My Low AMH “Diagnosis” and Being Told to Get Pregnant By 30 (Tick Tock)
The world of fertility and IVF is full of tests, results and the inevitable challenge of understanding what they mean for you. How these results are delivered and put into context is vital for patients as a misunderstanding can cause untold damage.
My Low AMH “Diagnosis” and Being Told to Get Pregnant By 30
In 2012 I was a junior embryologist at the Reproductive Medicine Centre in Sweden. Along with learning new skills and techniques to become a better embryologist, we had many opportunities for participating in research. The laboratory had studies such as comparing culture medium, comparing transfer medium and trialing new prospective equipment. In addition to the studies, we had ongoing in the laboratory, one of our lead clinicians was undergoing a PhD on AMH (antimüllerian hormone).
The theory behind AMH was that it would be a useful biomarker of female biological fertility.
A pre study trial needed participants that fulfilled certain inclusion criteria. Subjects needed to be healthy women, in a certain age group, ovulatory and regularly menstruating, and not taking any hormonal medication like birth control. I fit the study criteria, so I participated and had my blood drawn. Some time passed and one afternoon I popped my head into the research office and greeted the junior doctor who was assisting our clinician with his trial. I asked about my AMH results. She opened the files on the computer, looked up my name, looked up my result and responded “4”. I said, “cool thanks” and walked away.
Halfway down the corridor I start to shake and walked back.
I ask her what unit the results were in as AMH can sometimes be presented differently (conventional or international units). “pmol/L” she said. This equals 0.56ng/mL. “That’s… that’s really low” I reply. “Yeah, it’s not great” she said. I was 26. I was single. I decided to talk to one of my colleagues about it. I ended up speaking to several. All of them told me I needed to talk to Dr Margareta as she’d helped just about every female in our clinic.
I was torn because I didn’t think I had a reason to bother her but after some convincing I got up the nerve to knock on her door. With tears in my eyes and a lump in my throat I tell her about my AMH result. I was so junior at the time, my training hadn’t included a lot of reproductive hormone studies and the result left me worried and anxious about my future, my ability to have children. She was horrified about the way my result was given and apologized that the possibility of suboptimal results wasn’t discussed (I had been encouraged to participate as I was young and healthy). She proceeded to reassure me by explaining that AMH on its own is not a predictor of fertility, it should at least be accompanied by an AFC (antral follicle count) and that’s when I had my first date with Wanda (name of the ultrasound wand adopted by the wonderful TTC community). Margareta showed me the screen. She showed me my follicles and told me we’d run a few more tests to get a full hormone profile before making any conclusion.
Once the test results were back, she called me into her office and told me that things were okay, but not optimal. In a loving, caring manner, she told me to try to get pregnant by my 30th birthday. I was 26. I was single. On a personal note, this led to some awful relationships that I desperately tried to make work because I felt like I had an actual ticking clock in my head. When I finally met my husband, I felt a sense of relief. When we started to get serious, I explained to him that my fertility was most likely suboptimal and that I didn’t want to wait to try to have children, I kept telling him that 30 was a good age.
We were lucky and our journey wasn’t long.
I am forever grateful to my Dr who encouraged me to start trying by a certain age, even though there was never a guarantee that it would work. As much as I am pro fertility education and personally know the value of a fertility MOT, it does leave a question of how do we deal with a negative result? People often want to check their fertility status to know if they can delay having children, but what measures are in place to help support someone who may be told that they will struggle to get pregnant? Social egg freezing wasn’t available to me at the time, and if it had been I would have struggled to afford it. Instead, I spent years worrying if it would ever happen for me. I know the anxiety and stress I experienced before even trying to have children is nothing compared to what some people go through on their journeys to becoming parents, but it’s given me greater understanding to the emotional struggle that can come with trying to conceive. It made me a more caring and supportive embryologist and it’s made me a better coach.
Fertility Coach MSc, HCPC registered clinical embryologist, ESHRE certified embryologist
Important. Measuring AMH as a fertility marker can be considered controversial. On its own, it can give an indication to your ovarian reserve but it’s not enough to indicate biological fertility. AMH values are most useful when calculating dosage for controlled ovarian stimulation in IVF. (Ginekol Pol 2016;87(9):669-674. Anti-Müllerian hormone: structure, properties and appliance. Rzeszowska et al) (J Turk Ger Gynecol Assoc 2017 Sep; 18(3): 148–153. How to personalize ovarian stimulation in clinical practice. Sighinolfi et al) (Fertil Steril. 2013 Mar 15;99(4):963-9. Biomarkers of ovarian response: current and future applications. Nelson)
Medical Disclaimer:
The information provided in this blog is intended for general informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider or qualified medical professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this blog.