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


Interesting Article

Pressure to Father Child
Please take some time to read this article.

Short version: Timed sex can lead to issues with men’s libido and the researchers don’t recommend more than a few months of timed sex. Some men also are more prone to erectile disfunction and straying after prolonged timed sex. 
Long version: 
 “Any couple trying for a baby is told that timing is everything. But pressure to perform when their partner is at her most fertile drives men away, according to research. 
One in ten men has had an affair because of the pressure of rigorously timed sessions, while four out of ten claimed it made them impotent.
More than 400 men took part in the study, which found the pressure to conceive a baby caused men acute stress.
Fertility experts routinely tell couples to time intercourse to coincide with the window when a woman is ovulating. There are even highly sensitive devices designed to help couples work out – down to the minute – when she is at her most fertile.
But as the number of timed sex sessions increased so did the men’s level of stress, according to the research carried out in South Korea. None of the men in the study had ever had sexual problems. 
    The finding supports several previous studies showing that men who are under stress produce less testosterone, which has an effect on their libido.The authors suggested couples should be made aware of these risks and attempt timed sessions for no longer than three months at a time, with breaks for a few months in between. 
    Timed intercourse seems to impose a substantial degree of stress on male partners, inducing erectile dysfunction and, in some cases, causing them to seek extramarital sex,’ they wrote in the Journal Of Andrology. Andrology is the branch of medicine concerned with diseases in men, especially the reproductive organs.
    They added: ‘It is clear that the greater instances of timed intercourse trials, the more incidences of erectile dysfunction and extramarital sex and the greater the desire to avoid sex with the intended partner.’ All the couples in the study had been trying to conceive naturally for a year.
    The authors noted that having to sleep with their partner at a specific time ‘becomes a burden and is carried out as a job to be done, which imposes further stress’. They believe that higher levels of cortisol, the stress hormone, being produced by the body was to blame for lower testosterone. 

    Professor Allan Pacey, a senior lecturer in andrology at the University of Sheffield, said: ‘I’m glad someone has studied this, as the single biggest concern for men – usually when their partner is not in the room – is that they really find it a struggle when their partners are obsessed with timing.
    ‘While it is useful for couples to be aware of the fertile window, obsessing about it is not helpful at all. Men are being phoned up at three in the afternoon and told that the green light is on and they have to come home immediately.’
    Professor Pacey, also chairman of the British Fertility Society, added: ‘If couples are having regular sex two or three times a week, they will hit the fertile window.’
    In the UK the age limit for free IVF treatment is to be raised to
    42. Currently only women up to 39 are allowed three free rounds of NHS fertility treatment. Draft guidelines being put out for consultation by the rationing body Nice could allow 8,000 more women in their early 40s to benefit. At present they have to pay up to £5,000 per treatment.”

    Summary taken from this post on the Infertility board on

    Can It Be Genetic?

    It’s widly “known” that losses are not genetic. Doctors say there is no way that the trait can be passed down from either parent. Yet, when you ask the board if any of their immediate family members have had a loss, more say yes than no.

    Interestingly, though, more say no than yes when it comes to infertility (secondary or initially) with a good chunk unsure.

    The top Google searches when you type in “Are miscarriages….” pops up with genetic and hereditary. That’s not a coincidence.

    Once you’ve had a loss, you know how much it’s out there, like a new world has been exposed. But why does it seem to pop up a lot in your own family?

    Searching online and talking to doctors seem to bring up nothing. They’ll say it’s a fluke, a genetic abnormality (of your LO, not you) or that it’s just a coincidence. There seem to have been no true studies into why they seem prevalent in families.

    Perhaps one day,family losses will be a factor into your monitoring during your own pregnancy. Maybe it will help to boost your check-ins or ultrasounds or even just your betas.

    Until then, we’ll keep on keepin on.

    Interesting articles to read:

    Way Of Predicting Outcome Of Pregnancies With Miscarriage Threat Developed

    Are Miscarriages Hereditary? A question on

    Multiple Miscarriages Linked To Gene– from 2001

    Polycystic Ovary Syndrome- PCOS

    First off. What is PCOS?
    Polycystic ovary syndrome is a condition in which there is an imbalance of a woman’s female sex hormones. This hormone imbalance may cause changes in the menstrual cycle, skin changes, small cysts in the ovaries, trouble getting pregnant, and other problems.

