AMH {Information and TTCAL user experiences}

Anti-Mullerian Hormone (AMH) is a substance produced by granulosa cells in ovarian follicles. It is produced by primary follicles and is highest in follicles that are in the preantral and small antral stage (less than 4mm in diameter). Because AMH is produced only in small follicles, it is believed to be a measure of the remaining egg supply.
Finding out your AMH level is low (0.5 – 1.0 ng/ml) is devastating for most women. It is believed that you can do nothing to improve your AMH levels. It is used, along with other hormone levels, to determine if you are an IVF candidate. Finding out that your AMH level is low or very low (less than .5 ng/ml) is hope crushing. You feel like the window on your fertility is closing or that it may have already closed.

I have been on TTCAL long enough to see many of our ladies who have low and very low AMH go on to PgAL and PAL. Some of these ladies conceived via IVF, some with donor eggs, some with their own, and some naturally. I asked our grads to share their stories to help remind our ladies with low AMH that it is just one test and it does not mean that you cannot get pregnant with a healthy pregnancy. Thank you to all of our graduates who replied with their stories and agreed to share them with you.

I would like to give special thanks to MsAmandaPants who provided me with a copy of her well thought out and researched reply that she gives to ladies who post about receiving low AMH results. I have included it in its entirety.

A special note on supplements: many of our grads used supplements while they were still TTC and credit those with helping them conceive. If you would like to take any of these supplements, please talk with your doctor first.
buggirl72, AMH .17

From MsAmandaPants – AMH is an indicator of ovarian reserve–how many eggs you have left. Low AMH itself won’t cause a miscarriage, but it might (but not necessarily) point to egg issues that could have contributed to it. Most research suggests that AMH has more to do with the quantity of your remaining eggs. There are different opinions on whether it is also an indicator of quality. While it does not necessarily indicate poor quality eggs, there are some that think that the eggs that remain at the end of your reserve may not be the highest quality, that higher quality eggs are selectively ovulated first, but there are differing opinions. AMH is also used as a predictor of how well you might respond to fertility drugs; low AMH is often correlated to poor response (but not necessarily so– I have shitty AMH and had a decent response).

It is important to keep in mind that AMH is only one marker of ovarian reserve and should always be considered in the context of your entire medical history, appropriate CD 3 blood work (estradiol, LH, FSH), and an antral follicle count. These are all critical parts of a whole that make up your entire fertility outlook.
Age naturally plays a role in decreasing AMH since egg reserves decrease with age; older women would be expected to have a naturally lower AMH range. While a lower normal range would be expected in AMA women, there is a threshold at which your AMH might be deemed irregularly low for your age. AMA + abnormally low AMH is a bit more worrisome because you are naturally dealing with older eggs and the quality issues that come with that, as well as a decreased reserve of quantity. There are some studies that show that low AMH in younger women is less of an issue because they typically have younger, higher quality eggs, in which case it is likely merely an issue of quantity/remaining eggs.

Other factors can artificially influence AMH readings and, again, it is important to understand it in context of our your entire fertility picture. This also means understanding factors that can influence and skew CD 3 blood work. For example, high estradiol can falsely suppress FSH. High FSH, particularly when combined with a low AMH could be indicative of diminished ovarian reserve. Low vitamin D can also artificially suppress AMH. Anyone that gets a low AMH reading, particularly if not AMA, should have their vitamin D checked to determine if it could be falsely lowering your score. Finally, from what I have read, the AMH test itself is fairly difficult to run/process and can be prone to errors. If you get a low initial AMH reading and don’t show any risk factors or corroborating blood work/antral follicle count, etc., I would encourage a recheck before resigning yourself to a dx of low or diminished ovarian reserve.

There are a lot of conflicting reports about whether you can improve your AMH through supplementation. DHEA, CoQ10 (or, even better, ubiquinol the more readily available for absorption version of CoQ10) to support your egg health, have been linked to possibly improved AMH readings. This is fairly controversial and without significant acceptance in the larger medical community. Talk to your doctor about whether supplementations might be helpful in your specific case. Do not start any supplements without consulting with your RE. There are significant drug interactions and supplementation can also do more harm than good. DHEA, in particular, is a hormone that can have negative consequences if taken without appropriate need and monitoring.

Take heart, whether AMA or not, a low AMH does not necessarily mean that you are going to run out of eggs next month. It may, however, mean that your window to conceive is shorter than the average person and that you may need to consider more aggressive treatment under the direction of your RE. Low AMH does NOT, repeat NOT, mean that you can not get pregnant and stay pregnant.

