Anti-Müllerian Hormone (AMH)

For most women, age best predicts the chance of conception each month. However, despite having regular menstrual cycles and normal periods, about 10% of women lose their fertility sooner than expected. These women should think about having a family in their 20’s or very early 30’s.

There are several tests which help predict whether a woman may have a faster biological clock – one of these is the Anti-Müllerian Hormone (AMH) test. This test helps to estimate what is called ‘ovarian reserve’ by measuring the number of follicles developing in the ovary at a particular time. Once the test is complete, we compare the results with those of other woman of the same age. 

AMH is a hormone made by small follicles as they grow in the ovaries. This test is more convenient and less expensive than alternative tests like Egg Check, because it uses a simple blood test rather than ultrasound scanning, and can be done at any time in the menstrual cycle. It is available from all Fertility Associates clinics. An AMH test can pick up who might lose their fertility more quickly but it does not show who is more fertile than average. AMH does not predict ovarian reserve in women older than 40 or those with Polycystic Ovaries (PCO).

Important points

• Please remember that age is still a very important factor for fertility. The AMH tests can suggest when a women might have lower fertility than expected for her age. However, there is no evidence that ‘good’ AMH results mean that women have a higher fertility than expected for their age.
• We strongly recommend all women start their family well before 40 years of age.
• A normal AMH result does not exclude other possible causes of reduced fertility.

Graph of Anti-Müllerian Hormone (AMH) Levels

The graph shows the average AMH level for women without fertility problems according to age (the dark line) and the 10th, 25th and 75th centiles for this group of women.

GREEN	Above the 25th centile for younger, fertile women.	Very likely normal ovarian reserve - age is best predictor of your future fertility.	80% chance of 6 or more eggs in IVF.
ORANGE	Between the 25th and 10th centiles for younger, fertile women.	Some women in this range will have reduced ovarian reserve.	50% chance of 6 or more eggs in IVF.
RED	Below the 10th centile for younger, fertile women.	Very likely reduced ovarian reserve.	20% chance of 6 or more eggs in IVF.

Infertility Investigation II

Today is 12 Sept 2013 and scheduled to see Dr. Wong between 8.00 am to 10.00 am. With just a series of Q&A session and US, he was able to diagnosed the initial problem. Doc suspected a couple of things hence suggested to do some blood tests. That includes 2HPP (i.e. GTT - as I have family history), FSH and AMH. Told me the HSG test isn't useful as Dx for INF. See what I meant earlier ... a non-fertility specialist won't know the accurate way of findings. 

The Findings .... ....

As Doc suspected, my AMH is on the low side with a reading of only 6.6 pmol/L - for my age! This means I will hit my menopause very much earlier as compared to others and I don't actually have many follicles left hence Doc said we have no time to loose, that was his exact words. However, Doc assured me it is "still okay" as he has come across readings that's lower than mine and his protocols standard for treatment is readings between 4 to 6 pmol/L. Briefly mentioned one of his his patient was only 2 pmol/L and yet succeeded to move forward to next step.

Now this added further to the injury; for low ovarian reserve case, we are not warrant to the standard IVF Package Price treatment with Sunfert (approx. $15k to $18k for normal fertile woman). Mainly is because I will require much higher dosage of drugs to stimulate my FSH. The price difference is the cost of drugs. Other charges remain unchanged.

The Very First Visit to Sunfert

Called Sunfert for appointment & was told the earliest is a month from now! I was overwhelmed because I have no idea that INF is getting common these days. And since the recurrence infections didn't magically disappear on its own by now, I have finally decided to consult Dr. Wong Pak Seng, one of the most famous fertility specialist with the most reasonable charges within PJ/KL area for IVF procedures, so I was told. He is unlike other doctors who bear a resemblance of blood-sucking vampires on our hard-earned-over-the-years-salary. Not only that, his success rate is high with overall very decent profile and reviews by many. We were highly recommended to him by an acquaintance of DH, who is now in her forties (her spouse is in his early fifties) blessed with two beautiful girls, not twins but from the same batch of developed embryos. 

My first visit was on 26 Aug 2013 and Dr. Wong assured me that the infection is normal and not uncommon. Apart from hygienic reason, it may be hormonal changes which sometimes will take longer than usual to recover. He also said this will not affect fertility treatment and I shouldn't have waited for six months. Finally, I was asked to schedule the next treatment appointment on Day 2/3 CY. 

Why The D-Lay ?

Prior to the start of the continued investigation journey, several unpleasant encounters of infections took place, month after month. And it lasted for 6 dreadful months! The discomfort, pain, itchiness and anxiety were a real torture. Plenty hard earned monies were spent to treat and yet the re-occurrences. By then it is already Aug 2013.

Due to limited information and most importantly the hectic schedule at work, not 100% attention were paid to it - sad to admit the truth. 

