Saturday, April 16, 2011

I have a low AMH level - what should do I do ?

For older infertile women, AMH ( anti-Mullerian hormone, also known as MIS ( Mullerian inhibiting substance) has become the new FSH . AMH is a very good marker for egg quality - and provides us with a quantitative measure for egg quality and quality.

In the past, we had to depend upon FSH levels. A high FSH level suggests poor ovarian reserve, but FSH levels are not very reliable, because they vary according to which day of the cycle the test is done; and can also be artificially suppressed by a high estradiol level

AMH is a much better marker for ovarian reserve. It does not vary from cycle to cycle; and remains the same throughout the cycle. A low AMH suggests you have poor ovarian reserve - but even if your level is low, this does not mean you should panic !

Remember that it's just a test - and good doctors do not treat tests - we treat patients !

Step number one is to repeat it again - preferably from another lab.
Step number two is to run additional tests to check your ovarian reserve.

You have 2 options: an ultrasound test called the antral follicle count ?
and a blood test called a clomid challenge test.

Even if these are poor, this does not mean you cannot improve it ! While Western medicine does not have much to offer, there are alternative medicine options you can try to improve your ovarian reserve

These include the following:

1. Yoga
2. Acupuncture
3. DHEA, 25mg thrice a day.
4. Wheat germ daily
5. CoQ 10, 100 mg daily
6. Vit D3 ( Calcirol), 60000 IU, once a week for 10 weeks

Read the book, Inconceivable.

Re-test your AMH level after 12 weeks to see if it improves.

Even if it does not improve this does not mean you cannot get pregnant ! Patients with low AMH levels do also get pregnant on their own ( though their chances are reduced). After all, levels provide information about groups of women , and there can be a lot of individual variability !

If you have poor ovarian reserve, IVF is often your best option as it maximises the chances of a pregnancy. IVF allows you to make the best use of the few eggs which are left, by telescoping time.

Plan B would be to use donor eggs, if you are willing to consider this option. This has a much higher success rate







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60 comments:

  1. Since AMH is produced by the antral follicles, I've always thought of it as actually a surrogate measure for the antral follicle count, which is the true measure of your ovarian reserve. Is it that straightforward?

    So then the question is, do DHEA, coenzyme Q10, wheat germ, accupuncture etc, increase the number of follicles recruited from the reserve?

    Vitamin D of course is working by a different mechanism. Interestingly, I found that after increasing my vitamin D levels, my antral follicle count has actually dropped in half, going down from 30 to 15. Wonder whether that has something to do with Vitamin D- something else to study, IMO!

    ReplyDelete
  2. Unfortunately,nothing in medicine is ever simple !

    For most women, this correlation is pretty good and both AMH levels and antral follicle counts go hand in hand, which is what one would logically expect !

    However, there are always exceptions, and one can learn a lot by studying them ! There is a lot of inter-individual variability between test results and real life fertility - and patients need to appreciate the imprecision of all these tests, rather than starting to panic just because their numbers do not fall in the normal range !

    ReplyDelete
    Replies
    1. Hello Doctor,

      I am in USA, we have been married for 3 years, however with no children yet. Hence we approached a Gynecologist who did some blood work and said all my reports are normal. They checked my husband and found no sperm count in his Semen analysis. Then we approached Urologist he did ultrasound for my husband and found absence / blockage of VAS tubes. They suggested biopsy to be done for my husband before that the urologist wanted to me contact the IVF specialist to know if I am good to proceed for IVF/ICSI/IUI.

      I approached and they done their tests and asked me to take Synthroid 25 mcg as my AMH 1.4, TSH 3.8 and 2 month later changed to Synthroid 50 mcg.

      Simultaneously they scheduled for biopsy for my husband and they found enough sperms with low motility, they took the tissues of my husband and frozen it.

      They asked to me start my IVF Injections as below:

      Bravelle 300 and Menopur 150 this combination of injection I started taking from 23/04/2014 till 02/05/2014 with blood work and ultrasound done every alternate day. They found only one follicle growing on right ovary with two other which was un-measurable. The last measurement of follicle on 10th day stimulation was 17mm.

      Finally on 03/05/2014 doctor’s visit they said they can’t proceed with IUI/ICSI/IVF with 1 follicle. We were very upset on this.

      Please advise me on how to increase my follicle count with quality eggs so that my treatment doesn’t fail. I am not understanding as to why I didn’t understand why I didn’t respond to Injections. The medications and treatment cost is very expensive here. Can you please also let me know if any diet to be followed? We are not interested in other options like donor egg / sperm. Please help me what to do?

      Delete
    2. I do not think your doctor did a good job with superovulating you

      Your low AMH level ( www.drmalpani.com/amh.htm)
      suggests you have poor ovarian reserve .

      You can read more about this at www.drmalpani.com/oopause.htm.

      You can take the following to improve your ovarian reserve.

