anti-mullerian hormone testing

[Brookwater]

Anyone have this done or talk to your RE about it? I am just gathering information and trying to see if I should do it. I am 42 (almost 43!) and trying to make the decision if we should try IVF. We probably only have 1 bite at the apple for $$ reasons, so I want to go inwith as much info as possible. Any insight you can give me would be great!

From ******************:

AMH stands for Anti-Mullerian Hormone. AMH is produced by the egg follicle that the ovaries grow to prepare an egg for release into the fallopian tube. The levels of AMH found in the blood could be an indicator of a woman’s ovarian function. Essentially, an AMH test can tell you if your ovaries are still releasing eggs.

The theory is that because the level of anti-mullerian hormone found in the blood does not fluctuate throughout the month, it could be an accurate predictor of whether a woman is still fertile and how many eggs she has left in her ovaries. The manufactures claim that it is more accurate than a simple oestrogen test. If they’re right, then the test would be a predictor of who’s more likely to have success with in-vitro fertilization.

In addition to the test’s possible applications as a predictor of fertility, it may also be useful as a test for polycystic ovarian syndrome (PCOS). It is believed that women with PCOS have elevated levels of AMH in their blood, which would make the AMH test ideal for diagnosis.

How the Test is Done
Currently, the test is not covered by insurance and it expensive to have done. To perform the test 3mls of blood is taken on the second or third day of the woman’s period. Using the results of the test and an "Ovarian Reserve Index", the estimated number of eggs remaining in the ovaries is plotted on a graph showing the woman’s position compared with the average number for her age group. Makers of the test claim that this will predict ovarian reserves for the next two years.

Controversy
There is some controversy over what exactly this test can truly tell you, if anything. Using the test as a predictor of menopause is probably useless, but using it as an indicator of ovarian reserves may be more feasible. Whatever the use, fertility experts currently believe that the AMH test is about 70 percent accurate.

[YayaMimi]

I was tested and found to have a borderline level. My insurance did pay for the testing. If you are thinking about using 42/43 year old eggs, then you should do this test along with the day 3 FSH and day 10 FSH.

[Brookwater]

Thanks YaYaMimi! Glad to hear that your insurance paid for it. Are they pretty liberal with fertility tx? Mine only pays for diagnostic stuff, so I am hoping this would be included as well.

Did your RE recommend a particular day to get it on or was he/she of the belief that it did nto matter, like this article? I tried to post the website that I got it from but I take it that is not allowed??

[BC-tnahope]

My RE never even mentioned this test. Although since I do have high FSH I just figured if they did do it, it would just be another reason for them to kick me out of their program I know a few others on this board did, hopefully they will chime in soon.

[bes1622]

I have posted this before, so apologies for cutting/pasting and being lazy!

AMH is another test of ovarian reserve, just like FSH. Unfortunately, in the US, it is used as another "doom and gloom" marker for RE's to push you toward finding an egg donor.

Most women that have a high FSH will have a low AMH. There are lots of women who have had poor results with both who are now PG.

Antral Follicle count - determined by ovarian ultrasound on Day 2, 3, or 4 - is probably a better indicator of ovarian response than FSH -which will vary from month to month.

Lots of people obsess here about lowering FSH - to be honest, there is really no purpose to doing this unless you are trying to meet a certain threshold for your doctor to treat you. No study has ever shown that you respond better in a month when your FSH is lower - most RE's believe you are only as good as your highest number - so they don't often care if the number comes down.

You definitely need to have lots of other tests done along with the FSH - particularly thyroid testing. Also, to truly have premature ovarian failure - you should no longer be menstruating. If you are having periods, the more correct term is DOR, or diminished ovarian reserve.

Hope that helps - also feel free to join the CYCLE thread - it is full of women going through the exact same issues, and you may get more responses to your questions.

Additionally, do NOT be bullied into giving up by an RE because you have terrible FSH or AMH numbers. The HOPE board is filled with women who were given the donor egg speech over and over and told they had no chance of getting PG with their own eggs - and many have had children, many more are pregnant - some with twins and even triplets!!! If you do have the test, and your RE refuses to treat you because of it, RUN DO NOT WALK, to another RE. I personally wasted lots of time at 2 different clinics monkeying around with RE's that were not high FSH friendly. Your time is precious.

