Top 10 facts about anti-mullerian hormone levels and ovarian reserve testing.

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1) Anti-mullerian hormone (AMH) is the substance that is responsible for destroying the mullerian ducts (female reproductive organs) in developing male embryos.  An important discovery was the synthesis of AMH by granulosa cells (the cells surrounding a mature egg) and this was followed by the development of accurate blood tests to measure AMH.   For the past 20 years the importance of AMH with regard to ovarian function has been extensively studied.

2) AMH is produced in the greatest amounts by antral follicles measuring < 6 mm.  Follicles > 8 mm in diameter, theca cells and atretic follicles have virtually undetectable levels of AMH.  AMH is believed to impede the transition from primordial follicles into growing antral follicles.  During ovulation induction, there is a decline in the AMH levels.  This is to be expected as larger preovulatory follicles produce less AMH.

3) AMH levels decline with age.  A decline in AMH level may be the earliest marker of ovarian aging.  This is followed by a decline in inhibin B and later by a rise in FSH levels.  There are studies that suggest that AMH levels may (in the immediate future) be useful in predicting when a woman will undergo menopause.

4) Obese women have 65% lower mean AMH levels than non-obese women.  This suggests that obesity might be associated with diminished ovarian reserve.

5) AMH levels do not vary much throughout the menstrual cycle.  Unlike FSH levels (which should be measured on cycle days 2, 3 or 4), AMH levels can be measured on any day of the cycle.  It can therefore serve as a unique untimed marker of ovarian reserve!

6) AMH levels predict ovarian response in IVF.  Higher AMH levels are associated with greater number of retrieved eggs.  On the other hand, lower AMH levels (<0.5 ng/mL) predict poor ovarian response with a sensitivity of 85% and specificity of 82.3%.

7) AMH levels > 3.5 ng/mL are associated with an increased incidence of ovarian hyperstimulation syndrome.  AMH levels can therefore be used as a guide when deciding on the dose of fertility drugs for ovulation induction.  In patients with high AMH levels, the dose should be lowered and the opposite is true for patients with low AMH levels.

8) AMH levels are NOT influenced by birth control pills, pregnancy or by GnRH agonists (e.g. Leuprolide acetate, Lupron).

9) In cancer patients that have undergone chemotherapy or radiation, AMH levels may be a marker of ovarian injury.

10) A combination of age, AMH level, FSH level and ultrasound markers such as ovarian volume and antral follicle count can be used to assess ovarian reserve.  At InVia Fertility Specialists, we use AMH levels to screen our potential anonymous egg donors.  We prefer donors with AMH levels > 1.5 ng/mL.







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1,045 Responses to Top 10 facts about anti-mullerian hormone levels and ovarian reserve testing.

  1. Terra Lunsford says:

    I am currently 27 and have successfully donated my eggs twice in the last 2 years. I had my labs drawn to donate again and was turned down because my AMH level had gone from 1.0 to 0.7 and FSH from 6 to 11.3! I haven’t had much change in my life since the first labs so Im wondering what could have caused this? Are there medications that can cause this to happen? I had breast augmentation/implants and was taking percocet and accolade for awhile. I also was put on phentermine to help lose a little bit of weight that wouldnt budge with diet and exercise before my wedding (I weighed 135 and am 5’4″ – got down to 125 and now steady at 130). Could any of these be the culprit or could it have been the egg donations?

    • Your situation is unusual and I do not have an obvious explanation. It is unlikely that your blood levels have changed because of the egg donation cycle. Bukulmez et al.(Fertility and Sterility 2010;94:905-912) measured serum AMH levels in oocyte donors that had donated more than once. They found that AMH levels do not decrease over repetitive oocyte donation cycles, which may imply that accelerated ovarian aging may not occur in oocyte donors. Please be advised that you may be able to have children without any problems despite the blood test results.

      • Commenter says:

        Dear Dr Karande,
        I would ask please behalf my aunt, her AMH is below 0.1 ( very low), is she has any
        chance to be pregnant, or are there any plane to treatment . her old (41).

        Regards,
        m alyami

        • Dear m alyami
          Your aunt should consult with a fertility specialist to discuss treatment options. An ultrasound exam will give a better idea of the ovarian volume and antral follicle count. They may want to try a few cycles of fertility injections with intrauterine inseminations. In vitro fertilization may be discussed. This is a potentially difficult situation where the treatment needs to be individualized based on the couples needs. Other options include donor eggs, donor embryos, adoption and child-free living.
          Sincerely
          Dr V Karande

      • Anonymous says:

        Hi Dr. Karande,
        I wasn’t sure how to start a separate post so I hope this works. I am 33 and trying to conceive off and on for about a year and finally decided to see a fertility specialist. My tubes are clear, uterine lining and cavity are both fine, semen analysis came back great (about 33 million at iui). They said I responded well to Clomid (although to me it seems just OK since I only produced 1 mature follicle on each ovary). I had 2 unsuccessful iui’s. I decided to opt for IVF, and it wasn’t until I had my IVF consult that I was told my AMH is .84, however they said FSH and everything else they look at is great for my age. The doctor mentioned that I needed “the whole package” in order to be labeled as DOR. However my IVF cycle was canceled yesterday because I only produced 1 mature follicle and another small one. They initially started me at 300iu of Gonal F and 150 Menopur. And on day 4 upped Gonal to 450 with no luck and canceling on day 6. Luckily our insurance will cover everything. Tomorrow they will do another iui for the 1 mature follicle. My questions for you are: 1) Am I wasting my time with this 3rd iui 2) Do you think they should have started me at a higher dose initially since they knew of my low AMH level 3) Do I have a better chance second time around with IVF with a possible Lupron surge and increased meds, or because of my low AMH am I simply not producing eggs 4) Should I just continue iui’s instead of IVF since my ovaries usually produce 2 follies anyway 5) Do I have any real chance conceiving on my own without meds? I am so anxious for a baby and I feel like I’m running out of time :-(
        Thanks so much for your time,
        L

        • Hi L
          You could get pregnant on your own. We have had several pregnancies in similar situations.
          Your IVF response is indeed worrisome.
          There are several options that you may want to consider.
          1) Try again after taking DHEA 25 mg three times daily for 2 – 3 months or Androgel 1% for 3 weeks prior to stim start. A luteal esterase protocol with FSH 300 units + hMG 300 units would be a reasonable protocol for you.

          2) Modified natural cycle IVF is something you may want to consider. This includes stimulating with a combination of Letrozole 5 mg (days 3 – 7) followed by 150 units of hMG till day of hCG. You may produce only a couple of embryos (which are then cryo-preserved). Embryo transfer can be done in a subsequent cycle when a full complement of blastocysts is available (it may take more than one retrieval to achieve this).

