Increase in AMH
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Anonymous
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So, over the last four months my AFC has gone up each time. My FSH has consistently been 7 over the last 2 years. My AMH has slightly fluctuated between 0.6, 0.9, 1.0. I have not been tested in a year and wanted to know what it's at now....expecting it to be non existent. Well, it came back at 2.16. WTH?
Is this a fluke? How would it spike like that? Age:39 FSH 7 AFC 23 AMH 2.16 |
Anonymous
| if you were on long term birth control before - it suppresses AMH readings (not your actual egg counts). The further away you get from being on the birthcontrol the closer you get to your actual normal reading. |
Anonymous
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OP here, I've never been on birth control. I did one protocol last year where I took BC for 2 weeks but that's it.
I did 4 egg retrievals from May-August. Would the follistim and menopur affect the AMH level? I wanted it tested because my AFC keeps going up and up each try. But ,my eggs do worse and worse each time. The doctor has said she thinks we have an diagnosed sperm issue (his sperm is practically perfect....motility 90%, best grade it can be, etc and the DNA Frag is normal). |
Anonymous
Could be PSOS, but that would not develop suddenly like that... |
Anonymous
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AMH can fluctuate. And you can take things to help increase it - e.g., DHEA.
Number of eggs per cycle is not reflective of quality. At 39 you could get plenty of eggs, but few would be of a good quality. You do get a bump in #s from back to back cycles (so you see an increase in # of eggs retrieved in the later cycles), but not sure it would be solely responsible for the increase in AMH and it doesn't increase quality. The particular protocol can also affect quality. E.g., I had bad quality with higher amounts of Menopur (one RE used equal amounts Meno and GF, but I switched and another clinic's standard was to use much less Meno versus GF). Not sure what type of sperm issue there would be if the #s are all good and DNA frag is normal. Did she give you a clue? |
Anonymous
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Thanks for your post. No clue on the sperm issues. The doctor was not shocked by the AMH and said that I'm "producing eggs like I have an AMH of 2.16"
You said "At 39 you could get plenty of eggs, but few would be of a good quality." I'm not getting any to make it to blasts. That's why the doctor is starting to point to sperm. I just don't get it. |
Anonymous
NP - can you explain this more? I had a Mirena for a few years immediately before TTC. Would that impact AMH levels? |
Anonymous
You don't get why at 39 egg quality may be bad? |
Anonymous
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OP here.
I don't get how I could have great reserve, great hormones #s, great response to stims, great sperm numbers and then no blasts. I'm not getting abnormal embryos. I'm not getting anything past 3/4 days. I also should mention I have a 3 year old (natural pregnancy). Was that really my last good quality egg? at 35? With the exact numbers I'm getting today? |
Anonymous
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PP12:59 here. Sorry you're having issues OP. I know how frustrating and disappointing it is. Nothing past day 3 is not uncommon and egg abnormalities will cause embryos to arrest early. Yes - quality can suck at 39 and be good enough to get pregnant naturally and easily at 35. That's why everything over 35 is considered older (i.e., declining quality). Some people get lucky and find the right protocol and get a good embryo that sticks, but not everyone. That's why at 40 the success rate is only 20% (not counting all the women who have hormone levels such that they can't do IVF) - 39 has a higher rate of success, but it's still not high. REs will likely tell you that your odds are probably on the better side since you get lots of eggs (that's what I was told, and some REs consider it a numbers game, which is correct to some extent). Still, numbers only get you so far.
When IVF doesn't work, you'll get different explanations and advice. It sucks that there isn't often a clear answer and that things can go poorly after having early positive outcomes. Your best bet is to get second opinions and change up the protocol (and maybe the RE). I was in the exact same situation at 41 (prior natural pregnancy at 39, plenty of eggs but no/few blasts other than when I did a very low dose cycle that resulted in a chemical). At 43 after many cycles, I decided to cut my losses and am doing a transfer from my DE cycle next week (issues were not sperm, as we got 10 blasts, 6 normal, from 17 eggs). I hope it turns out better for you, of course, and you're younger than I was, so that's definitely helpful. |
Anonymous
| I had the same thing OP. I was 37 and my AMH ranged from .3 to 1.0 and got better every time I tested (the .3 was the first time) and my AFC was always 10. Most REs said this was a descrepency. It made no difference, I could not get pregnant again (secondary infertility). |
Anonymous
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I'm 30 and had the opposite problem. AMH was 1.2 last October and then 0.5 in January right before I started IVF. But AMH doesn't drop like that so my doctor thought that the test must have been wrong. I ended up with 20 mature eggs that cycle (though only 4 blasts and only 1 was normal). My doctor said that AMH can give clues into your reserve but the real test is how many eggs you get and there was no point in re-testing mine after having such a good number of eggs.
Either way I was totally freaked out and spent a lot of time googling it and found online that there could be a connection between vitamin d deficiency and a false low AMH. Since mine went down from October to January, I'm curious if Vitamin D was the reason. It seems like maybe yours has been going up from Winter to Summer, so maybe it could be tied for Vitamin D too? I was never actually tested for deficiency, so I'm totally guessing. |
Anonymous
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Supplements made mine increase over the course of a couple of years to something like 3.9 at age 42. Once I stopped supplements it dropped to 0.9 I was told it can fluctuate, different labs can matter, that there used to be a different standard of measurement several years ago, and also that being Vitamin D deficient can suppress AMH (I think I have that right, but it doesn't sound right just now).
I also retrieved many eggs but had trouble making blasts, with all embryos arresting at Day 4 in the lab. But for some reason I can get early chemicals through intercourse, which means the embryos survive longer than Day 4. Embryos just do better in my body than in the lab. You could try a Day 3 fresh transfer maybe? I also have learned that male MTHFR can be associated with poor embryo viability in the lab and my husband is homozygous C677T. |
Anonymous
| Where did you learn about MTHFR impacting embryos in labs? |
Anonymous
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(Not the PP, but I did help a friend look into it recently) There are different mutations for MTHFR, so you can't say generally what MTHFR mutations do. Certain mutations in the mother are associated with birth defects and blood clots (related to folate metabolism/elevated levels of homocysteine) , and there are studies that link poor folate metabolism with poor egg and embryo quality. C677T is a mutation that (if homozygous) can cause elevated homocysteine levels, but the negative effects are based on the mother's genetics typically. Perhaps a male with the mutation affects sperm DNA quality, as high homocysteine levels affect DNA methylation, but then I'd expect you'd see that in a DNA frag test (but I haven't seen or looked for studies on that).
There have also been studies that associate certain mutations with recurrent miscarriage, better embryo quality, fewer eggs per than expected based on AMH levels, and other studies that show mutations have no effect. MTHFR is something you'd really need to talk to your RE about and be tested for. |