      1. Yoga. Find a yoga teacher and tell them you need to learn exercises to help you improve your uterine blood flow
      2. Acupuncture. An acupuncture specialist can suggest what he can offer to help improve your fertility
      3. DHEA, 25mg thrice a day. This is an anti-aging hormone
      4. Wheat germ oil, 1 capsule daily. This is a nutritional supplement

      Continue these until you get pregnant

      5. Cholecalciferol ( Vit D) , 60000 IU, once a week for 4 weeks




      Read the book, Inconceivable, at http://www.amazon.com/Inconceivable-Winning-Fertility-Julia-Indichova/dp/0966007859/ref=sr_1_2?ie=UTF8&qid=1330844751&sr=8-2

      We would use the Letrozole -Antagon protocol for you which we use for poor ovarian
      responders. This will help you grow more eggs of better quality.

      PESA- ICSI treatment starts from Day 2 of your cycle.
      Day 1 = Day of bright red bleeding. If the bleeding starts after 6 pm count
      the next day as Day 1. Ignore the spotting.
      On Day 2, you need to do an
      ultrasound scan at our clinic to confirm there is no ovarian cyst, after which we start
      your superovulation .
      Tab Letrozole 5 mg daily from Day 2 - Day 6

      Inj Menogon ( 75 IU), 8 amp ( 600 IU ) daily from Day 2. The dose of HMG
      will depend upon your ovarian morphology and your antral follicle count.

      From Day 7, you stop the Letrozole and start Inj Orgalutron/ Antagon, 0.25 mg daily .
      This is a GnRH antagonist. The Menogon continues.

      We do the next scan on Day 7, after which you would have to be in Bombay
      for about 10 days. Your husband is needed on Day 12-Day 14 ( the day of the
      egg pickup). All the treatment is performed at our clinic, which means you
      never have to go elsewhere.

      This is what the daily schedule would look like.

      Day 1.
      Day 2. Vaginal ultrasound scan to confirm there is no ovarian cyst. If
      there is no cyst, we can commence superovulation.
      If there is a cyst, we aspirate ( puncture) it and continue with the
      treatment.
      Tab Letrozole 5 mg daily . Inj Menogon ( 75 IU), 8 amp ( 600
      IU ) daily
      Day 3 Tab Letrozole 5 mg daily . Inj Menogon ( 75 IU), 8 amp
      ( 600 IU ) daily
      Day 4 Tab Letrozole 5 mg daily .Inj Menogon ( 75 IU), 8 amp (
      600 IU ) daily
      Day 5 Tab Letrozole 5 mg daily . Inj Menogon ( 75 IU), 8 amp
      ( 600 IU ) daily
      Day 6 Tab Letrozole 5 mg daily . Inj Menogon ( 75 IU), 8 amp
      ( 600 IU ) daily
      Day 7. Vaginal ultrasound scan to monitor follicular growth
      Day 7 . Inj Menogon ( 75 IU), 8 amp ( 600 IU ) daily. Inj Orgalutron, 0.25
      mg daily
      Day 8. Inj Menogon ( 75 IU), 8 amp ( 600 IU ) daily. Inj Orgalutron, 0.25 mg
      daily
      Day 9. Inj Menogon ( 75 IU), 8 amp ( 600 IU ) daily. Inj Orgalutron, 0.25 mg
      daily
      Day 10. Vaginal ultrasound scan to monitor follicular growth
      The Menogon and orgalutron injections continue until the follicles are
      mature ( approx Day 12). Then the HCG injection is given, and eggs retrieved
      36 hours after this.
      Embryo transfer is performed 3 days later.
      After the transfer, luteal phase support is provided with daily Progynova
      ( estradiol valerate2 mg, 3 tab daily; and Uterogestan ( 200 mg), 6 vaginal
      suppositories daily.
      You can travel back 3 days after the embryo transfer.
      14 days after the transfer, you need to do a blood test for beta HCG to
      confirm a pregnancy.

      You can print out an IVF calendar ( of your cycle ) at
      www.ivfindia.com/ivfcalendar2.php



      Delete
    3. Hello Doctor,

      I am very confused and don't understand all medical terms and levels. My doctor asking me to go for egg / sperm donor. I am really in depression please tell me in simple steps what is the diet and things to be followed to get pregnant with the frozen sperms at my hospital in USA. Please suggest me according to USA so that it will easy for me in getting tablets etc. I will be great full to you.

      Delete
  3. Hi Dr.

    I am 30 yrs old with 2 failed letrozole cycles (1 chem preg) and 1 failed gonadotropin cycle. My Amh was 1.6 and FSH was 10.6--my dr is saying IVF asap. I have a 2 year old that we conceived naturally (with the help of some monitoring). I am trying to destress as i know stress is playing a huge roll in this.

    Any advice would be appreciated. Thank you.

    ReplyDelete
  4. Since this website mentions the work of Julia Indichova and her book Inconceivable, I would like to say that her approach is really unique and has helped many women with bad diagnoses. I also learned from Julia that talking about
    stress and infertility creates a lot of confusion and often does more harm than good.
    Several women with low AMH conceived with her tools, you can read the testimonials on her message board, www.fertileheart.com. She even has some special imagery on her latest CD
    that are specifically created to support healthy ovulation. She works with diet and visualizations. you could also look at her video on fertility success stories on youtube. Hope this can help other women!