          Sincerely
          Dr V Karande

          • Anonymous says:

            Thanks Dr. Karande for getting back to me. I’m currently in my 2 ww for iui. The Dr. called and gave me some alarming news and said my hysteroscopy showed mild inflammation in the uterus that she wants to treat with an antibiotic if I’m not pregnant. She assured me that it’s nothing to worry about, but of course I worry lol. Do you think this could have been the underlying issue as to why none of my previous iui’s never worked? Should I still proceed with IVF if I’m not pregnant or try iui another time after they clear the mild inflammation? Also, can the mild inflammation cause implantation issues? Thanks again Dr. :-)

          • I do not understand what your physician means by “inflammation”.
            If an “infection” is diagnosed, then you do need an appropriate antibiotic.
            We generally try IUI 3 – 4 times prior to proceeding with IVF.
            Sincerely
            Dr V Karande

          • Anonymous says:

            Thanks Dr. Karande… Yesterday I got a call from the doctor and they said my h-scope revealed very mild inflammation of the uterus that, if I’m not pregnant from this iui, they will simply treat with an antibiotic. They assured me that it’s not serious, but I can’t help but wonder if this could have been the problem all along with the failed iui’s. Do you think this could have had an impact on the failed iui’s? Do you think I should still proceed with IVF next cycle or try another iui? Thanks so much for your time :-)
            L

          • Anonymous says:

            OK thanks Dr. Karande… They said they will treat with antibiotics if I’m not pregnant this cycle. They led me to believe it’s not a serious issue. But my .84 amh is an issue, should i be worried. Should i proceed with IUIs going forward if i don’t produce enough follies? Also, I had blood work done this morning and they said my Progesterone was .59 and they like to see it at 10 or higher. But in the past it’s always been normal like around 20 something. What does this mean for me? I am so upset right now but I also appreciate you taking the time to respond. :-)

          • Please have them repeat your AMH level.
            I have seen wide fluctuations in results which may be due to issues with the Gen II assay that is currently used to measure AMH.
            Your “low” progesterone level merely indicates that you had not yet ovulated this cycle.
            Sincerely
            Dr V Karande

          • Anonymous says:

            I went in for baseline yesterday to begin the next IVF cycle. The nurse seemed hopeful since she saw 12 antral follicles (6 on each side). She also said I should see better results with the Micro Lupron surge. My concern is that they’re putting me on bcp for 8 days. This feels like I’m going backwards. But anyway, in your professional opinion, do you think my 12 antral follicles could mean more mature follicles for possible collection, particularly with the Lupron surge? Thanks again Dr.

          • Birth control pills are routinely used with the microdose lupron protocol and therefore not a problem.
            The protocol is one of the more aggressive protocols and will often result in an increase in the number of mature eggs retrieved.
            Good luck with your cycle!
            Sincerely
            Dr V Karande

        • Anonymous says:

          Thanks Dr. Karande,
          this iui cycle was a negative. Of course I’m devastated but I’m going to keep trying. So once my cycle starts, they are putting me on a Lupron surge where I’ll be taking like 600 units of gonal along with the menopur. the doctor does not sound hopeful at all. he basically says my ovaries are functioning like a 40 or 41 year old. It scares me because I hear the doubt in his voice, I really want to believe this can happen for me and my husband. My FSH are usually between 6 and 7. I did not think my .84 amh really meant my eggs are low quality? in your opinion, do you think my ovaries are functioning like a 40 year old? Do you think I’ll be able to get more than 5 eggs from this protocol?

          • We recently reviewed our pregnancy rate at InVia in patients with similar clinical situations. We analyzed almost 175 IVF cycles and realized that we have a pregnancy rate of lees than 10%!
            We are currently looking into “IVF lite” –where we use a combination of Clomid + modest doses of hMG to stimulate poor responders. The embryos are cryo-preserved on day-3. Patients will go through 2 – 3 cycles till around 6 cryo-preserved embryos are pooled.
            Subsequent transfer has shown the pregnancy rate to be closer to 25% in this difficult group of patients.
            Here is a link with more information
            http://www.inviafertility.com/ivf/drvkarande/ivf-lite-new-strategy-managing-poor-ovarian-responders/
            Sincerely
            Dr V Karande

  2. hormone level testing says:

    nice stuff with a good 10 tips of medical science.

  3. Commenter says:

    sir, i read on your site that below 1.5AMH levels , donor egg is preferred , but in my woman’s case her AMH levels are 0.8 and her age is 34 years and 7 months, and i want only her miniature , and i will not lose hope and try hard , i dont want donor egg, kindly throw some light on this, what are the chances of her pregnancy through ivf ??? hope to hear some positive

    • Dear Sir
      An AMH level of 0.8 ng/mL is considered adequate. Your wife does not need donor eggs based on the information you have provided. When screening potential egg donors, we would like the AMH level to be > 1.5 ng/mL in order to maximize the number of eggs that will be available for the recipient couple.

  4. Avinash says:

    A @sterlinggrey1980 A few causes have been idieieftnd for early menopause, or premature ovarian aging. One is genetic; another is autoimmunity. It can also be caused by cancer treatments or a surgical loss of ovaries.

  5. Commenter says:

    Dear Dr Karande,
    I would ask please behalf my aunt, her AMH is below 0.1 ( very low), is she has any
    chance to be pregnant, or are there any plane to treatment . her old (41).

    Regards,
    m alyami

  6. Commenter says:

    does oral contraceptive pills before IVF affect the result of amh test ??

  7. Commenter says:

    dr. pls halp me our.

    i have pcos problem and my amh level is 6.17
    my body weight is 78 kg.
    my age is 34 yrs want to conceive fast

    can contact at ramanpk2000@yahoo.com

    • You should make an appointment with a fertility specialists. If you are from the Chicago area, you may want to schedule a consult with one of the physicians at InVia Fertility Specialists. Thanks. Dr V Karande

      • Commenter says:

        Hi Dr. Karande,

        I just learned that my AMH level is .97. I am a 32 yr old and have been trying to conceive for 6 months.

        Are there ways (nonprescription) to improve this? Also, do you know if this number fluctuates? Due to stress, alcohol, sleep, etc?
        thanks!

        • Your AMH level is normal for your age. I am not sure why you seem to be concerned. Yes, the number can fluctuate. Your physician should evaluate your day-3 FSH level and antral follicle count in addition to your age, weight and AMH level to give you a better idea of your ovarian reserve. Obesity is associated with low AMH levels. AMH levels are not affected by stress, alcohol, sleep or by your cycle day.

