case for OP though.
assuming the typical us unit
This could be the source of our disagreement. I've been assuming typical UK units, and forgot the USA is weird (joke).
In the UK anything below 5 is low for anyone under 39. If a patients AMH is below 1 most clinics, including where I work, won't offer treatment with own eggs.
Here's a link to how the UK interprets AMH. This isn't where I work, BTW!
1.7 at 33 in the UK would be classed probably as POI rather than POF, but still of concern.
How would AMH be linked to irregular cycles?
As AMH falls and people start approaching perimenopause or premenopause - either with age, or due to POI/POF which can be diagnosed through AMH in conjunction with FSH/LH, hence my initial recommendation for ancillary tests - it's typical to see a level of dysregulation.
Not saying that's the case for OP though.
s3anreilly
New member
@s3anreilly In light of the irregular menses, we would probably still recommend ancillary tests to examine if any trend exists over time, or if anything else is looking borderline/potentially suspicious.
But as I said in my first post - there is nothing to preclude OP from conceiving naturally when she does ovulate, and she should absolutely seek a second opinion.
Original RE sounds like a douche in any case!
But as I said in my first post - there is nothing to preclude OP from conceiving naturally when she does ovulate, and she should absolutely seek a second opinion.
Original RE sounds like a douche in any case!
s3anreilly
New member
ahcadvocacy
New member
@s3anreilly Same. I saw the progesterone and was like... but you ovulated this cycle?
@s3anreilly Yes, my cycles had been irregular for about 8-9 months prior, suddenly after getting the COVID vaccine. OB thought it was worth looking into.
s3anreilly
New member
s3anreilly
New member
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