  • MsAmandaPants – February 2012: 1st pregnancy: natural BFP after one month of trying. Ended in MMC and D&C.
    • April-October 2012: trying on our own with no success, despite temping, OPKs confirming ovulation, good timing, etc.
    • November 2012: 2nd pregnancy: natural BFP after 6 or 7 cycles of trying with no luck, ultimately determined to be complete molar pregnancy
    • December 2012: RPL/AMA testing, including AMH. AMH comes back at .53. Crushing. Diagnosed with low AMH, DOR, and complete molar pregnancy. Benched until August for molar pregnancy.
    • August 2013: Recheck of AMH to determine how much it had decreased during mandatory bench time. It came back at .29. Devastating.
    • August-October 2013: Started fertility treatments in August because of worsening AMH. 3 IUIs using Femara and injects (Menopur) and Ovidrel trigger. All failed, although I had a decent response to fertility drugs, 3, 4, 6 mature follicles, respectively).
    • December 2013: We were told we would have to move to IVF. Recheck of AMH to see if ubiquinol was helping and to determine how much worse it had gotten before moving to IVF. It came back at .54, showing some improvement.
    • A few days later in December 2013: Learned I was pregnant. I had been told that I had to move to IVF and was letting my body and brain rest from treatments for a couple of months before jumping into that. I got pregnant on my own, on a treatment break.

During my molar pregnancy mandatory bench time, I was exercising very heavily (training for half marathons) and I was also regularly taking between 200 and 300 of ubiquinol (the more bio-available version of coQ10) daily. I can’t say for certain that it was the result of my efforts, but my AMH did show improvement during this time. I also took high quality prenatals throughout the period I was TTC.

Grateful&Thankful AMH was .23 & my first RE told me there was no way to increase it. I took 2tsp daily of Royal Jelly & 300 mg of CoQ10 2x a day for 3 months. After retesting my AMH was .77

I don’t have any tubes so IVF was my only option any way. I got pregnant via IVF after taking those supplements for about 2.5 months. I miscarried due to a SCH. I’m currently pregnant again after IVF 5.5

I wanted to add that I’ve heard RJ can make fibroids grow so if you have trouble with fibroids, you may want to tone down your dosage.
2MomsinCA – Hi! Low AMH was devastating. I did a full work up with the RE before even attempting to ttc so I found out I had an AMH of .8 early on. My paperwork at every RE appt from then on said my diagnosis was “diminished ovarian reserve.” Ouch.

I took ubiquinol coq10, L-arginine, and pure royal jelly daily for about 4 months during the ttc process. I also practiced yoga and abdominal massage through the whole process. We did a total of 6 IUI’s and 2 ICI’s over the course of 10 months. The 2nd through 5th IUI were medicated with clomid, trigger shot, and progesterone suppositories. My 6th, final and sticky IUI was medicated with injectable menopur, trigger, and progesterone suppositories. My 2nd, 4th, and 6th IUIs resulted in BFPs. I lost the first two by 6 weeks. I was very good about taking my supplements for the 2 months prior to starting the injectable cycle and once I started menopur I stopped all supplements, did not do any vigorous exercise, and ate plenty of protein.
Emma2370 – In June ’13 my AMH came back at .39 July ’13 BFP naturally mmc at 8 weeks, November ’13 BFP ended in chemical pregnancy. December.’13 natural BFP healthy baby girl. I took my prenatal and royal jelly supplements. We had no issues getting pregnant staying pregnant with a healthy viable pregnancy was the issue. My DH has an chromosomal inversion which could have contributed to our losses. We did make an appointment with a RE just before our BFP.

2RedTulips – My OB ordered my bloodwork in July 2013, and that’s when my AMH came back at 0.2. I was devastated. We had already suffered one miscarriage and had been trying again for eight months at that point.

With those results, OB sent me to an RE, and we did a full work-up. In addition to my low AMH (tested at 0.8 at the RE’s), DH had poor morph, and we were given a less than 2 percent chance of conceiving naturally. Devastation #2. The one piece of good news I received during that time was that I had 12 resting follicles, which was a big shock.

We both started a slew of supplements per the RE. I also started a low-gluten diet, acupuncture and baby aspirin.

We were gearing up for a first round of IUI (certain we’d have to do IVF after a cycle or two) when I got a BFP. So, I call this baby our “2 percent baby,” because he ducked in under the wire.

So, from the time we received the low AMH results to conception was four months.