          • Commenter says:

            Thanks for your reply. My doctor said it warranted concern and what I have found on the internet indicates my number is average for someone 39-40 years old. Thanks for the note about the other tests, I’m going to call today.

  8. Commenter says:

    Hi
    I’m 31 an my AMH levrl is 57.1? Is that high?
    Thank you

    • Yes it is! Patients with a high AMH level are at risk for ovarian hyperstimulation syndrome (OHSS). If you need ovulation induction, your physician will probably use a very low dose of the medications and monitor you very carefully for OHSS. It also means your ovaries are “bursting” with eggs. The good news is that the pregnancy rate is generally very good in patients with high AMH levels.

  9. Commenter says:

    Thank you for the informative article. I received my results today and do not know how to interpret them… 40 years of age, AMH .56 and FSH 11.8, TSH 1.04 and a heathy weight. Could you assist please. Thank you.

    • Your ovarian reserve test results are consistent with your biological age. You should pursue pregnancy aggressively without further delay. Getting help from a Board Certified Reproductive Endocrinologist will be your best bet!

  10. Commenter says:

    If I’m currently pregnant, can I still get an AMH test?

  11. Commenter says:

    Dear Dr Karande,
    I just learned that my amh level is 8.52 pmol/L which my doctor said is low for my age (38). Using different scale it seems to be around 1.19 ng/ml. My fsh on day-3 is 6.14, estradiol 42.86. Is it really that bad? I would like to try to conceive naturally but my doctor says waste of time and suggests IVF.

    • Your AMH level and FSH level are both normal. Please ask your doctor as to why he thinks you need IVF. Have you been trying for at least 6 months? Have you tried simpler treatments? Your age, however, is a concern and you should get pregnant without further delay before your age-related decrease in ovarian reserve kicks in.

  12. Commenter says:

    Thank you, I don’t see fertitly doc till next week. Do you think his put my on a low dose of clomid as i already ovulate?

    • Probably not. In patients who “already ovulate” we use a higher dose (100 mg). A 25 mg dose is sometimes used in high-responder patients.

      • Commenter says:

        Hi
        I have pco, not the syndrome, so i have no symptons. I’m not over weight, I get a regular period, and i ovulate everything month. is there anything that can help, eg: clomid, metformin.
        Thank you

        • To diagnose polycystic ovary syndrome two fo the three need to be present 1) Polycystic appearing ovaries on ultrasound 2) Irregular or absent menses 3) Increase in male hormones (hyperandrogenism) — increased hair, acne etc. I am not sure what you mean by you “have PCO”. I am presuming you have polycystic appearing ovaries on ultrasound. This is very common and 22% of women have this finding. If you have been having unprotected intercourse for a year without getting pregnant, you should consult with a fertility specialist. You are welcome to contact us at InVia Fertility Specialists (847 884 8884) and we can give you specific advise as to whether you need to be on clomid or metformin. Hope this helps.
          Sincerely
          Dr V Karande

  13. Commenter says:

    I am 32 years old and had a hysterectomy 3 years ago but they were able to leave one ovary. I went last week to see if IVF would be a possibility. The doctor was able to see 7 follicles, but my AMH level was only 0.17. She said that using a donor egg would be my only possibility. Is that accurate?

    • The AMH level is low for your age. The antral follicle count is normal. I am presuming your FSH level is normal. Your best chance for pregnancy will probably be with a donor egg. For many patients the best option is not necessary the first choice. You may therefore attempt a cycle with your own eggs. You could be stimulated with an aggressive protocol with the understanding that there is a low chance of success. If you are in the Chicago area please feel free to schedule a consultation at InVia.

  14. Commenter says:

    My Friend is 34 years. She has tried iui for 3 times.she went ectopic pregnancy in 2008 and her right tube is removed. In 2012 she underwent laproscopy to determine her other tube is blogged, but everything is normal. Now she has discovered that her AMH level is 0.6. Can u pls suggest what she should do.

  15. Commenter says:

    I am 38. I’m a bit confused with my test results. My AMH level is 8.0 microg/L – that seems to be VERY high? My FSH-level is 3.9 E/L. What does this mean?

    • AMH levels are generally expressed in nanograms (ng/mL). A level of 8.0 microgram per liter is the same as 8 ng/mL. This indicates that you have a lot of follicles in the ovaries. It is commonly seen in women with polycystic ovary syndrome. A level greater than 3.5 ng/mL can increase the risk of ovarian hyperstimulation syndrome. Your ovarian reserve test results are excellent for age 38!

  16. Commenter says:

    I’m 28 years old i just had all of my day 4 blood results back. I have a few questions, my FSH was 10.1 on day 4. Is it possible that it would be lower on day 3?

    Also, my estradiol level was 45

    my prolactin was 10.9

    my LH was 11.1

    and my AMH is 3.97

    My RE is out of the country and I cant get any answers. I feel like i’ve lost my mind and just need help. Before my bloodwork, he recommened unmedicated IUI for DH and I for 5 cycles due to DH’s ED. I currently am on the cancellation list to get an appointment

  17. Commenter says:

    Dr. Karande,

    I am a mom of 2, 33 yrs old, miscarried at 10 weeks September 2012, and have been trying to get pregnant since. I just had my AMH tested and my level was 0.16 while I was ovulating (which I have ovulated every month). I have read reviews that ovulation can affect the AMH levels to show low. What are your thoughts on this?

    Thank you for taking time to my post and all of these other posts!

    My best,
    Jennifer H.

    • Hi Jennifer
      AMH levels are not affected by ovulation.
      Your AMH level is undetectable indicating diminished ovarian reserve.

      My suggestion to you is to consult with a physician and pursue another pregnancy aggressively.
      You should have your FSH, E2 level, and antral follicle count assessed.

      Sincerely
      Dr V Karande

  18. Commenter says:

    I had my fertlilty work up done on day 4 of my cycle. I am nervous and anxious about my results. I am only 28 and my Bmi is 18-19
    My fsh was 10.1
    My amh was 3.97
    My estradiol was 45
    Prolactin 10.9

    I also had oral surgery the day before my lab work. Do my results look bad for me?

    • Your results look fine.
      A FSH level of 10.1 is a bit elevated but you may still be okay
      FSH levels on day 2,3 or 4 are similar.

      The AMH level is excellent.

      Please discuss this further with your physician when he or she returns.

      If your antral follicle count is also normal, you may have nothing to worry about.