    P.

    ReplyDelete
  5. Anonymous5:33 PM

    Dear Dr,

    If you could excuse me I would like to give my views on this post. AMH is a harmone secreted by growing follicles (pre-antral and antral) and hence its decline correlates with the decline in the number growing follicles. Thus it helps in determining ovarian reserve.

    Does increasing AMH production by artificial means can increase pre-antral and antral follicle count (ovarian reserve)? Actually not. Research findings till date did not find a feed-forward loop. More AMH, more antral follicles but adding AMH to ovaries does not increase AFCs. Infact addition of AMH to neonatal ovaries in vtro inhibits primordial follicle recruitment and hence can decrease AFC. Thus it can also preserve ovarian reserve for a longer period. Slower recruitment of primordial folicles = longer reproductive period. Mice which do not produce AMH deplete their ovarian reserve faster and reach menopause quicker (they are fertile!). So if we artificially increase AMH or give AMH from outside recruitment of primordial follicle is prevented. This can explain Jay's observation that after taking Vit D (for increasing AMH levels) her AFC has decreased to half.

    A very recent publication 'Vitamin D Regulates Anti-Mullerian Hormone Expression in Granulosa Cells of the Hen' has found an opposite effect of what Jay has experienced although it is not a study in humans.

    The message is AMH is not an indcator of egg quality. But people with poor egg quality can have low AMH ( because aged people have poor egg quality and they also have less ovarian reserve). I beleive they are two different process not mutually exclusive. So a younger woman with low AMH doesnt necessarily have to have low egg quality. Woman with PCOD have higher level of circulating AMH (bcoz of more AFC) but not necessarily good quality eggs. The second message is increasing AMH artificially can decrease your AFC count and hence eggs available to be collected via IVF.Might be for a women with PCOD Vitamin D therapy can help if it decreases their extremely high AFC!

    The entire thing is interesting because PCOD woman have more AFC and hence more AMH. Might be such high AMH levels prevent ovulation (by preventing selection of follicle hence no mature follicle) and also prevents primordial follicle recruitment. This means PCOD women can be fertile for a longer period of time than their normal reproductive counterparts interms of egg production. An older PCOD woman can produce more egs because her ovarian reserve is preserved but do they have good quality eggs is again a question here!

    Just my few cents on this topic.

    ReplyDelete
  6. Anonymous7:36 PM

    Dear Dr,

    Want to make some changes to my previous comment :)

    1) More AMH, more antral follicles but adding AMH to ovaries does not increase AFCs.

    This sentance should be read as: More antral follicle count = more AMH but adding AMH to ovaries does not increase AFCs.

    2)I beleive they are two different process not mutually exclusive.

    This should be read as : I beleive they are two different process WHICH ARE mutually exclusive.


    Actually you hypothesize somethng in science and scientific community already knows it :) Well something to support the last paragraph of my previous comment :
    http://www.jeanhailes.org.au/resources/international-research/1290

    Hope my comment is useful!!!

    ReplyDelete
  7. Anonymous3:56 PM

    Hi Doctor,
    'am a 35 years old with no kids. Have got a series of failed IUIs. Had 2 IVFs. first resulted in pregnancy only till 6 weeks and 2nd IVF failed.
    My recent AMH is 9.98, FSH - 8.71, LH - 10.47, Estradiol - 39.89 and Progestrone - 0.38.
    Pls suggest, is it difficult for me to conceive ?

    ReplyDelete
  8. Anonymous9:45 PM

    Dear Dr. Malpani,
    My doutor told me that my amh decrease from .58 to .30 in last 4 months while i was ranking dhea 3 times a das. He suggest to use eggs donated. What eles can i do to increase the amh until january 2013 to do Ivf .
    Best regards
    Vivino

    ReplyDelete
  9. Anonymous11:32 PM

    Hi Doctor,

    My wife is 40 years old, AMH is 0,2 and FSH is 6,1 and LH is 3,4, TSH 0,68, T4 16, our Doktor said there is no chans to my wife to get a good egg...

    What can we do?

    Mick

    ReplyDelete
  10. Anonymous11:15 AM

    Dear Dr. Malpani,
    I am a 40 year old lady who recently learnt that my AMH is 0.2 and my husbands sperm count is 5 million but motility 3%. Seeing this combination the Doctor here sees no hope in continuing it further. However since I was insistent she said that we could only once try (ICSI) Intracytoplasmic sperm injection. However before that we need to undergo a series of genetic test which we are currently doing. If they come normal we can go for ICSI.
    My question is would be there some chance of having a normal child through this procedure or is it better to accept it as our fate and leave it for good.
    I really need your answer as it would go a long way in clearing the dilemma.
    Thanks...
    A lady who wants to a mother....

    ReplyDelete
  11. Anonymous1:55 PM

    Dear Dr.
    I am 34 for years of age. I was diagnosed with grade 4 endometriosis in the year 2004 and operated on that very year. My recent amh and fsh test results show the levels at 0.03 and 14.78. I had done one cycle of ivf. Now doctors are suggesting ivf by donor egg.I am not being to come to terms with the concept. I ovulate normally and experience ovulation pain and light brown discharge during ovulation. Please help.