ETA: I am 39, by the way. I also took all the supplements with the RE’s blessing (L-Arginine, DHEA (prescription compound only), DHA, Inositol, Vitamin C, Vitamin E, CoQ-10 and Melatonin)

Eliz77 – My AMH was tested twice under two different REs and came back at 0.27 both times-tested in August 2013 and January 2014. Both REs recommended we try naturally for two cycles and if no success, move on to letrozole and IUI. We did get pregnant both times one 2nd cycle, 1st time ended in natural MC at 7 weeks. This one is far from a success story, but doing better than previous.

However, neither RE felt the low AMH was reason for losses or cause of concern. It was explained to me as having a lower egg reserve due to AMA, not necessary an indicator of quality since all other results came back normal.

Due to 2nd RE’s discovery of two copies of the MTHFR c77t gene, I was put on low dose aspirin, folate and started lovenox and calcium once an intrauterine pregnancy was determined. I know opinion vary on whether this is reason alone for losses, but since it was the only thing found amiss, RE decided to be proactive in his treatment plan just in case.

If we lose this pregnancy, my RE has already said he would like to move to IVF with PGD.

Daisy19782011 – Age 35, AMH .16
Did a back to back IUI with injections (gonal F) and a trigger. Got pregnant on 1st cycle. I lost that baby at 19 weeks, unrelated to IF, and did the same protocol 3 months later and got pregannat again. All of my other numbers are OK though, and we have not MFI.
BootsOrHearts –
I am trying to remember my AMH number from way back, I think it was 0.25 I’ll have to ask my doctor as the online records don’t go back that far.
Jan 2012: AMH 0.25 (?) @ 38 years old, diagnosed with DOR, told we are unlikely to get pregnant except via IVF or donor eggs.
Later that month. . . . natural BFP! Loss at 18 weeks, unrelated to DOR diagnosis
Started taking DHEA, one pill/day
2012/early 2013 Lots o’ failed fertility treatments, but good response to IVF, estrogen priming protocol: 7 retrieved, 7 mature, 5 fertilized (with ICSI) and 4 available for transfer, 2 implanted (resulted in C/P) and 2 frozen
April 2013. . . natural BFP @39 years old. Isaac, a.k.a. Baby Boots born 11/23/13.

egsquared –
I had 4 early losses between September 2011-August 2012. In October of 2012, my AMH was .18 at 36 years old. All my other results were normal, and two different RE’s recommended IVF. We had to wait until January 2013 to do an IVF cycle (switched to DH’s insurance). I had 9 eggs retrieved (which I thought was a low number), 5 fertilized with ICSI and two available for a 3 day transfer. we implanted both and got pregnant that cycle. DS was born 4 weeks early in September 2013.

In the months leading up to our IVF cycle, I took DHEA, CoQ10 and myoinositol.

The RE explained that with low AMH, you have a higher percentage of abnormal eggs left, so I was probably having bad luck and getting BFP’s on the cycles where my body released a bad egg. He said we could just keep trying naturally and we could get lucky and get a ‘good’ egg and a BFP, whereas with IVF we would be picking the best looking embryo(s) out of the group. We chose to go the IVF route to hopefully avoid any additional losses and because age/time was not on my side.

rslh10 – 28 years old, DX of .58 AMH in March 2014. Started Clomid CD 3-7 with trigger on CD 15, BFP the first try, but ended up ectopic @ 5w6d.
I was taking prenate minis, vitamin D, and biotin. Also my FSH was 7.5, and all the other blood work that had been drawn has been normal. HTH


What is this stuff? Cervical Fluids

“Typical” Cervical Fluid Pattern

While your cervical fluid pattern may vary from cycle to cycle and it may vary from woman to woman, a typical cervical fluid pattern looks like this:

Immediately following menstruation there is usually a dry vaginal sensation and there is little or no cervical fluid.

After a few days of dryness, there is normally a cervical fluid that is best described as “sticky” or “pasty” but not wet. While this kind of cervical fluid is not conducive to sperm survival these days may be considered as “possibly fertile” if found before ovulation.

Following these “sticky” days, most women generally notice a cervical fluid that is best described as “creamy”. This fluid may be white, yellow or beige in color and has the look and feel of lotion or cream. At this point the vagina may feel wet and this indicates possible increased fertility.

The most fertile cervical fluid now follows. This most fertile fluid looks and feels like raw egg white. It is slippery and may be stretched several inches between your fingers. It is usually clear and may be very watery. The vagina feels wet and lubricated. These days are considered most fertile. This is the fluid that is the most friendly and receptive to sperm. It looks a lot like semen and, like semen, can act as a transport for sperm.

After ovulation, fertile fluid dries up very quickly and the vagina remains more or less dry until the next cycle. Some women may notice small amounts of fertile-looking fluid after ovulation as the corpus luteum produces small amounts of estrogen, but you are not at all fertile after ovulation has been confirmed.