      Hope this helps
      Dr V Karande

      • Commenter says:

        Do you think that since my lh is 11.1 and higher than my fsh, it will be problematic? Also I ovulate on day 16-18 with 30-32 day cycles. Does that indicate poor egg quality?

  19. Commenter says:

    Hi Doctor,

    I am 31 years old and my AMH came back at 0.8ng/ml. My doctor told me that I would have issues to conceive naturally. I did not try yet but there is not possibilities for me to get pregnant naturally?…Also she told me to freeze my embryos asap if I wanted to have more than one kid. It is a lot of information and I do not know to do with it. Thanks for your help,

    Anna

    • What constitutes a “normal” AMH level varies from lab to lab. A level of 0.8 ng/ml will be considered somewhat low for your age at InVia. We like our egg donors to have an AMH level of at least 1.5 ng/mL. An AMH level should not be considered alone. It should be used in combination with a day-3 FSH level and antral follicle count to get a better idea of ovarian reserve. It remains a mystery to me as why you would want your AMH level drawn if you are not trying to conceive. You CAN certainly conceive naturally! My best advise to to you is to discuss your situation with a Board Certified Reproductive Endocrinologist.
      Sincerely
      Dr V Karande

      • Commenter says:

        Hi im 21 and got my blood results back today for my AMH levels and it was 45
        What does this mean?? How bad are my chances of getting pregnant i suffered for PCOS before my first pregnacy is it bad this time around?

        Jess

        • I am not sure why your doctor recommended checking your AMH level. It indicates your ovaries have PLENTY of follicles and consistent with your diagnosis of PCOS. You indicate you have already achieved a pregnancy. I see no reason why your chances of getting pregnant will change based on this AMH level alone.
          Sincerely
          Dr V Karande

  20. Commenter says:

    Dr. Karande

    I am 36 yrs old and I just received my test in the mail. It says my AMH is .76 Will I be able to conceive without help?

    • Your AMH level is normal for your age. In addition, you need a baseline FSH level and an ultrasound to measure your antral follicle count to assess your ovarian reserve. If you have been trying for more than 6 months, you and your partner should consult with a Board Certified Reproductive Endocrinologist to see if you do need help.
      Sincerely
      Dr V Karande

  21. Commenter says:

    Dr, I am 34 with a FSH of 8.1 and an AHM of 0.92. My husband and I have been trying to get pregnant for 9 months unsuccessfully. We do not want to attempt IVF. What are the chances we could get pregnant naturally? Would a drug such as clomid increase our chances of getting pregnant?

    • Your FSH and AMH level are both normal. To complete your work up, you need a baseline antral follicle count, TSH, prolactin level and a HSG to assess tubal patency. Your husband should have a semen analysis. If these tests are all normal, the initial approach is usually with three cycles of clomiphene citrate and timed intra-uterine inseminations. The per cycle pregnancy rate with clomiphene citrate is 10%. The cumulative pregnancy rate after 3 cycles approximates 25%. IVF is generally reserved only for those patients who do not conceive with simpler interventions.
      Sincerely
      Dr V Karande

      • Commenter says:

        Thanks Dr Karande for your reply. All of those other tests are normal. Do you know what the statistics are of us getting pregnant without any intervention?

        • 85% of couples will conceive within one year of trying. Another 10% will conceive on their own in the second year. What this means is that your chances of conceiving on your own are about 2 – 3 % per month in the second year. Hope this helps.
          Sincerely
          Dr V Karande

  22. Commenter says:

    Dear Dr. Karande,

    I’m 37, my amh reault 1.2ng/ml, total AFC on day 3 is 9 (4 in left ovary and 5 in right ovary, fsh on day 3 is 6.4. I’ve been planning to have my first baby with my husband 4 years ago but he died in a car accident. I haven’t met anyone since then and I just wondered how much time I still have to get pregnant. Is it already too late? Please help as my doctor is not very supportive and optimistic.
    Thanks in advance.
    Megan

    • Hi Megan
      I am so sorry your loss. Your ovarian reserve test results are normal. You, however, should be aware that (at your age) with every year your chances of getting pregnant will diminish. If you are not ready to have a baby right now, please consider the option of freezing your eggs. At InVia Fertility Specialists, we have a successful egg freezing program and will be happy to assist you. Give yourself the gift of time!
      Sincerely
      Dr V Karande

    • Commenter says:

      Megan, I’m 34 and my boyfriend passed away suddenly 15 months ago. We had been trying for a baby I’m in the same boat. My AMH was 1.2. Just wanted to let you know you aren’t alone. -Joni

  23. Commenter says:

    I am 33 years old I had a tubal ligation in 07 with my last child our family was complete! My husband passed away in 08 from cancer we had no clue he was even ill. I have since been in a relationship and starting ivf we knew this was the only way. I had all my blood work done everything is perfect except for my amh level 0.16 I am not over weight at all healthy no smoker & drinker so is partner and my cycles have always been normal. I am very scared now!! going for ulta sound on monday. How much will this affect our out come. We have paid for 2 cycles 1 fresh one forzen with no insurance help. I was so hopeful now not so much!

    • I am sorry for your loss! An AMH level < 0.16 ng/mL is not good. Your physician will probably recommend a very aggressive stimulation protocol. Despite this, there is a possibility that only a handful of eggs will be retrieved. The one factor in your favor is that you are relatively young. It is therefore possible that you will conceive despite a low number of eggs retrieved. Good luck!

  24. Commenter says:

    Dr. Karande,
    I received my cycle day 3 test results today. I am 26 years old, my AMH level was 0.64 and my FSH level was 9.4. My doctor suggest 2 months of injectibles followed by IVF if not successful. Does this sound like an accurate plan?
    Katrina

  25. Commenter says:

    thanks for this article. i have my baseline in a few days. but have been so confused about my hormone results. does it look like i have the numbers to conceive? am i normal?

    i am 40 and had a tubal 15 years ago. i had bloodwork twice. at period and during.
    FSH: 6.5/7.2
    AMH: 2
    Estradiol: 66/71
    Prolactin: 8.4

    • Your ovarian reserve test results are normal. However, please be advised that you have a significant hurdle to overcome — your age! Just because your FSH/AMH levels are both normal that does not necessarily mean that everything is (and will remain) hunky dory. A 25 year old with these numbers will have a much higher pregnancy rate than a 40 year old! My suggestion is that your pursue pregnancy without further delay. If you are not ready for a baby, please discuss egg freezing with your reproductive endocrinologist. This option, however, is more effective in women under age 37.
      Sincerely
      Dr V Karande

      • Commenter says:

        thank you dr. v for your response. i go in a few days and am quite anxious.