The end result is that these numbers may mean it will be more difficult for you, but no study has EVER shown that a certain FSH or AMH level is prohibitive. We've seen women here with really not-so-good numbers beat the odds. Your AFC and response to meds is a much better predictor than any lab test.

I wish you all the best -
Good luck!
Bess

[hijumpgrrl]

I had AMH tested after my FSH came back high. My AMH was actually higher than my FSH indicated it should be (likely related to my age--I'm only 29, was 28 at the time). My RE was encouraged by my AMH, and as a result, we're in the middle of IVF cycle #2 with my own eggs. I think it could be used "against" you, as bes mentioned. It doesn't really give you any NEW information, if your FSH has already come back high.

[Brookwater]

Wow! Thank you so much for that information Bess. No prob with the cutting and pasting. there are so many posts here that I can't get to them all and some are so long it is a bit overwhelming you know?

I spoke to my RE yesterday and he basically said he would order one for me if I insisted, but, as many of you said, it is just another indicator of what we already know, and not really any new information. I did have my FSH retested (my clinic only does about 6 - 12 months, not ever cycle like I have seen some people here). My first one in Dec was 10.8 and this one was 14.2. I started to hyperventilate but he told me that they can move around (which I had read too) and that I was a good responder to the meds my 1st two cycles so he saw no reason to do anything differently.

I just would like as much informaiton as I can get or some type of guarentee and I know that is not possible. If we are going to spend the $$ of IVF I want to know I have more than a 5% chance of getting preggers. I do not want to be resentful later that we 'wasted' the money when we could have put it towards adoption or hell, gone on a great vacation or paid down on the morgage,. Anyway...I am getting into to vent land. Thanks for all of your help ladies.

[TMF001]

Brookwater,
My doctor told me that AMH can be used as an indicator to determine how a woman with DOR will respond to stimulation. Granted, he admits that there aren't really any studies that suggest doing this. My AMH was done AFTER I'd done over a year of stims and was pretty consistent with my poor response. I agree with some of the other posts, that I think the only purpose it would serve would be to discourage you from IVF. I'd be very surprised if you had a normal AMH.... but if you did, then it may help you decide to go with IVF.

I think you have a tough decision to make, and shouldn't feel that you've just thrown your $$ away if you try IVF and it doesn't work. Unfortunately for women like us, it takes a few times sometimes before it works. However, some lucky women get pregnant on their first try of IVF. You have to make the decision that you'll be able to live with for the rest of your life. If it's THAT important to you to have your own biological child (as opposed to DE or adoption) then you should do IVF. Good luck and keep us posted.

[sue404]

Hi,

I've just turned 40, in good health, and have never had children. I have been trying to get pregnant for 7 months now and recently went to a fertility clinic.

I was just mailed my AMH results from my tests. My AMH level is 0.00. I guess it doesn't really matter what units that is in because 0.00 doesn't really require units. In fact 0.00 actively defies requiring a unit.

Needless to say, I am devastated. And I'm sure that the readers here can understand that the word devastated is so overused, often describing the reaction to a bad hair cut or a failed pumpkin pie at Thanksgiving, that when applied to losing one's chance at having children it really doesn't seem like this is the right word at all.

I'm very new to all of this. And have done some preliminary searches on having absolutely no AMH at all and this seems to indicate that I have pretty much hit menopause or am a hermaphrodite. Perhaps its the shock of receiving such news written as 0.00 (attached with a graph where they were supposed to plot my results, but couldn't, given it was a logarithmic scale and 0.00 doesn't even mathematically exist on that scale. I can imagine the confused nurse, looking at this graph, quickly noticing the lack of a 0.00, wondering where the hell to place her well-manicured dot, giving up, and just writing 0.00 across the top) but I find it hard to believe that I am either menopausal or a hermaphrodite, except unfortunately, menopausal is still the more likely of the two. I was hoping that someone here might be able to provide some information on what an AMH of 0.00 might mean. The same handwriting that wrote 0.00 also must have tipped over the remains of their bucket of sympathy or tact because they also wrote "extremely low to nil reserve". That's bad for pregnancy, right?

[TMF001]

Brookwater, I think you have to put the AMH in the context of your other tests (antral follicle count, FSH level, etc). If your FSH is really high and your AFC is almost zero, then your AMH level may be correct. However, if it doesn't correlate to your other fertility tests then your doctor may want to check it again. I'm not sure what the sensitivity/specificity is of that test. Good luck.