Dear all, just joined this network. Hope you can help. Got my Anti-Mullerian Hormone test results - 4.9 pmol/l. What does it mean?

[Epp-Ebe]

I also got my LH level test (3.8 U/L), FSH test (10 U/L) and oestradiol level test (255 pmol/L) results. Not quite sure how to interpret them. My GP said that all is normal but would not refer me for treatment as am 41. I believe that my AMH test results are not good. Hope somebody can help.

[Louiemac73]

I don't know what the results mean sorry, but your GP has no right to say you can't be referred. You may not be entitled to free NHS treatment, but if you can afford to pay, private clinics will treat you. Choose a good clinic and contact them, they'll ask for a referral from your doctor so then you can go back to them and they won't refuse. Even if you just book the initial appointment, you'll get expert opinion, rather than relying on your GPs general knowledge. Good Luck!!!!!! (I know as I've just had my 40th and got referred to a superb clinic in the North WEst)

[Epp-Ebe in reply to Louiemac73]

Dear Louiemac, Thank you for your kind advice. It helps a lot. I will go back to my GP and ask again.

[DianeArnold Partner Nurse Fertility Network UK]

Hi Epp-Ebe. Just to explain your hormone results a little for you. Your AMH is telling you

that you are in the “low” fertility range, which would mean that it might be difficult to

stimulate your ovaries during an IVF cycle. Your FSH is at the top end of “normal” and

your LH and oestradiol are within normal limits. I believe that you should go back to

your GP and ask him/her to refer you to an infertility specialist. You could possibly then

be investigated further and any appropriate treatment needed would be recommended,

although it may be that you would have to pay for it – I don’t know. Some clinics will

offer a cycle of IVF treatment up to the age of 42 years provided that your ovarian

reserve is still OK. Hope this helps a little, and I do wish you well with the outcome. Kind regards. Diane

[Epp-Ebe in reply to DianeArnold]

Dear Diane, Thank you for your kind advice. It helps a lot. I will go back to my GP and ask again. I saw him last week and was told that he would not refer me to the NHS treatment because I am too old (41 years). He said that he does not know about private treatment and would not advise me regarding private clinics. I will try again.

How to find out whether my ovarian reserve is still OK? Which test is needed for this? I was under impression that the AMH test shows my ovarian reserve.

Thank you for your advice. Look forward to hearing from you soon.

[Louiemac73]

No problem, glad to help. Where are you based?

[Epp-Ebe in reply to Louiemac73]

Hey Louiemac, lovely to hear from you. I am based in London. Hope all goes well for you. xxx

[DianeArnold Partner Nurse Fertility Network UK]

Hi Epp-Ebe. Your recent AMH gave you your ovarian reserve, which is telling you that you might be difficult to stimulate during a cycle of IVF – as I explained before. If you were to go for a cycle of IVF, I would discuss with your consultant whether it would be best to go with a “short” protocol, so as to not shut your ovaries off any more than necessary. You could also ask your GP to order a blood test to check your FSH (follicle stimulating hormone) again on Day 2-3 of your menstrual cycle – normal is 2-10. Kind regards Diane

[Epp-Ebe in reply to DianeArnold]

Hi Diane, thank you for your kind reply. Is there anything I could do to improve my ovarian reserve (herbal supplements, acupuncture?)

I already had FSH test done in August (result 10 U/L). Is it common to get a repeat test done so soon? I have an appointment to see my GP this afternoon, will ask again.

How to find a good consultant in London, would you be able to recommend

anybody?

Can you recommend a good hospital/consultant for IVF in London or abroad? I am almost 42 years old, too old for NHS support.

Thank you for your kind advice. We would love to have a baby and were trying naturally for years (with one miscarriage). We realised recently that we can not hope and wait any longer, need to seek some professional help.

Hope to hear from you soon. Thank you and have a lovely day.

[DianeArnold Partner Nurse Fertility Network UK in reply to Epp-Ebe]

Hi Epp-Ebe. Low ovarian reserve is usually the result of reduced oestrogen which allows the FSH level to rise. This can be a slow process and last a few years, but if the FSH level stays persistently high, then an early menopause is more likely. The reason the FSH rises, is because it is trying to encourage you to put out more oestrogen. Egg quality is always a worry, but if you feel you need to have further testing apart from the usual FSH level, then you might opt for the “Anti-Mullerian Hormone” check. Although this is not available on the NHS, it has the added benefit of not needing to be taken on day 2 of the menstrual cycle. It can also help identify premature ovarian failure and can help predict ovarian reserve whatever your age is.

However what helps to make good potential eggs into good mature eggs, that can be fertilised and develop into good embryos and babies, is the environment in the follicles on the ovaries that contain the eggs. These follicles contain hormones and many other chemicals which help egg growth and maturation. The quality of follicles and therefore eggs can possibly be improved, by lots of different approaches including dietary, by adding more protein and zinc to your diet. Acupuncture and hypnotherapy also have been known to improve blood flow to the ovaries, but cannot permanently lower the FSH. Your level can naturally go up and down as you enter low ovarian reserve, which some alternative therapists will claim is due to their treatment. Also, there is a new drug treatment with Dehydroepiandrosterone (DHEA). It is still in its early days, but some women with reduced ovarian reserve that have been given 75 mgs of this drug a day in divided doses of 25 mgs 3 times a day for around 2 months, have been found to respond better to stimulation during IVF. However, you would need to discuss this thoroughly with your consultant, as there are potential side effects.

Unfortunately, I am unable to recommend consultant/clinics as this is seen to be advertising. Rest assured though, that all clinics are checked regularly by the HFEA (Human Fertilisation & Embryology Authority), and if they don’t come up to par will have their licenses withdrawn. If you have a look at their website hfea.gov.uk you will be able to access details of all clinics in the UK and what they can offer you. Hope this helps. Kind regards. Diane