      • Commenter says:

        I’m curious why you are so sure that age is such a factor– especially for older women without prior fertility problems? For example, I am also 40, but here are my numbers, which seem so much better than many women 10-15 years younger:

        AMH: 2.3
        Day 3 FSH: 6.7
        Estradiol: <20
        AFC: 15 (both ovaries)
        Non-smoker/non-drinker

        So why would my chances be so much worse than someone just a few years younger than me, let alone 10+ years younger than me? I hear about egg quality issues, but I have yet to find actual substantive studies or explanations for this– at least for older women without prior fertility problems.

        Also, what's the problem with high BMI? That's also used a lot as a speculation for low fertility– probably more inexplicably so than age. But why exactly? Low AMH & high FSH & low AFC– those factors make sense for predicting fertility but why BMI??

        • Commenter says:

          Just a couple more comments on egg quality & age: measures of AMH & FSH are direct indications of egg quality. It would seem that the numbers speak for themselves & they are self-evident measures, because if I had poor quality follicles they wouldn’t be able to generate high AMH would they? Obviously at 6.7, FSH my follicles are high enough quality not to need higher FSH levels to function, no?

          Maybe the problem with older women conceiving isn’t actually with women at all, but with their male partners who are usually around the same age or older, & may have sperm viability problems. I’d be curious to see the stats of older women with younger men.

        • I cannot comment on your specific situation as I do not know all your details. Are you trying to conceive?
          Your ovarian reserve test numbers do appear to be normal.
          However, age is an independent variable that needs to be considered in their interpretation.
          A woman is born with all the eggs she will ever have. Fertility starts to decrease around age 28 and then decreases even more after age 35. After age 40, fertility decreases very rapidly as is confirmed with IVF pregnancy rates. There have been plenty of studies confirming this age related decrease in fertility.
          Just because your test results are normal, that does not necessarily mean your eggs are “okay”.
          There, however, indeed are plenty of 40 year old women who will conceive without any problem. You may be one of them.
          Sincerely
          Dr V Karande

          • Commenter says:

            I’m still confused. Why would age be the biggest factor here if all my other numbers are normal? I’m looking for specifics here, not generalizations. I don’t smoke, I don’t use drugs, not even prescription meds– all which can greatly degrade egg quality. Yet someone who’s simply under a certain age could smoke 3 packs a day, use every drug in the book, have much lower AMH/FSH/AFC than me– their eggs would STILL automatically be considered better quality than mine?

            And where does the egg quality issue end anyway? Oocyte grading? Blastocyst grading? Fetus grading? Baby grading? Child grading?

          • Why would age be the biggest factor? Because it is! Age related decrease in fertility is a well-established fact. The decrease is independent of ovarian reserve test results especially after age 40. A 40+ year old with normal ovarian reserve test results is NOT as fertile as a 20 yo with the same numbers.

            You have raised an interesting point about gamete morphology — there is often no difference in the appearance of embryos from a 40 yo vs. 20 yo! Although they appear the same, the younger patients embryos have a much higher rate of implantation. Looks can indeed be deceiving!

            Sincerely
            Dr V Karande

          • Commenter says:

            To answer your question, I’m helping a relative get pregnant because she doesn’t like the idea of using some anon donor eggs from some desperate girl who’s probably doing it for cash. She’d much rather have a wider age range of donors (with wider range of life experience & proven track record, doing it for the right reasons) to choose from. But unfortunately, the IVF clinics aren’t giving her much of a choice in the matter, as they only get eggs from kids in their early 20′s. If the eggs are of sufficient quality after blastocyst grading & biopsy, why shouldn’t she have a wider age range to choose from?

          • It may be unfair to describe anonymous egg donors as being “desperate”. In my experience, egg donors are generous, kind and giving individuals who want to make a difference in the life of the recipient couple. Egg donors are compensated for their time and effort. We do not buy or sell eggs. They get paid the same amount irrespective of the number of eggs, egg quality or the cycle outcome.

            The reason most clinics prefer to use younger donors (less than 30 yo) is because the pregnancy rates are higher! Once again, age is a very important independent variable irrespective of the ovarian reserve test results.

            Hope this helps

            Sincerely
            Dr V Karande

          • Commenter says:

            I was reading through comments, and I saw someone say that young donors are desperate. I agree this is really unfair. In May (when I was 21 years old) I decided to be an egg donor. My motivation was not money, but the fact that I hope to be an infertility specialist in the future and decided that I could start to help women sooner than when I graduate from medical school. Initially I was going to be willing to do it for free, but this isn’t an option ( you are allowed top opt to take lower compensation). There is a lot more work that going into it than just one doctors appointments. There are a lot of test, time, blood test, injections, and for myself an hour and a half drive. The process time line is specific. I also had a lot of other classmates, future OB/GYN, who donated truly to help. Their intentions were to help people directly and indirectly. We would directly help the recipient and the money received went to medical school tuition to help others in the future. I met a lot of other people through visits that all had great intentions and motivations. All the donors have excellent records and wonderful accomplishments (at least at my office, this information is provided to the family), everyone had to successfully complete their college degree. It is your sisters child. so I do understand her concern, but don’t be so fast to group all donors into one category. There is a group of us out here who inspire to help women with conception for the rest of our lives, and donation was our first step to doing this. I would encourage your sister to look through the donor books. I believe she will find someone in their 20′s with wonderful intentions and an excellent track record. (Also, what is there to insure that a 30+ year old is donating for the right intentions/)

          • I would like to thank you for this reply.
            In fact I like it so much that I would like to post it as a blog (so that more people get access to it).
            I would like to post it anonymously to protect your identity.
            Can you please give me your consent?
            Thanks
            Sincerely
            Dr V Karande

          • Commenter says:

            I am 22 years old with a AMH of 1.1. Antral follicle count of 13 and 8.
            Are these results normal or low?
            Do you think it would be ok to postpone a pregnancy for 4-5 years in order to become financially stable and settled?
            I was considering starting birth control, would this affect my future fertility?
            Is there any actions, medications, diets, supplements, ect. that could help me preserve my fertility in the future?

          • These are excellent questions and I am not sure I know the definite answers.

            I am guessing, from your previous comment, that the AMH level was checked when you were screened to be an egg donor.
            The AMH is a bit low for your age but that does NOT necessarily mean your fertility is compromised. Also your antral follicle count is excellent and you are very young — all of these suggest you should be able to get pregnant.

            A lot of young professionals in your age group postpone pregnancy by a few years in order to become financially stable and settled. I see no reason why you cannot do the same. I, however, am not able to guarantee you that your fertility will be fine 5 years from now. I just do not know the answer.

