Low AMH

I have asked many questions, searched medical resources, and poured through fertility clinics’ websites. As far as I understand, AMH, the Anti Mullerian Hormone, relates to ovarian reserve – quantity of eggs, response to fertility drugs, and chances of a natural, healthy pregnancy. There appear to be at least two different scales for AMH: from 0-6.8 ng/ml and from 0-48.5 pmol/L. There are also differing opinions on what is determined as low AMH or normal. If you have another AMH scale, post to let me know! I’m intrigued to find out.

I am in the process of understanding the diagnosis of Low AMH. I am also trying acupuncture, herbs, diet, and abdominal massage because I was told there were no treatments to improve low AMH.

Stick with me and I’ll share anything I come across!

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Eating for TCM

I mentioned I began a diet to aide Traditional Chinese Medicine (TCM) with herbs from my acupuncturist. To summarize the diet, I avoid eating foods with little nutritional value and opt for nutrient dense foods, focusing on eating whole foods. The first step for me was avoiding white sugar, white flour, white rice, white potatoes, and all dairy. I have exchanged my cow’s milk for rice milk. Almond milk, soy milk, and coconut milk were other options, but I by far preferred the taste of rice milk. From the guidelines, goat’s milk and cheese are okay to eat and I do like to taste of the goat cheese, but I have yet to sample the goat milk.

I avoid processed foods the best I can and have been making my own breads at home using honey instead of sugar and water instead of milk. I have added pumpkin seeds, sunflower seeds, hazelnuts/filberts, and almonds to my cabinet staples and I try them with my cooked greens. I discovered a love for kale and collard greens when sauteed with red onions, olive oil, and garlic with a few red pepper flakes.

That is another part of the diet: making sure all veggies are at least slightly cooked and not eating anything straight from the fridge. I was told this was so my body didn’t have to expend the energy to warm it before digestion. If that allows my body to focus its energy on keeping me healthy and making a family, it’s a small price to pay.

Depo Provera

I am not sure why this method of birth control is approved for use.

The first four weeks after my first shot, I was fine. The rest is a different story. After those four weeks, I bled for four weeks, had 1.5 weeks without, then another two weeks of bleeding. I read that spotting was normal, but I had to wear at the very least a liner and change it often during this whole time.

After those first four weeks, I had many other side effects which didn’t make me feel that I was myself. I felt “off” emotionally and psychologically. I also had physical concerns: aches and pains for no good reason, dry eyes and other things, and my vision changed substantially.

My Depo Provera shot was in February, lasting until May, but I didn’t have a period from May until August.

Now, I find out that my ovaries are failing prematurely.

I am told that Depo Provera had nothing to do with it. I have a hard time believing that.

Please don’t do this to yourself.

Learn from my mistake.

Let the Testing Begin

July of 2011, we met with my OBGYN. I felt anxious, but excited and had faith that she would know exactly what to do. She did not see any red flags in my history and no reason to be concerned. She advised us to consider the Clomid Challenge along with some blood tests to see how my body responds. I wasn’t sure if I was ready for that yet, so she recommended ovulation predictor kits, ClearBlue Digital – which worked really well for me and eliminated any confusion with results. The tests were positive on days 11 and 12, then on day 12!

September of 2011, we decided to go forward with the Clomid Challenge and Semen Analysis. The SA was “normal in every way” and they even remarked “we don’t often see people with such high numbers in all areas” Yay! I took 100mg of Clomid on days 5-9 and actually felt quite good, a little loopy, but quite good. Blood tests planned on day 3, day 10, and 10 days past ovulation.

October of 2011, I get a phone call that my blood test for 10 days past ovulation is canceled because of the day 3 test results of my AMH level. My OBGYN had consulted a reproductive endocrinologist about the results and they were referring me to move on to the endocrinologist immediately. My AMH was 1.0 and, at age 28, that was “low.” I was told that we had a 10% chance of conceiving on our own and 30% with IVF.

The earliest date I could get in to see the reproductive endocrinologist was late October which left me a few weeks to worry, stew, and do “research” along with calling my insurance company to find out they cover nothing beyond testing and diagnosis and they only cover up to $2000 total for a lifetime of infertility testing and diagnosis.

During this time, I met with an Abdominal Massage specialist who was also an herbalist. She had an amazing ability to help me understand what was going on with my body, what could be done, and what next steps could be. She also talked to me about what she could do with herbs and massage – the massage was amazing! I went to visit her again in November and she taught me how to do the massage myself to increase blood flow to my reproductive organs.

My appointment with the reproductive endocrinologist involved even worse news – only a 1% chance of conceiving on our own. She recommended the most aggressive approach – IVF with strong meds. She told me that statistics show I would go into menopause by age 32 or 33 and that I have ovaries of a 40-year-old…. Not what a 28-year-old dreaming of a family wants to hear. She ran down a list of indicators for my low AMH – family history, drug use, infections, surgeries, etc. She could find no reason for my low AMH. We were able to do an ultrasound to count my follicles (antral follicle count) and found 8 in my right and 5 in my left ovary – many more than she expected to see with such a low AMH. A “normal” count for age 28 would be around 24 or 25 follicles. The RE recommended Acupuncture, but didn’t know of any other “treatments” to improve my AMH level. We asked to have my day 3 tests repeated since all the other hormone levels were great. We also agreed to have tests done to identify if I carried any genetic mutations or conditions that could prevent pregnancy or explain my infertility. Genetic tests all came back normal.

November 2011, I began Acupuncture. I find it very relaxing, cleansing, and re-energizing. I think I will continue with acupuncture as part of a healthy lifestyle. I also began a diet focused to aid Traditional Chinese Medicine. My acupuncturist adds herbal supplements to my daily intake of prenatal vitamins and calcium supplements. I also began taking my Basal Body Temperature in October even though my OBGYN and RE didn’t see any reason to. My acupuncturist and the abdominal massage therapist both value the information from basal body temperatures. It is also much cheaper than continuing to buy ovulation predictor kits – and I don’t have to pee on anything!

Day 3 tests are repeated and they match the first tests from September. My AMH is 1.1, so I take that as an improvement :) and credit it to my massage, acupuncture, diet and herbs along with doing my best to de-stress.

December 2011, HSG was performed and my fallopian tubes are clear. My uterus has a little indentation, but not a full-blown septum. Nothing the RE was concerned about. I had major cramping during the HSG – the kind of cramps that make you nauseous and send that warm wave across your body. Once the catheter was removed, cramps were minor. I spotted the rest of the day and had achy cramps, but nothing that stopped me from my normal activities.

My husband and I have decided since my schedule is so busy during January, we’ll wait until February to consider IUI with Clomid. I’m not interested in pumping my body full of medication, so I will ask about any other options (Femara, Lupron, Injectables?).