Cervical Fluid and Their Meaning

Dry – Probably Not Fertile

Sticky – Probably Not Fertile

Creamy – Possibly Fertile

Watery – Fertile

Egg white – Most Fertile

How can I tell the difference between fertile cervical fluid and semen?

If you find that you have more watery or eggwhite days than you would expect and that these often follow days or nights that you had intercourse, then you may be mistaking seminal and cervical fluid. They have similar properties because they share the same function: transporting and nourishing sperm. You will find, however, that fertile cervical fluid (eggwhite) is more clear and stretchy and shiny. It will stretch a couple of inches without breaking. Semen may be more whitish and is more likely to break when pulled.

If you are in doubt and it is near your fertile time, always record eggwhite cervical fluid, even if it may be obscured by seminal fluid. This way, you will not miss a potentially fertile time. Emitting semen immediately after intercourse by doing kegel exercises (which is sometimes recommended for people who are charting to avoid pregnancy so that cervical fluid is not obscured) is not recommended when you are trying to conceive. While most sperm reach their destination within your reproductive tract quite quickly after intercourse, you don’t want to sacrifice your chances of conception to have a perfect chart.
Taken directly from Fertility Friend

Yoga for Fertility?

Yoga: relaxing, stretching, and…good for baby-making? Some people think so!

A woman named Brenda Strong created a yoga program the promotes women’s health and fertility. How? It can help lower chronic stress, detoxify the body, and increase blood flow to those organs that are oh-so-important for fertility. Brenda uses a “fertility ball” (a small rubber ball) to stimulate specific areas on the body that she believes are conducive for fertility.

For $25, you can get the DVD and for $40, you can get the ball (shouldn’t they come together?).

Don’t want to spend all that money? (Though in the grand scheme of things, I guess $65 for something you’ll use a lot isn’t too bad, considering we spend hundreds on pee sticks we use once! And it certainly can’t hurt anything, right?) Check out Brenda’s top five yoga positions for Fertility, below!
The best yoga positions to aid fertility have a few key things in common:
-Increase Circulation to the Reproductive Organs
-Balance Hormones
-Reduce Stress
You made have already heard that inversions like headstand and shoulder stand are powerful fertility aids. Those positions didn’t make our list for one simple reason: they should be done with proper supervision. These poses made our list of the five best yoga positions to aid fertility because they don’t need supervision. In fact, they can be done in the safety and privacy of your home.

This pose is one of my favorites and I almost always start my Fertility Yoga classes with this because of it’s ability to soften the internal organs, open the pelvis, unburden the heart and calm the mind. It is sort of a one-stop-shop to get all your needs met! I like to use one or two bolsters, but you can use a bolster and a block, four blankets or a combination of the above to create your own cozy haven for relaxation. Set up a block or bolster for height crosswise. Then lay (for the spine) a bolster or blankets perpendicular to the first. You should have a gentle sloping ramp where the head is highest, then heart, then pelvis on the ground. If you have neck issues, occasionally using blankets instead and rolling the top one under to support your cervical spine feels good. The key is that your torso is supported at an angle, your hips are on the floor and you can lean back, draw your heels in, soles touching, and relax. If your groins are overly tight or loose, you may benefit by a block, or pillow under each knee to soften the groins and support the pelvis in relaxing. If your shoulders are tight, you can elevate the elbows in the same manner with pillows or a block at each elbow. The key is that once you are settled to stay and breathe deeply, allowing the mind to scan the body for tension and release it breath by breath. I also like to infuse the internal organs with white light as you inhale, and allow yourself to release any tightness on the exhale, creating more space internally with each breath. You can stay for 5-15 minutes in this pose for the greatest benefit.

Pigeon pose is one of my personal favorites, because I have tight hips. If your hips are very tight see Reclining half pigeon below as an alternate pose. Double pigeon helps to release stored emotional trauma in the periformis muscle, which guards the gateway of energy in the hips. The hips are the sister hinge to the jaw and when released, tension, emotional pain and chronic holding get released, allowing increased blood flow, and energy to the reproductive organs in the pelvis. Double pigeon is a seated pose where one shin stacks perfectly on top of the other, and creates an equilateral triangle from the shins to the pubic bone.
Feet are flexed, spine long and pubic bone threads back so that the hips can release up and over the bent legs. Breathing is key in honoring your body’s edges of resistance and allowing it to open when it’s ready, establishing trust. You can extend the arms straight in front, with your elbows on the floor and create prayer pose with your hands and place your thumbs at your third eye, fore fingers on the forehead or extend the fingers on the ground and walk the hands out until your arms are straight. Breathe until the discomfort softens, and then change sides, alternating opposite foot on top of knee. Shins parallel.