            Birth control will not affect your future fertility.

            I have written a blog on improving your fertility. Here is the link http://www.inviafertility.com/blog/uncategorized/drvkarande/how-to-improve-fertility-and-increase-ivf-success-rates.

            Sincerely
            Dr V Karande

  26. Commenter says:

    Hi, I have a question.

    I am 25yrs old. In the test AMH level in my blood is 0.08ng/ml. So kindly let me know is there any possibilities to get pregnency through IVF method.

    • Are you sure it is not 0.8 ng/ml? The assay has a lower limit of 0.16 ng /ml. Your age is in your favor. You will probably produce few eggs but can still get pregnant. Please consult with a Board Certified Reproductive Endocrinologist to discuss your specifics.
      Sincerely
      Dr V Karande

      • Commenter says:

        Dear Sir,

        My wifes age is 28. She received a stage 1 blood test taken at the fifth day of cycle. Her AMH came back as 12.3 pmol/L, FSH 6.7 U/L, LH 4.4 U/L. What
        are our chances of success with IUI or IVF. Expecting your reply for our own peace of mind.

        Regards
        MK

        • Her test results are all normal.
          Good luck!
          Sincerely
          Dr V Karande

        • Commenter says:

          Hi Sir
          My wife age is 28 years we go to gynac for treatment & he suggest us for IVF & regarding of that treatment we made a blood test of AMH & in report it was showing a range of 0.87 ng/ml my doctor is says it is low so he suggest us to take a eggs from doner but we dont want to take a doners egg we want our own so can you tell me that it is possible to increase a lveel of AMH by taking medicine or Injection. Please give me some advoice

          • Based on the limited information you have provided, I do not agree with your doctors recommendation of donor eggs.
            We have had plenty of pregnancies with an AMH of 0.87 ng/mL. If the other test results are normal, we generally start with at least 3 cycles of clomiphene citrate with intrauterine inseminations before considering IVF.
            Please get a formal second opinion from a fertility specialist.
            We would welcome you as a patient at InVia.
            Sincerely
            Dr V Karande

  27. Commenter says:

    I turn 38 Saturday. My AMH is 1.9; FSH 6 last cycle (day 3), 7.76 this cycle (day4). Estradiol 51 (day 3), LH 6.6, prolactin 10.6.

    My RE said he’d like to see AMH above 1.4, but he made it sound like over 3 meant PCOS and that was bad. But so many other women who have posted here have AMH levels well above 3 with positive comments. Is 1.9 low?

    HSG/hysteroscopy normal. MRI shows adenomyosis in posterior wall (estimated 30% of uterus). I tried clomid last month and will gain this month. Should I get more aggressive with treatment? Move to injectibles/IVF because of AMH and adenomyosis diagnosis, plus age? Thanks!

    • An AMH level of 1.4 ng/mL at age 38 is normal. The pregnancy rate with Clomid in your age group is 6 – 8 % per cycle. It would be reasonable to try injectables with IUI (15 % per cycle pregnancy rate). If 3 such cycles fail, IVF with a pregnancy rate of 35 % per cycle would be a next step.

      Hope this helps.
      Good luck
      Sincerely
      Dr V Karande

  28. Commenter says:

    if amh level is .61 and fsh level is 28.2 then is ovoulation is possible ? and what is normal level of amh & fsh level.
    pt. age is 42

    • AMH and FSH are indicators of ovarian reserve. Ovulation is possible with a FSH of 28.2, however, the quality of the egg being released will be compromised. Please check my other blog on AMH and age for the mean, median values for AMH at various ages. We like the FSH level to be < 10 mIU/mL

      Sincerely
      DR V Karande

  29. Commenter says:

    I am currently 22 and went to donate my eggs at a fertility clinic. After they drew my blood they told me I was not eligible due to my amh level of .40. I don’t understand what this means for me and my future.. Some insight would be most helpful. My family has no history of fertility issues and my mom went through menopause at age 42.

    Ashley

    • A “good’ donor is one who will produce a lot of good quality eggs. With an AMH level of only 0.4 ng/mL; you would probably produce a low number and were therefore rejected by the clinic. It dies not necessarily mean the egg quality is compromized especially at such a young age. This also does NOT necessarily impact your ability to conceive on your own. These are levels that are applicable only to assisted reproductive cycles.
      Hope this helps
      Dr V Karande

  30. Commenter says:

    Im 36 with an Amh of 0.3 and Fsh 4.6.What are my chances of
    getting pregnant ?

    • An AMH level of 0.3 ng/mL is low. Your FSH level is normal. If you and your partner are ready to pursue a pregnancy you should pursue one aggressively. Please consult with a Board Certified Reproductive Endocrinologist to discuss your specifics.
      Sincerely
      Dr V Karande

  31. Commenter says:

    i am 33,my lh is 6.82, fsh 5.61,estradiol serum 46.01 n amh is4.91.i just want know what are my chances of getting pragnant with icsi? is my amh that high?

    • Based on this limited information I would say your chances are excellent. An AMH level of 4.91 ng/mL is on the higher side. Your physician will use a lower dose of gonadotropins and watch carefully for ovarian hyperstimulation in your case.
      Sincerely
      Dr V Karande

      • Commenter says:

        thanks dr. actually my case is of male factor obstructive azoospermia with normal spermatogenesis. i had to icsi failure results as biochemical pregnancy. in both cases i have multiple eggs coz of hyper stimulation but only 3 came out as good grade one embryos.what can be the reason behind my bio chemical pregnancy? please guide me what should i do? what precautions should we take in next cycle?

        • I do not have all the information I need to give you a specific answer. Please meet with your doctor or get a second opinion from a Board Certified Reproductive Endocrinologist.
          Sincerely
          Dr V Karande

  32. Commenter says:

    HI, I am 37 years old with one 7 year old child and 2 miscarriages in the last 3 years both at 8 weeks (at 34 and 35 years). I have PCOS. I recently tested my AMH level and it came back as 0.15. My doctor indicated that there is no hope (i dont want to do aggressive treatments). Please note that my last two pregnancies I had no issue with conception and conceived naturally within less then 2 months. So what does a low AMH mean here if i have been able to conceive naturally. I am a bit confused.