I am very suspicious that it was caused by the Chinese herbs I'm consuming for day and night, prescribed by a gynae, Prof. Yin LR from Tung Shin Hospital, KL. Apparently from the first few visits, I was told that the body heat is very bad. Tried for about two months and that's it. Until today, there are no answers to it.  

Infertility Investigation I

Made an attempt to visit Prof. Raman at FEMC located PJ as he was highly recommended by my colleagues. To my surprise (at first, visiting an O&G), the clinic waiting time is crazy and unacceptable. The wait will take about 3-5 hours and actual time spend with Prof. was less than 20 minutes. But after several visit, we got used to it, despite early or late appointments. When asked around, everyone said it is very common for most of the gynae in town. 

On our first visit, initial test were required for further Dx and it was mainly (and the only) HSG test for me. An unpleasant experience but has soon forgotten. Results was conclusive, no blockage in the tubes. And that was on 31 Jan 2013. Prof. then prescribed Clomid, advised the window time and followed with a jab. All instructions were strictly adhered. Then, on Clomid Cycle 2, a side effect was observed. It didn't dawn at me that it was a side effect caused by Clomid as we were not told by anyone from the clinic, who I now think, is and should be their responsibility. Generally my vision was affected and I would say it’s only minor as it was blurry, unable to focus. It did impacted me at work looking at the computer screen and while I was driving. At first, I thought my vision has worsened and told my DH that I needed an eye check. But … at our age now, not possible, right? 

So I stopped Clomid at Cycle 2 @ 25 Feb 2013. At that time, I wasn't aware of my INF issue because the doctor did not reveal any information to me. I had no idea if the Clomid had help to stimulate extra follicles. I had no idea if I my uterus lining is housing well. I had no idea if there were abnormalities growth. Since I’m uninformed, so I assumed everything’s normal. Furthermore, we simply don’t have the chemistry. Even DH didn't like him. Not to mention the wasted waiting time, even the parking is difficult. So from experience and a little piece of advice --> do consider the location of your Gynae and the chemistry.

Some TTC Abbreviations

2WW : Two-week wait (until you can take a pregnancy test) 

Babydust : Fairy dust, good luck getting pregnant

BBT : Basal Body Temperature

BFN : Big Fat Negative (test result)

BTDT : Been There Done That

BTW : By The Way

CB : Cycle Buddy

CD : Cycle day
CF : Cervical fluid
CL : Corpus Luteum
CM : Cervical mucus
CP : Cervical position
CY : Cycle 

D&C : Dilation & Curettage

DH : Dear/Darling Husband

DIAFYO : Did I Ask For Your Opinion

Dx : Diagnosis

EDD : Estimated Due Date

EPT : Early Pregnancy Test
ET : Embryo Transfer

FET : Frozen Embryo Transfer
FF : Fertility Friend

FMU : First morning urine
FP : Follicular Phase
FSH : Follicle Stimulating Hormone
FTTA : Fertile Thoughts to All

GMTA : Great Minds Think Alike

GnRH : Gonadotropin Releasing Hormone

GTT : Glucose Tolerance Test

hCG : Human Chorionic Gonadotropin (pregnancy hormone)
H&H : Happy and Healthy
HPT : Home Pregnancy Test
HRT : Hormone Replacement Therapy

ICSI : Intra-Cytoplasmic Sperm Injection
INF : Infertility
IM : Intramuscular
IMO : In My Humble Opinion
IUI : Intra-uterine Insemination
IVF : In Vitro Fertilization 

LH : Luteinizing hormone
LMP : Last Menstrual Period
LP : Luteal phase 

MC : Miscarriage
MS : Morning Sickness

O : Ovulation
OB : Obstetrician
OB/GYN : Obstetrician/Gynecologist

OT : Off Topic
OTC : Over-the-counter

P4 : Progesterone

PG : Pregnant 

PIO : Progesterone In Oil
POAS  : Pee On A Stick

Rx : Prescription

S/A : Semen analysis 

TTC : Trying to conceive
TTYL : Talk to You Later
US : Ultrasound
UTI : Urinary Tract Infection

WBC : White Blood Cells
WNL : Within Normal Limits 

WYSIWYG : What You See Is What You Get

A little about Me …

I settled down in June 2008 with gleeful hopes and great anticipation to a new chapter of life. Time flies without us both realizing it and by then, whoosh! We are now in our mid-thirties and still living life very much pretty the same. So we decided to try for a baby with hope to bring further joy and excitement to life and the family. However nothing happened when we started to TTC approximately a year ago and so. Yes, I know I know, the trial window time is between 12 to 24 months but hey … age is catching up (the same old granny reminder story) and technically, me can’t wait no more. With that, mild aggressiveness kicks in.

Of all these no-harm-give-it-a-try-journey are purely 100% recommendations by friends and colleagues. Some of it was indeed mind-boggling. Some, totally ineffective to me.