*There tends to be unexpressed emotion in the hips. If you are in double pigeon you can sit on a bolster and work at simply lifting up through your heart and gently leaning forward. In 1/2 pigeon can you get your ankle to cross your knee? If so, then use the elbow on the knee to gently press it away from you to open the hips. If doing this doesn’t help, try sitting in a chair and crossing you ankle over your knee and let gravity take it down to soften the hip. Hinge forward from the hips and breathe.*

Reclining Half Pigeon (thread the needle)

A safer version for the knees is to lay on your back. Hug both knees into your chest. Lower your left foot to the floor and stack your right ankle on top of your left knee. Reach through the center hole and clasp your left shin. Flex the top foot and soften the bottom ankle. Gently pull the leg in to activate the periformis on the right side. Breathe deeply and visualize more space where you feel the tightest. Breathe until it softens. Change sides. Be aware of added unnecessary tension in shoulders, jaw and face, keep breathing deeper to soften any reactions to the sensation. [Obviously you will not be on a island in a koi pond. : ) Make sure you’re resting your head on the floor]

According to B.K.S. Iyengar this pose is a blessing to women. It stimulates the abdominals and ovaries.
Sit comfortably on a rug or yoga mat. Draw your heels together in front of your pubic bone, allowing your knees to open outward.

*If your knees won’t open fully, this just means your pelvis isn’t open yet. For your comfort, you can sit on a blanket or firm pillow to elevate your hips, this will help. [see picture below]*

Close your eyes a moment and tune into your breath. Soften your belly and allow your inhale to fill the space between your belly button and pubic bone, as if you could breathe into your womb. As you exhale draw the belly gently in toward the low back, massaging your internal organs.
Press your feet firmly together to allow your inner groins to stretch as you elongate the spine up and out of the hips. Stay here a few breaths.
As you breathe, your body will soften into the pose. If you feel you can lean forward without collapsing the lower back, extend forward over your heels reaching up through the crown of the head.
Hold onto your feet with your hands, and gently press your knees toward the floor with your elbows. Breathe into the sensation in your hips. Keep your shoulders and face soft.
This pose helps to open the hips and increases circulation in the pelvis, it has been known to help balance irregular menstruation and helps the ovaries to function properly.

This asana stretches the hamstrings and helps the blood to circulate properly in the pelvic region and keeps it healthy.
Sit on your mat or rug, and open your legs wide.

*If your legs won’t open fully, this just means your pelvis or hamstrings aren’t open yet. For your comfort, you can sit on a blanket or firm pillow to elevate your hips. This will help.*

Flex your feet back toward your face and make sure your feet are straight up and down, perpendicular to the floor. Lift up through your heart and extend your spine on an inhale. With a long spine, slowly walk your hands forward until you feel the first sensation in your groins and hamstrings. Stop here and breathe. Inhaling as if you could breathe into your womb, allowing the belly to soften and swell then exhale drawing your belly in. When you feel the body has opened, walk your fingers forward until your next edge of sensation. Stop and breathe, and then continue. Once you are fully extended (this will be different for every woman), you can slowly rise, lead with the heart and gently shake out your legs.
This Yoga asana (or pose) is beneficial because it helps regulate menstrual flow and also nourishes the ovaries. One of the wonderful benefits of Yoga is it teaches you to respect your journey. It requires that you approach everything as a process. Treat yourself gently as you approach these poses, knowing that mastery doesn’t occur overnight. Treat yourself just as gently as you proceed on your path toward parenthood.

This pose is restorative and helps to calm the nervous system and the heart rate. It is powerful for women because of its inversion qualities and ability to focus on the 2nd chakra, which houses the reproductive organs.
Find space at a wall. Place a bolster or thick firm cushion, a couple of inches from the wall. Sit on the cushion and walk your legs up the wall until your hips are level and your back is on the floor. Put one hand on your belly and one hand on your heart or the arms can lay open, creating space in the heart.
This pose is about receiving. Let your breath be soft and deep, allow your mind to quiet and let the pose “do” you. You will feel the circulation in your body shift. Imagine a waterfall starting at your legs, pooling at the hips and slowly spilling down into the heart and the brain. This visual will follow the natural flow of energy as it cultivates a calm nervous system. This pose can be done while you’re menstruating as long as the hips are level. This pose has great healing qualities and is a gem for women.
I know what I’ll be doing tonight! At the very least, maybe it will help me stretch out (always good for FWP!) and relax a little. 🙂