The morning before my hysteroscopy and d&c, the IVF nurse called with my day 3 AMH results.
The level was at 1.5.
A few months ago I wrote a post titled Ovarian Age after listening to a Creating A Family podcast on predicting IVF success. The guest RE discussed factors that determine IVF protocols, predict IVF success and provide a patient's "Ovarian Age". He gave an example of establishing Ovarian Age using one factor, AMH (AMH seems to be the preferred diagnostic for determining ovarian reserve). An AMH level of 1 would be expected for a 40 year old woman, whereas an AMH level of 1.5 would be expected for someone who is 34. At the time I heard this, my last and only AMH test had come back at 1.1. So naturally after two IVF miscarriages and an AMH matching someone older than my chronological age, I latched on to the idea that my ovaries were 40 years old, freaked out and wrote the post.
There were comments to that post that reminded me that AMH is just a number, just as FSH is just a number (Yes, that is true when these tests are taken individually). But my antral follicle count (not just a number, btw; you can't make more eggs than you have) was on the low side, I'd had three early miscarriages and my RE continued to express concern about egg quality, so...
So. What does my current AMH of 1.5 mean? I know, probably nothing. According to the guest RE, it is more consistent with my age than it was last year. My FSH is under 9, my antral follicle count this cycle was in the average range and my AMH is 1.5. Maybe they are all just numbers that fluctuate slightly or maybe my odds are better with these values than they were last year. I have learned since writing the original post that a 35 year old with an AMH of 1 still has a better chance (on paper) of achieving pregnancy than a 40 year old with an AMH of 1. Age is still the biggest predictor of success with one's own eggs.
But really, the most important thing I have learned in the last year of IVF treatments is this: Just as I should not let these numbers discourage me or affect my attitude about a particular cycle when they are not great, I should not put too much emphasis on the results when they seem normal. If it is just a number when it is bad, it is also just a number when it is good. They are always just numbers. I will let my RE worry about what they mean for my cycles.
Also, thank you to all of you who set me straight about the Antagonist protocol. Alex, Erika, Fran and KMP, all of whom have different diagnoses and who had success with this protocol.
6 comments:
After being in this IF blogland for a few years, I have learned that it's all a big crapshoot. There are so many things that those docs can test for to predict success, but in the end it comes down to trying again. And maybe again and again. I know this is no help, but I really like your attitude about the numbers. Just numbers - let the doc worry about those. Fingers crossed for this next cycle!!!
It is so frustrating. My numbers were always really good yet even after 3 different protocols I barely made any eggs (two was the most). Then my sister who had a terrible FSH number and is older was able to produce 16 for me and now I have twin boys as a result. Good luck and I agree with Alex, you have a great attitude. I always felt I needed to micro-manage things so I felt like I had some control.
Sounds like a good thing that your numbers are going in the positive direction! i wonder if injectable IUIs can be "antagonist" - if so, I might be doing one of those. Last cycle I did Lupron, but not this one, and it's supposedly more "gentle."
I like your sense of humor. Wishing you lots of luck as you move forward with this cycle!
Personally I think that like in every experiment you may get there with the best conditions one month and maybe slightly different the month after. We are not machines and we have to accept that our parameters are flexible! Your numbers are great to be honest.
The thing that makese most nuts with all of this is that there really isn't a range given or an uncertainty but just a hard and fast number for so many of these. And, then, the numbers change every month and seem to mean nothing! Makes me nuts.
I nevere had a chance before to say it but I had an antagonist protocol, too. I am definitely not a poor responder - an over responder in fact. And, I've heard that the protocol works for over responders, too. Makes no sense to me at all. But, there you go. I had a good number of eggs (15 mature) but poor fertilization (all but 5 were abnormal) which might be a sign that the eggs developed badly -- maybe from the protocol? No idea. But, the eggs we did get were great and, obviously, worked out really well.
I let my RE worry about those kinds of things too. I've read a lot of posts from other bloggers where the numbers are reported from each blood draw. I've never even heard any of my numbers from my RE's office and I've come to prefer it that way. Less for me to obsess about.
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