    ReplyDelete
  12. Anonymous1:57 PM

    I am 36 yrs old and was diagnosed with an AMH of 4pmol/L - I.e. very low. I was devastated after having been given hope with my FSH & LH of 4.1 plus good estrogen and progesterone levels, plus I knew I was ovulating. We had been trying to conceive for around 18 months. Anyway, long story short, a few days after my low AMH came back and we were about to begin IVF, I discovered I was already pregnant - naturally. I'm now 15 weeks and confident things are progressing well. I hope my story gives people some hope. Number are sometimes simply numbers and miracles can and do happen.

    ReplyDelete
    Replies
    1. Anonymous12:18 AM

      Thank you for giving some of us hope :)

      Delete
  13. Anonymous10:16 PM

    Respected Dr. Malpani,My age is 31 i m married for last 4 years, but have not conceived yet, recently i got my amh done it was 1.7 ng/ml, what does this mean? can i conceive naturally? Plz answer my query

    ReplyDelete
  14. A low AMH does not necessarily mean you are infertile ! Women with low AMH levels can have babies too !

    Do a complete workup before starting treatment haphazardly.

    You need to do ALL the following simple medical tests:

    semen analysis for your husband ( to check his sperm count and motility). Read more at www.drmalpani.com/sperm.htm

    blood tests for you for the following reproductive hormones - FSH ( follicle-stimulating hormone),LH ( luteinising hormone),PRL ( prolactin) , AMH ( antiMullerian hormone) and TSH ( thyroid stimulating hormone) on Day 3 of your cycle, ( to check the quality of your eggs). Do this from a reliable lab such as SRL ( www.srl.in). Day 1 = Day the period starts.

    HSG ( hysterosalpingogram, X-ray of the uterus and tubes, www.drmalpani.com/hsg.htm) on Day 8 of your cycle ( to confirm
    your fallopian tubes are open);

    The vaginal ultrasound scan on Day 10-11 should check for the following. a. ovarian volume b. antral follicle count c. uterus morphology d. endometrial thickness and texture

    Please send me ALL the detailed test results and medical reports . You can scan them in as a single doc or pdf file and email them to me.

    Please send me all the results together, rather than piecemeal, so I can interpret them intelligently

    With these test results, we can determine what medical problems are causing your
    infertility.

    If there is a problem, then we can treat it !

    Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

    You can talk to some of our patients by email at http://www.drmalpani.com/success-stories.htm

    We look forward to helping you to have a baby !

    Regards,

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270
    FAX ( India) 91-22-22150223.
    Helping couples build families !
    PS Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    ReplyDelete
  15. Hi Dr. I wondered if you would give me your thoughts on my case?

    I am 25, I had my AMH test done twice over a 10 day period, first it was in the reduced response category at 2.25 and then came back even lower 0.95. I had my FSH, LH and Oestradiol which came back normal, and my follicle count was 15 over the two ovaries. My womb looked fine on the scan. I know that AMH is a predictor of IVF success, which considering my score doesn't look good for me, I know that most stats will tell you that an average of 30-35% success for those under 35. But I wondered if you had any further thoughts on my chances specifically. I have been referred as a high priority case on the NHS for IVF. I am hoping that because I am young my chances are higher than a normal person because the majority of people going through IVF are older??

    also, i am healthy, sporty - go to the gym, i dont smoke i very rarely drink although my BMI is 28/29

    any thoughts would be appreciated.

    Thank you

    ReplyDelete
  16. Dear Sacha,

    The fact that you are young and you have a good antral follicle count means you have a good prognosis, so please don't panic.

    Let me know how your cycle progresses !

    Best of luck !

    Dr Malpani

    ReplyDelete
  17. where and in what form can I find Wheat germ? how should I take it?

    ReplyDelete
  18. 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 ?

    ReplyDelete
  19. Hi Dr

    Could you send me the items you listed above? or tell me where i can get them?

    ReplyDelete
  20. This comment has been removed by the author.

    ReplyDelete
  21. Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at www.drmalpani.com/afc.htm

    You can try the following to improve your ovarian reserve.

    1. Yoga
    2. Acupuncture
    3. DHEA, 25mg thrice a day. This is an anti-aging hormone
    4. Wheat germ oil, 1 capsule daily. This is a nutritional supplement
    5. Coenzyme Q10 , 100 mg daily .This is an antioxidant

    Continue these until you get pregnant

    6. Cholecalciferol ( Vit D) , 60000 IU, once a week for 4 weeks




    Read the book, Inconceivable, at http://www.amazon.com/Inconceivable-Winning-Fertility-Julia-Indichova/dp/0966007859/ref=sr_1_2?ie=UTF8&qid=1330844751&sr=8-2



    ReplyDelete
  22. Anonymous11:42 AM

    Hello doc im a 40 year old i've had my tubs burned and i want to have a baby i have 3 kids already but i want one more i had my amh levels tested and they came back 0.1 iknow i have to go thur ivf to have a baby because of my tubs but should i tke dhea to raise my amh levels i want to use my eggs if i can.please help

    ReplyDelete

  23. Your low AMH level ( www.drmalpani.com/amh.htm)
    Suggests you have poor ovarian reserve .

    You can read more about this at www.drmalpani.com/oopause.htm.

