Sunday, August 03, 2014

Can I get pregnant with a low AMH ?


This is one of the commonest questions I am asked.

The answer is – It depends !

After all, the chances of a pregnancy in a woman with a low AMH will be completely different if she is 26 years old and has been trying to have a baby for only 5 months; as compared to exactly the same AMH level in a 46-year old women with irregular periods,  who has failed to conceive even after trying for over 2 years.

The point is that doctors do not treat numbers or lab results – we treat humans !

In order to interpret an AMH level intelligently, we need lots more information . How old is the patient ? What’s her antral follicle count ?  Has she been pregnant before ? Has she done IVF before ? What was her ovarian response  ?

It takes time to get the right answers to these questions.  The problem is that patients want quick and dirty and simple answers. They expect that IVF specialists and experts, and that it should be easy for them to answer such a simple question, because they have so many years of experience. When I explain that it’s not possible to do so, they often get upset, because they think I am not willing to share my knowledge ; or that I am not really such a wise expert after all !

The truth is that the quality of the answer does depend upon the quality of the question . It also depends not only on the expertise of the doctor, but on the sophistication of the patient. Anyone can ask a question, but does the patient have the maturity to be able to understand the answer ?

When I explain that the answer is complex; and that it’s hard to answer what the chances of the individual patient are until we actually judge her ovarian response ( something which can only be done by actually doing an IVF cycle for her), mature patients appreciate that I am being open and truthful with them. They know that I am not hedging or being evasive, because the truth is that medical science is full of complex biological variables ,and we still cannot accurately predict how an individual patient will behave. The proof of the pudding, as always, is in the eating.

It’s easy enough to provide a short and terse answer – but then patients think that I am being rude and unhelpful ! Clinical medicine is full of surprises and nuances , and it’s not possible for doctors to provide simple black-and-white answers to many questions.  There are always going to be exceptions, and doctors are not fortune-tellers. We  have had patients with a low AMH level who get pregnant on their  own; and we have  seen patients with normal AMH levels who respond poorly during IVF treatment.

We try to provide an intelligent and honest balance when counselling patients. We don't want to create unnecessary anxiety , but neither do we want to give false  hope ! It can be tricky walking this tight rope !

This is why Information Therapy is so important. Patients need to learn to become better patients, before they can expect their doctors to become better doctors.  The more the time and energy they spend in crafting their questions and doing their homework , the better their doctor will be able to help them.

Patients need to take responsibility for asking high quality questions if they want their doctor to provide high quality answers. Patients get upset when the doctor provides them with the unvarnished truth,  because this may not be what they wanted to hear. They are likely to get upset with the doctor and badmouth  him, as being rude and blunt. However, it’s always better to know the truth. This may cause you to be upset on a short-term basis, but this is far better than living in false hope, which causes much more long-term pain and angst.

Need help is making sense of your AMH level ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

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