    PCOS is one of the most common causes of fertility issues in women, but it’s rarely addressed publicly and can be, at times, hard to diagnose. Starting as young as 13 or 14 and ranging up to menopause, PCOS can affect any woman and with a variety of symptoms.

    Symptoms of PCOS can be mild, moderate or severe. They can also be a ‘coctail’ of any that are listed below:

    Changes in the menstrual cycle:
    Absent periods, usually with a history of having one or more normal menstrual periods during puberty (secondary amenorrhea)
    Irregular menstrual periods, which may be more or less frequent, and may range from very light to very heavy

    Development of male sex characteristics (virilization):
    Decreased breast size
    Deepening of the voice
    Enlargement of the clitoris
    Increased body hair on the chest, abdomen, and face, as well as around the nipples (called hirsutism)
    Thinning of the hair on the head, called male-pattern baldness

    Other skin changes:
    Acne that gets worse
    Dark or thick skin markings and creases around the armpits, groin, neck, and breasts due to insulin sensitivity

    Some women may only exhibit irregular periods or some women may have irregular periods, increased hair, insulin resistance, elevated testosterone, etc. all at once.

    When you sit down with your Dr, OB or Endochronologist, and list out your symptoms, be they many or one, you may be given a round of testing. These tests will determine your insulin, how it’s processed, your testosterone, estrogen and thyroid. There are other tests that may be run, but the previous listed are the most common. Other tests may include:

    Estrogen levels
    FSH levels
    LH levels
    Lipid levels
    Pregnancy test (serum HCG)
    Prolactin levels
    Vaginal ultrasound to look at the ovaries
    Pelvic laparoscopy to look more closely at, and possibly biopsy the ovaries

    Once a diagnosis is confirmed, treatment may begin. As varying of the symptoms, so are the treatments. Some may only need a diet and weight modification. Others may need medications as well as diet and exercise adjustments. All will be an effort to balance hormones and increase ovulation regularity.

    Medications include:
    Birth control pills or progesterone
    Metformin or Clomid
    LH-releasing hormone (LHRH) analogs

    Only you and your doctor can determine what the best course of action is. If you are ever uncomfortable with a diagnosis or treatment, seek a second opinion. Learning from others with the same experience can also be beneficial. There are two fantastic groups called SoulCysters and PCOSSupport that can help connect you with others, give you information and help guide you through this confusing time.

    Never be afraid to ask a question or ask for help. PCOS can be confusing and scary at times. Follow directions and try to stick to a healthy diet and exercise routine.

    Additional information:
    Medical publication-
    WebMD Overview-

    Infertility- Testing, questions and information

    There’s a wide range that will “qualify” someone to be considered infertile. For a man, it could be low sperm count, no sperm release, or sperm that are physically incapable of going into the egg on their own. For a women, the list seems to be greater. The range is generally seen as:

    You are in your mid-30s or older, have not used birth control for 6 months, and have not been able to become pregnant.
    You are in your 20s or early 30s, have not used birth control for a year or more, and have not been able to become pregnant.

    How will we be tested?
    As a general start-out, both partners are given a general overview. This includes:
    Medical History
    Physical Exam
    Blood and Urine Tests- (LH, prolactin, Progesterone, thyroid, testosterone, and STD’s)

    There are certain tests specific to each partner that maybe done. Women may be asked to do a postcoital test (checking cervical mucous) and a home LH test. Men may be asked for a semen analysis to check the amount and “capabilities” of his sperm.

    Should all the tests not give definite answers a second level of tests could be performed. A general antibody test and karyotyping will be done for both partners. For women a pelvic ultrasound, Hysterosalpingography (HSG), Sonohysterography (SHG), endometrial biopsy and laparoscopy may be performed. For men and ultrasound and/or testicular biopsy may be performed.

    It’s been studied that for 80% of couples, the cause is either a sperm problem, irregular or no ovulation, or blockage in fallopian tubes. For about 15% of the diagnosed ‘infertile’ couples, there may be no answers resulting in a diagnosis of unexplained infertility.