    You can try the following to improve your ovarian reserve.

    1.Yoga
    2. Acupuncture
    3. DHEA, 25mg thrice a day.
    4. Take wheat germ daily
    5. Coenzyme Q10 , 100 mg daily
    6. Cholecalciferol, 60000 IU, once a week for 4 weeks


    Read the book, Inconceivable, at http://www.amazon.com/Inconceivable-Winning-Fertility-Julia-Indichova/dp/0966007859/ref=sr_1_2?ie=UTF8&qid=1330844751&sr=8-2

    IVF with aggressive superovulation would be your best option as it would maximize your chances of getting pregnant quickly and help you make the most of the eggs you have left

    Treatment takes about 20 days. Should I send you the treatment plan ?

    Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

    Treatment can be expensive, but a baby is priceless.

    Plan B would to consider natural cycle IVF. Read more at www.drmalpani.com/naturalcycleivf.htm

    Plan C would be to use donor eggs, if you are willing to consider this option

    This has a much higher success rate

    You can talk to some of our patients by email at http://www.drmalpani.com/success-stories.htm


    We look forward to helping you to have a baby !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270
    FAX ( India) 91-22-22150223. Our US FAX is 1-775-249-6041
    Helping couples build families !
    PS Read our book, How to Have a Baby - A Guide for the Infertile Couple, online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://doctorandpatient.blogspot.com/





    ReplyDelete
  24. Hello Doctor,

    My AMH is 1.34, FSH/LH Normal, Is there any option other than IVF ? IUI is successful with Low AMH level ?

    ReplyDelete
  25. Dear Bijal,

    A low AMH is worrisome. In what units was this measured ? ng/ml ?

    A normal FSH and LH is not necessarily reassuring, because these tests are not as good at measuring ovarian reserve as an AMH level is.

    However, do remember that we do not treat numbers - we treat patients !

    What's your age ?

    How long have you been trying to have a baby ?

    Is your husband normal ?

    Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at www.drmalpani.com/afc.htm

    I need more information to be able to provide you with intelligent advice.

    Could you please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better?


    We look forward to helping you to have a baby !

    ReplyDelete
  26. Anonymous12:23 AM

    Doctor,

    My AMH was 0.5 in June 2012; 1.1 in June 2013 - how can this be?? I have had 20 cycles -7 IVFs and 13 IUIs-numerous losses-but clinging to hope. I am so confused by recent AMH levels...what does this mean?

    Thanks,
    Angela

    ReplyDelete
  27. Dear Angela,

    You are a remarkably determined woman !

    AMH levels can fluctuate - this is quite common in any biological system !

    Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at www.drmalpani.com/afc.htm

    Can you send me more details about your IVF cycles ? What were the meds which were used for
    superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? What was the endometrial thickness ?
    How many embryos were transferred ?
    What was the embryo quality ? DO YOU HAVE PHOTOS OF YOUR EMBRYOS ? You can see what embryos should look like at http://www.drmalpani.com/embryos.htm
    Can you please send me the printed treatment summary from your IVF clinic ?

    We look forward to helping you to have a baby !

    ReplyDelete
  28. Anonymous1:35 AM

    Dr.,

    Thanks for responding! I realize AMH levels can fluctuate - but this is a strange jump - isn't it??

    Oh boy - each IVF was so different - I get scns quite often. I've usually been on max meds with each IVF cycle - 525 gonal-f with 150 repronex. Eggs retreived ranged from 10-12 over the years. I have 0 embryos that ever went to freeze - my last IVF was successful with my first ever Day 5 transfer (3 were transfered) but i had a very rare "c-section scar pregnancy" which led to me needing chemotherapy and waiting for months to resolve. Today I underwent an HSG to check tubes, but all looks good. My E2 and Prog levels were usually pretty normal-at times my prog would drop but i was also on prog injections. My thickness varied, but was never wonderful...I understand egg quality was B range last attempt; but made it to Day 5 for the first time. Yes - I have photos of my embryos...I am not sure if it is dangerous to try IVF again at this point since i need max meds...or go with clomid and try one last IUI...what are your thoughts? Thanks again!!
    ~Angela

    ReplyDelete

  29. Your low AMH level ( www.drmalpani.com/amh.htm)
    Suggests you have poor ovarian reserve .

    You can read more about this at www.drmalpani.com/oopause.htm.

    You can try the following to improve your ovarian reserve.

    1.Yoga
    2. Acupuncture
    3. DHEA, 25mg thrice a day.
    4. Take wheat germ daily
    5. Coenzyme Q10 , 100 mg daily
    6. Cholecalciferol, 60000 IU, once a week for 4 weeks


    Read the book, Inconceivable, at http://www.amazon.com/Inconceivable-Winning-Fertility-Julia-Indichova/dp/0966007859/ref=sr_1_2?ie=UTF8&qid=1330844751&sr=8-2

    IVF with aggressive superovulation would be your best option as it would maximize your chances of getting pregnant quickly and help you make the most of the eggs you have left

    Treatment takes about 20 days. Should I send you the treatment plan ?

    Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

    Treatment can be expensive, but a baby is priceless.

    Plan B would to consider natural cycle IVF. Read more at www.drmalpani.com/naturalcycleivf.htm

    Plan C would be to use donor eggs, if you are willing to consider this option

    This has a much higher success rate

    You can talk to some of our patients by email at http://www.drmalpani.com/success-stories.htm


    We look forward to helping you to have a baby !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270
    FAX ( India) 91-22-22150223. Our US FAX is 1-775-249-6041
    Helping couples build families !
    PS Read our book, How to Have a Baby - A Guide for the Infertile Couple, online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://doctorandpatient.blogspot.com/





    ReplyDelete
  30. Anonymous4:06 PM

    my AMH level is low 1.07 can I get pregnant advise please

    ReplyDelete
  31. Hi Doctor,

    i married 1 year for now, not gotten pregnant. in Fertility center amh result is 0.5 and my age is 27. Can you please provide the possibility to get pregnant and any treatment to increase amh levels.

    ReplyDelete
  32. Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at www.drmalpani.com/afc.htm


    Your low AMH level ( www.drmalpani.com/amh.htm)
    suggests you have poor ovarian reserve .

    You can read more about this at www.drmalpani.com/oopause.htm.

    ReplyDelete
  33. Asudamla4:40 AM

    Hi Dr. Malpani,

    I have just found out this internet site and I was so happy.
    first sorry for my English. I hope I can explain correctly my sitauation.
    I'm 39 and married for two years. and I could not get pregnant during this period. and I made 4 times FSH, E2, TSH, proloactin test. my last FSH was 11,42 (befor 9 , 7, 11, )and finaly decied to make directly IVF.
    when we (me and my husband) saw dr. she told me that my TSH was so high to start IVF, actually it was 6. And I was happpy becasue I thought now I know the reason of not getting pregnant and with treatment my tsh level would be good and I can get pregnant by IVF. And then I started to take medicine to make it lower then 2,5 by seeing an endocrinologist dr.
    Also my IVF doctor asked me to take amh test. Here starts my very bad story. 3 days ago I learnt that my amh was 0.01! I wished to be dead. the most thing I want in this world to have a baby but now it seems to me impossible until I saw here.
    my next period is 31 october and I will start to IVF. do you think I have a chance?
    my cyclus are very regular, in every 28-29 day I have my period and take 6-7 days. I have never thougt that my amh will so bad.
    please give me some hope and advice.
    thanks.

    ReplyDelete
  34. Asudamla4:51 AM

    Hi Dr Malpani,

    I forgot to ask you one thing that was the one of reason to write you.
    can high TSH level have a negatif effect on AMH?
    I mean if my tsh level becomes to normal range, can my amh leve change?
    many thanks in advance for your reply.
    and loves from Turkey

    ReplyDelete
  35. No, the TSH has no effect on the AMH level.


    Your low AMH level ( www.drmalpani.com/amh.htm)
    suggests you have poor ovarian reserve .

    You can read more about this at www.drmalpani.com/oopause.htm.

    Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at www.drmalpani.com/afc.htm

    We look forward to helping you to have a baby !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

    You can add a google review for us at https://plus.google.com/102706636605134081909/about

    My Facebook page is at www.facebook.com/Dr.Malpani

    You can follow me on twitter at https://twitter.com/drmalpani

    Watch our infertility cartoon film at http://www.ivfindia.com

    Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://blog.drmalpani.com

    ReplyDelete
  36. Anonymous3:34 PM

    Hi Dr Malpani

    I am 28yr old female with PCOS diagnosed 4yrs ago. I am on yamini and bigomet SR 500. My amh level is 0.99 and my husband's sperm count is 0.1 million per ml as per his latest test. We are planning to go for ICSI after 4 months. Can u pls suggest some supplements we can take to improve our fertility and what are our chances of success with ICSI.

    Thank you.

    ReplyDelete
  37. Your low AMH means you do NOT have PCOD. Patients with PCOD have a high AMH level ! Please stop your bigomet - this will reduce your reserve even more.

    I agree ICSI would be your best treatment option

    Treatment takes about 20 days. Should I send you the treatment plan ?

    We look forward to helping you to have a baby !

    Dr Malpani

    ReplyDelete
    Replies
    1. Anonymous1:40 AM

      My latest fasting blood sugar report was 122. When im on metformin it goes down to 115. Please send me the treatment plan and supplements that my husband and I can take to improve our chances. We have about 3months time.
      Truly appreciate your help doctor. 
      Thank you so much

      Delete
  38. Anonymous12:46 PM

    My latest fasting blood sugar report was 122. When im on metformin it goes down to 115. Please send me the treatment plan and supplements that my husband and I can take to improve our chances. We have about 3months time.

    Truly appreciate your help doctor.
    Thank you so much.

    ReplyDelete
  39. Anonymous11:42 PM

    Hello Doctor,

    I know I am commenting on an old post, but hope you answer my question. How often should the AMH test be repeated while undergoing fertility treatment, should it be before every IUI as well.
    Thanks...