    • You need to be thoroughly investigated for recurrent miscarriages. Something has changed dramatically in the last couple of years. Patients with PCOS have plenty of eggs and therefore usually do not have low AMH levels. You may have to reconsider your position regarding not wanting aggressive treatment.
      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you for your reply Dr. I had a Torch test and Karyotyping done after my second miscarriage. They all came back normal. My husbands tests were normal too. I dont know what else to do. I am not able to accept aggressive treatment without proper investigation done on what could be the issue. So far I have not received much help on diagnosis. Now the AMH results have added to the confusion. Can you please suggest some tests. Thanks P

  33. Commenter says:

    I am 28, normal weight, was informed today by my GYN (who is also a fertility specialist) that my AMH is 0.41 and that I should consider having my eggs frozen. I am not currently trying to conceive and take OCP. Is egg freezing a reasonable suggestion or am I being misled??? No other tests were done regarding FSH. TSH is 1.44 with possible high t4 (though I have no history of hyperthyroidism). Thanks doc!

    • I do not know the answer to this very interesting question. I am not sure anyone does. In older women ( > age 40 y) AMH levels have been used to predict age of menopause. In this age group, if the AMH level was < 0.2 ng/mL, there was a good chance that menopause will occur within the next 6 years. I plan on writing a blog summarizing what is known about AMH levels and menopause. Why did your doctor check your AMH level?
      Sincerely
      Dr V Karande

  34. Commenter says:

    I would ask please behalf my aunt, her AMH is below 1.5 ( low), is she has any chance to be pregnant, what would you advice me , please

  35. Commenter says:

    Late 2011 my AMH was 1.9. I was 25yr old at the time. I am now 27 and my AMH level is .8 Is that decrease in AMH normal? It seems like a quick drop to me. I was focusing on my career but now I am thinking that maybe I should start trying to conceive if my level is dropping so rapidly.

    • Commenter says:

      Note:(goes with my previous post) I found out my AMH level from the IVF clinic where I was trying to become an egg donor. When I signed up in 2011 my AHM was 1.9. I was matched with a women last week(after waiting so long) but when my AMH came back .8 we obviously could not move forward. Now I am concerned about having children of my own in the future. I will be seeing my OBGYN in a couple weeks to discuss all this but I wanted to see what you think in the meantime before I worry myself to death. Thank you!!

      • I will try and answer both your posts at once. AMH levels do vary across normal menstrual cycles. I have recently written a blog about this. http://www.inviafertility.com//do-amh-levels-vary-across-normal-menstrual-cycles
        Egg donor cycles are very expensive for the recipient couple and IVF Centers tend to get picky with their egg donors. We like our egg donors to have an AMH > 1.5 ng/mL. I am not sure if this truly impacts your chances of getting pregnant on your own. A definitive answer to your (very interesting question) is currenlty not known. Why don’t you get a third AMH level done?
        Sincerely
        Dr V Karande

  36. Commenter says:

    Hello. I am 38y4m old and have a 13 month-old. I am still breastfeeding. D3 FHS was 7, AMH 0.52, E2 <15, LH 2.5, TSH 0.61. I have had two menstrual cycles recently (28d apart). My mother entered menopause at age 50y. I am now concerned about AMh level. Please clarify what these numbers mean. We would like to have more children.

    • Your AMH level is a bit low but not unusual for your age. Your fertility is decreasing every year now. If you do plan on having more babies, please consider stopping breastfeeding as it will prevent ovulation and decrease your chances of conceiving.
      Sincerely
      Dr V Karande

  37. Commenter says:

    hello ! i am 39 yr old my E2 level on day 3 is 124.5 ng/ml n my fsh level is 5.45 ng/ml can i coceive naturaly or need of ivf iam trying last one yr with clomoid 50 mg then with hmg 75 mg for 5 days my ovulation is on day 11 and 29 day cycle plz help me

    • Your E2 level is high for day-3 and may be masking an elevated AMH level. The elevated E2 could be from a functioning cyst. Please have them repeat a day-3 FSH, LH, E2 level with a vaginal ultrasound and an AMH level. In your age group, Clomid has a 6% per cycle pregnancy rate and most of the pregnancies are in the first 3 – 4 cycles. IVF is a perfectly reasonable option for you.
      Sincerely
      Dr V Karande

  38. Commenter says:

    I am 25, and get tested as an eggs donor in the near future. Ultrasound came back I have 10 antral follicles, AMH 0.16. Is that mean I am not a good candidate? Will I be responding to the medications and producing a good number of eggs for the potential recipient? Or, should I better off not donating and reserve the eggs for my future use?

    • That is a low AMH level for a 25 yo. Most program’s will not accept you as an egg donor. This does not mean you cannot get pregnant on your own. It is a good sign that you have 10 antral follicles.
      Sincerely
      Dr V Karande

  39. Commenter says:

    Hello. I am 38 years old and D3 FSH 7, AMH 0.52, LH 2.5, E2 <15, TSH 0.6. I have a 13month old who is exclusively breast fed and would like more children. I am healthy otherwise. What can I make of these numbers?
    Thank you.

    • I just replied to a similar question. At your age, you may be running out of time. My best advise is to stop breast feeding and try getting pregnant without delay. If you do not conceive within six months of trying, please consult with a Board Certified Reproductive Endocrinologist.
      Sincerely
      Dr V Karande

  40. Commenter says:

    Hello Doctor_
    I’m 30 and just recently got my test results back with fairly devastating results; AMH is .2 and FSH is 9.7. (HSG and all other tests are normal). I understand that my chances are grim, and also know that these results are unusual for my age.
    My questions are 1) what could have caused this
    2) what are my options knowing that I will likely be a “poor responder” and 3) should I expect to go into early menopause??
    Thank you!

    • Your AMH level is indeed low for your age group. We do not understand what causes this. My best advise is to pursue pregnancy aggressively. You may produce few eggs, but, being so young you still have a good chance of conceiving.
      Sincerely
      Dr V Karande

  41. Commenter says:

    I am 34 years old. If my initial amh was 3.3, and it has dropped to 2.7, 1.2, after IVF cycles, how should I interpret this? I have a repeat level after my third cycle, which is 1.9ng/ml, but this was performed by another lab in another country. Does this mean my egg reserve is diminishing rapidly with each cycle? I only retrieved a few eggs each time. Thank you

    • I have recently written a blog about this very issue. AMH levels DO vary from cycle to cycle. All three levels you have mentioned are normal. You should get a second opinion from a Board Certified Reproductive Endocrinologist for specific advise regarding your case.
      Sincerely
      DR V Karande

  42. Commenter says:

    Previous conception at age 37 w/ aid of clomid, ovidrel, and IUI. Unexplained infertility; possible ovulation issues. Healthy, term child DOB 2008. No AMH was taken.