    The most common causes of infertility have been found to be
    Impaired function of sperm
    Impaired delivery of sperm
    General health and lifestyle
    Environmental exposure

    Fallopian tube damage or blockage
    Ovulation Disorders
    Elevated Prolactin
    Polycystic Ovary Syndrome (PCOS)
    Early Menopause
    Uterine Fibroids
    Pelvic Adhesions

    There are a variety of treatments can be done to help with any diagnosed explanation of infertility.

    For men, the solution may be as simple as medication, increased frequency of intercourse or aid in unblocking tubes allowing adequate semen release.

    For women, there is a large list of aids:
    Clomiphene (Clomid, Serophene)
    Human Menopausal Gondrotriphin or hMG (Repronex)
    Follicle Stimulating Hormone or FSH (Gonal-F, Bravelle)
    Human Chorionic Gonadotripin (Ovidrel, Pregnyl)
    Gonadotropin Releasing Hormone
    Aromatse Inhibitors
    Metformin (Glucophage)
    Bromoctrptine (Parlodel)
    Assisted Reproductive Technology (IUI, IVF, ICSI)

    As with any medical treatment, there can be complications. With fertility medications, the result may be multiple pregnancy, overstimulated ovaries, bleeding or infection, low birth weight, or birth defects.

    As with any medical advice, you should only listen to your doctor. They will know the best test, treatment and level of risk for each procedure or aid you may be prescribed.

    Additional links and information:

    (overview of tests)

    (breakdown of tests)

    (Understanding Infertility)

    (infertility ‘causes’)

    (Discussing infertility with a dr)

    (Treatments and drugs)

    (Recent news and updates about infertility)

    Feel free to join the discussion on The Board if you have any questions or input or put a comment down below!

    RPL- Testing and General Information

    What is RPL?

    RPL means Repeat/Recurrant Pregnancy Loss. Generally when a woman has had two or more losses confirmed by an OB, they are sent for RPL testing. Many doctors have varying views on when a woman should receive RPL testing. Some may say after “x” many weeks, three losses, or even after a certain age and a certain number of losses. Only your doctor will have the correct answer for you and your situation. If you ever question your doctors decision, it is best to seek a second, professional, opinion.
    What will they test for?

    Genetic testing

    Studies have concluded that about half of all first trimester miscarriages are the result of chromosomal abnormalities. These generally occur on a sporadic basis, meaning that they are random occurrences. They are, however, related to the age of the woman and are more likely to occur with advancing maternal age.

    Research suggests that after a couple has had 2 or more unexplained miscarriages, there is a 2-5% risk that one member of the couple is a carrier of a balanced chromosome rearrangement. Chromosomal analysis of the products of conception (the miscarried fetal tissue) and of the woman and her partner may provide additional important information that will affect future reproductive decisions and additional testing recommendations.

    Hormonal testing

    There are several hormonal imbalances that can contribute to miscarriage rates. These can be evaluated with simple blood tests and treated if present. The recommended hormonal testing will depend up on the symptoms experienced, but may include thyroid, prolactin, follicle stimulating hormone, fasting glucose and insulin levels.

    Hematologic and Immunologic Testing

    Several blood disorders have been implicated in recurrent miscarriages. Women with abnormal blood clotting may be predisposed to early or late miscarriage and women with high risk personal or family histories should be tested. Women with these disorders have a high success rate when properly treated. Testing and treatment of low risk patients continues to be debated among physicians, however even in these cases, the most common abnormalities should be ruled out.

    Uterine Abnormalities.

    Distortion of the uterine cavity may be found in approximately 10% to 15% of women with recurrent pregnancy losses.

    There are some great online resources to finding out how much testing will cost, a breakdown of each area of testing and what they all mean. Once you get tested and talk to your doctor, you can then move forward. Never start your own treatment based on what is found online. Only your doctor will know the best way to treat you and help you achieve a healthy pregnancy.

    (RPL information)

    (RPL Overview)

    (Should you ask for Genetic Testing?)

    (Information on testing cost and breakdown)

    Check back for information on Infertility information and testing information and some of the common factors into fertility difficulties.

    Feel free to add any questions or comments in the comments section below or in this thread on TTCAL- RPL Blog Post- Link and Discussion/Questions