    ReplyDelete
  40. Anonymous1:37 PM

    Hello doctor,
    I am 30 years old.got marrued 5years back. I did my amh test after vagial ultrasound. My amh is 0.2. So what would be the next coyrse of action

    ReplyDelete
  41. Anonymous1:45 PM

    Hello sir,
    I am 30 years old married 5 years back. We are trying for baby. I did amh after vaginal ultrasound . My AMH is 0.2
    Sowhatwould be the next course of action

    ReplyDelete

  42. Your low AMH level ( www.drmalpani.com/amh.htm)
    suggests you have poor ovarian reserve .

    You can read more about this at www.drmalpani.com/oopause.htm.

    Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at www.drmalpani.com/afc.htm

    ReplyDelete
  43. Anonymous7:54 PM

    Hi! Dr, I am 41 with no children and my AMH count is 2. You recommend I've for a low count however, my GP says I can't have IVF as my AMH is too low. Does this mean I only have egg donor as an option? Or, could i try naturally with Comid or something?
    Is there any treatment at all available on the NHS?
    I have been pregnant in the past (2007 being the last time) but have miscarried each time. My GP is going to send me to the recurrent miscarriage centre to check all is well in there but.. I'm at my wits end worrying I'm going to be childless. C x

    ReplyDelete
    Replies
    1. Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at www.drmalpani.com/afc.htm

      In what units was the AMH tested ? pmol/L or ng/ml ? Read more at www.drmalpani.com/amh.htm

      Time is now at a premium for you - please don't waste it ! You should never have any regrets that you left any stone unturned and didn't give yourself the best shot at fertility treatment.

      Dr Aniruddha Malpani, MD
      Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
      Mumbai 400 005. India

      Clinic Mobile: 9867441589

      Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

      Helping you to build your family !

      You can add a google review for us at https://plus.google.com/102706636605134081909/about

      My Facebook page is at www.facebook.com/Dr.Malpani

      You can follow me on twitter at https://twitter.com/drmalpani

      Watch our infertility cartoon film at http://www.ivfindia.com

      Read our book, How to Have a Baby - A Guide for the Infertile Couple,
      online at www.DrMalpani.com !

      Read my blog about improving the doctor-patient
      relationship at http://blog.drmalpani.com

      Delete
  44. Anonymous2:46 PM

    hi, doctor. i am 30 yr old, married for 5 yrs. i had an laparoscopy followed by cystectomy in both ovaries in 2011 August.my amh level is very low 0.1 with FSH 9. Doctor found no follicle in tvs scan. plz help me.

    ReplyDelete
    Replies
    1. The cystectomy was a bad idea. It has caused you to have ovarian failure :(

      I am sorry, but your high FSH level confirms you have ovarian failure.
      You can read more about this at http://www.drmalpani.com/premature-ovarian-failure-pof.htm

      Your best option would be donor egg IVF ( www.drmalpani.com/eggdonation.htm) or embryo adoption ( www.drmalpani.com/embryoadoption.htm)

      Which would you prefer ?

      We look forward to helping you to have a baby !

      Dr Aniruddha Malpani, MD
      Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
      Mumbai 400 005. India
      Tel: 91-22-22151065, 22151066, 2218 3270


      Helping you to build your family !

      PS Watch our infertility cartoon film at http://www.ivfindia.com

      Read our book, How to Have a Baby – A Guide for the Infertile Couple,
      Online at www.DrMalpani.com !

      Read my blog about improving the doctor-patient
      Relationship at http://doctorandpatient.blogspot.com/

      Delete
  45. Anonymous4:32 PM

    One of my known is having problem in getting pregnant., married 20 yrs back, got pregnant naturally after one year but aborted due to personal reasons, again after one year got pregnant naturally, her financial condition was poor as her husband was having no work. got aborted Gynac in her town suggested to put Cu T , kept CuT for one year. After removal she could not get pregnant.All the reports were normal including tubes patent. Done 6 IUI cycles & IVF , but no positive results. Can CuT cause permanent infertility? what is the solution for this. AMH level at present is 1.4. Can she try for another IVF ET cycle or Surrogacy is the answer. age is 41 years. Husband is 43 with all reports normal. Kindly answer and suggest further treatment options .

    ReplyDelete
  46. Anonymous6:06 PM

    Dear Dr. I'm 38 & Husband is 41. I want a 2nd opinion, we've been trying for 7 months & recently conducted tests. Results after my Cloud challenge indicates FSH-12 AMH-.37. My Husband sperm analysis indicates semen conc -7.0, Semen Morp-6 Motility-27 non viable- 43.5% Obgyn prescribed vitamins for Hubby & suggests IF with donor eggs. Please advise!

    ReplyDelete
    Replies
    1. Your low AMH level ( www.drmalpani.com/amh.htm)
      Suggests you have poor ovarian reserve .

      You can read more about this at www.drmalpani.com/oopause.htm.

      You can try the following to improve your ovarian reserve.

