Infertility/Fertility/AMH/FSH levels and fertility predictions
Hello Dr. Ramirez, it's Karri in NY. I had my third child in October after several years of unexplained infertility. I previously had two children without issues and then went on to have around 9 miscarriages before changing fertility doctors and immediately getting pregnant using Bravelle (miscarried w/crinone, clomid, femara, no meds, etc). The whole time I felt it was an issue of low progesterone based on symptoms I experienced, but even the suppositories didn't seem to keep me from miscarrying. Before starting me on Bravelle, my new MD ran some additional tests that the previous MD had not. He checked my FSH levels x2 and my AMH levels. The FSH was within normal limits the first time, and a month later it was slightly elevated. The AMH level was 0.16, which temporarily crushed my dreams with such a low result. Looking back, I had all the symptoms of low progesterone, which I guess the low AMH levels could also explain. With that being said, getting pregnant was never an issue; I just couldn't stay pregnant. I am on the fence abut TTC one more baby, as it was such a difficult process the last time. Since having my son, I feel like I did before my second child was born. I don't have heavy bleeding, I am able to lose weight, I am not as tired, my hair isn't falling out, I am not cold all of the time, and my mood has improved. I feel as though my hormone levels went crazy after my first son and after this pregnancy, they have gone back to where they were 6 years ago. I know AMH levels are supposed to predict egg quantity/follicles but not quality, so it leads me to believe that this number is pretty reliable and won't really change much over time. I am curious if having a baby can reset hormones so to speak and put me back into balance, and if so, would that potentially change AMH and FSH levels? I am only 32 and I have also read that obesity can have an impact on levels. I am not sure that my OB will recheck the levels and it seems silly to go back to the infertility specialist just to have my values checked, but it could impact whether or not we try for another baby in the future. So I guess what I am wondering is can AMH and FSH levels change as the hormones change? Could the last values have been wrong if my body was out of balance, and is it worth asking to have them rechecked? Thank you very much.
Hello Karri from the U.S. (New York),
FSH and AMH levels are just guides to a woman's fertility and NOT necessarily a prediction. They are measures of the ovary's abilities to stimulate. They can fluctuate from cycle to cycle so we use the highest FSH level and the lowest AMH levels to tell us what the "potential" is. They DO NOT PREDICT fertility or the ability to get pregnant!
Protocols are highly variable between clinics and doctors, so I don't comment on specific protocols. However, since Bravelle worked, I'd still with that or a similar medication. I always supplement with progesterone and there are various ways to do this but the two best and main ways are injections and suppositories. Injections are best but hurt a lot. Suppositories are messy but easier to use. However, with suppositories, since there can be variabilities in absorption, you might have to increase the amount being taken (for instance, increasing to 2-3 times per day). Some clinics will check progesterone levels in the luteal phase which can be useful if you are taking progesterone and to make sure that the levels are at least 20.
I don't believe in beating a lab test to death. One is usually enough of a guide to plan treatment. Doint more doesn't change anything.
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com
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