      1.Yoga
      2. Acupuncture
      3. DHEA, 25mg thrice a day.
      4. Take wheat germ daily
      5. Coenzyme Q10 , 100 mg daily
      6. Cholecalciferol, 60000 IU, once a week for 4 weeks


      Read the book, Inconceivable, at http://www.amazon.com/Inconceivable-Winning-Fertility-Julia-Indichova/dp/0966007859/ref=sr_1_2?ie=UTF8&qid=1330844751&sr=8-2

      IVF with aggressive superovulation would be your best option as it would maximize your chances of getting pregnant quickly and help you make the most of the eggs you have left

      Treatment takes about 20 days. Should I send you the treatment plan ?

      Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

      Treatment can be expensive, but a baby is priceless.

      Plan B would to consider natural cycle IVF. Read more at www.drmalpani.com/natural-cycle-ivf.htm

      Plan C would be to use donor eggs, if you are willing to consider this option

      This has a much higher success rate

      You can talk to some of our patients by email at http://www.drmalpani.com/success-stories.htm


      We look forward to helping you to have a baby !

      Dr Aniruddha Malpani, MD
      Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
      Mumbai 400 005. India
      Tel: 91-22-22151065, 22151066, 2218 3270

      Helping couples build families !
      PS Read our book, How to Have a Baby - A Guide for the Infertile Couple, online at www.DrMalpani.com !

      Read my blog about improving the doctor-patient
      relationship at http://doctorandpatient.blogspot.com/

      Delete
  47. Anonymous7:50 PM

    Hello Dr. Malpani,

    I have a high FSH and not getting period but i like to conceive naturally. Can you suggest me natural medication i can take? I lived in Canada so suggest me accordingly.

    Thanks for your help.

    ReplyDelete
    Replies
    1. I am sorry, but your high FSH level confirms you have ovarian failure.
      You can read more about this at http://www.drmalpani.com/premature-ovarian-failure-pof.htm

      Your best option would be donor egg IVF ( www.drmalpani.com/eggdonation.htm) or embryo adoption ( www.drmalpani.com/embryoadoption.htm)

      Which would you prefer ?

      Time is now at a premium for you – please don’t waste it ! When you are 50 years old and looking back at your life, you should never have any regrets that you left any stone unturned and didn’t give yourself the best shot at fertility treatment. Treatment can be expensive, but a baby is priceless !

      Taking treatment at a world-class clinic will maximize your chances of success and give you peace of mind you did your best !


      We look forward to helping you to have a baby !

      Dr Aniruddha Malpani, MD
      Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
      Mumbai 400 005. India
      Tel: 91-22-22151065, 22151066, 2218 3270


      Helping you to build your family !

      PS Watch our infertility cartoon film at http://www.ivfindia.com

      Read our book, How to Have a Baby – A Guide for the Infertile Couple,
      Online at www.DrMalpani.com !

      Read my blog about improving the doctor-patient
      Relationship at http://doctorandpatient.blogspot.com/

      Delete
  48. Hi Dr,
    I got married 1 yr back.my age is 25 . I was having a problm of irregular periods before marriage when it started after marriage also I went to adoctor she prescribed me 21 days medicine for regular cycle.after I stopped that medicine from last three four months I m having a prolonged heavy bleeding which only stops after medicine. Doctors ask me for some test in which I came to kne that my amh is very low .44 and also I have two fibroids 16×14mm and 13×13 mm plus I have pcod problem.she advised me for tb tst also.my montoux and tb gold is positive but my tb pcr test is negative.she started akurit 4 for three months.now my main concern is I want to stop this heavy bleedingand want to conceive.please tell me..which treatment should I start first.

    ReplyDelete
  49. You do NOT have PCOD. Patients with PCOD have a high AMH level !
    The two small fibroids will not affect your fertility
    These TB Gold tests are very unreliable ! You can read more about this at http://www.drmalpani.com/tuberculosis-and-infertility.htm

    Your low AMH level ( www.drmalpani.com/amh.htm)
    suggests you have poor ovarian reserve .

    You can read more about this at www.drmalpani.com/oopause.htm.

    Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at www.drmalpani.com/afc.htm

    Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !
    You can talk to some of our patients by email at http://www.drmalpani.com/success-stories.htm

    Treatment can be expensive, but a baby is priceless.
    We look forward to helping you to have a baby !

    ReplyDelete
  50. Anonymous2:21 AM

    Hi Dr, I conceived a beautiful boy when I was 30 without any effort. I used Mirena since then for 4 years. I haven't been able to get pregnant again and I have been trying for almost 2 years (Now IM 37). A year ago I got all my tests and everything was fine except for my AMH which was almost undetectable (0.16). I took all recommended products for a year and last month my AMH levels were up to 0.84. I have been doing ovulation tests and seems like I'm not ovulating although in my last ultrasound I had 3 follicles and 7 in each ovary. I was wonder if Clomid could help me to ovulate or what do you recommend I can do. I don't have the resources for IVF nor IUI. Thanks a lot for your help.

    ReplyDelete
  51. Yes, if you cannot afford anything else then it makes sense to try the clomid ( though I wouldn't be too hopeful !)

    ReplyDelete

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