    Recently, at 41, AMH .09 and FSH 19. Reprod. Endo said low ovarian reserve. Refuses IVF w/ own eggs due to less than 1% chance of conception. Advises egg donation. With those readings, do you agree?

    • Your age + ovarian reserve test results do suggest that your chances of conceiving with IVF are indeed less than 1%. The initial response to the egg donor option is usually a resounding “NO”! At InVia Fertility Specialists we have an excellent psychologist that helps our patients decide if this is an acceptable option for them. Pregnancy rates with egg donation currently are greater than 60% per cycle. There remains a small chance that you could get pregnant on your own!
      Sincerely
      Dr V Karande

  43. Commenter says:

    Hello doctor. You mentioned that you were going to write a subsequent entry about interpreting AMH levels as it relates to expectant age of menopause. I had my AMH levels tested as there is a family history of early menopause (mid thirties) in my family. My AMH came back at 1.4 ng/ml and I am 27. That is what the normal range is for someone who is in their late thirties/early forties. Just wondering if there is literature out there of a ball park figure on how long I can expect it to be before I start menopause.

    • That particular blog is on my “to do” list. I will get to it soon! An AMH level of 1.4 ng/mL may be normal for your lab. Please have an evaluation with a Board Certified Reproductive Endocrinologist. In addition to an AMH level, it is useful to check day-3 ovarian volume, antral follicle count and a day-3 FSH/E2 level.
      Sincerely
      Dr V Karande

  44. Commenter says:

    I have a question of the variability of the AMH test. My first test 6 months ago resulted in .49. This worried me and I had the test redone and the result was .79. I went to see a fertility specialist who re-ran the tests and came up with 1.20. I then took some time and had to revisit the specialist who ran once again for and it came out to be .45. I’ve heard the AMH test was more reliable than other tests, however I am confused and frustrated since I don’t know where I really am in terms of accuracy with my AMH. The MD did a ovarian ultrasound which was good and FSH were normal. How should I interpret the bad AMH results?

  45. Commenter says:

    Today I found out that my AMH level is .98 and I am 28 years old, which I’ve read should be much higher for my age.
    My day 3 levels were: FSH 9.22, LH 5.15, Estradiol 24.6
    I have been trying to conceive for a year and a half- had a miscarriage 6 months ago.
    Seen a fertility specialist who didn’t really give me any “cost effective” options. What would you recommend with my results.

    • If your work up is otherwise normal, the initial approach usually is ovulation induction with clomiphene citrate and timed inseminations. I have written a blog on this option which you may find to be useful.
      Sincerely
      Dr V Karande

  46. Commenter says:

    HI ! I AM 39 YR old and this month my foolicle size is
    19mm 19mm ed thickness is 9.5 on day 8 . on day 7 at size 17mm18mm i take hcg 10,000 . my ovulation is on day 9 at size 19mm20mm and ed thickness is 9.5 it is normal report or not ?

    • Based on the information you have provided me it appears that you have developed a 19 – 20 mm follicle on day 9 of stimulation and you were instructed to take your hCG trigger shot. All this appears normal. Good luck!
      Sincerely
      Dr V Karande

    • Commenter says:

      iam trying for concceving but my meanses is coming on 28 th day my amh level is 1.5 then what to do ?

      • Both twenty-eight day cycles and AMH level of 1.5 seem to be normal. I do not have enough information to give you specific advise as what to do next. Your best bet will be to consult with a Board Certified Reproductive Endocrinologist.
        Sincerely
        Dr V Karande

  47. Commenter says:

    Dear dr, i had 3 children two boys and a girl till the age of 24 years. i got ligated on the third birth. I am 38 years and 8 months now. I am remarried now and my husband is in his 40′s. Since we wanted to have children we tried an IVF 4 years back that was not very successful. i had my regular cycle till 4 months back and then suddenly didn’t have my periods for three months, in fourth month i had my period back but with heavy bleeding that lasted for a month almost. Eventually i had to take folic acid and primolut N i.e Norethisterone medicines to check the bleeding. this month i had normal periods. i Also conducted my hormonal profile and my FSH value was 6.8. Once i checked with my doctor she asked me to go for AMH test as the FSH value could be under the influence of above mentioned medicine. the result of AMH was “NOT DETECTED” i.e. less than .1 pmol probably. do i stand any chance for becoming a mother….?

  48. Commenter says:

    Hi,

    I just had my first IUI today and received my blood work. This is what came back… I am 36 years old.
    AMH – 1.22
    Estradol – 36
    FSH – 7
    LH 2.4

    Do you think I have a chance of getting pregnant?

  49. Commenter says:

    I am 40 years old with AMH level of 0.6. Is that low for my age? My BMI is 17, would gaining weight increase the AMH? Thanks

    • Your AMH level is consistent with your biological age. I am not aware of any data suggesting that gaining weight will increase your AMH level.
      Sincerely
      Dr V Karande

      • Commenter says:

        Hi Dr V Karande,

        I am 31 and have recently had the following results,
        AMH 8.6 pmol
        FSH 4.6 u/L
        LH. 2.2 u/L
        Oestradol 420 pmol
        Proactalin 252 mU/L
        T4. 11.9 pmol/ L
        TSH. 2.20 mU/L
        Progesterone 49.7 nmol/L

        From an ultrasound report
        Day 11
        Rt ovary follicles <10mm
        Lt ovary 17.5 10 10 10

        Can you decipher the above for me can I still have ivf?

        • I am assuming your blood test results are all normal.
          Based on your progesterone level, these bloods were done in the luteal phase.
          At age 31, if other simpler techniques have failed, you are indeed a candidate for IVF.
          Sincerely
          Dr V Karande

          • Commenter says:

            Hi Dr V Karande,

            Thank you for your response it is greatly appreciated.

            My Progesterone was carried out on cycle day 21 and the Oestradol, Proactalin, Free T4, TSH were all carried out on cycle day 3.

            The alarming thing to me is that when my AMH tested at 8.6 i was told this is low for my age and that time isnt on my side and as such i should proceed straight to IVF.

            I have been trying to conceive for 18 months and would like to conceive naturally but do not want to miss my opportunity. With my above results what would be your course of action?

            Again Thank You

          • Your AMH level seems to be elevated (not low). How old are you? I do not understand why you need IVF. If you have been trying for 18 months, you do need help. Please consult with a Board Certified Reproductive Endocrinologist. We would love to see you as a patient at InVia.
            Sincerely
            Dr V Karande

      • Commenter says:

        Thank you dear Dr. Karande! In addition I have FSH 7.4, LH 5.4, Prolactin 12.8 and Estradiol 58 (on day 3 of menstruation). Six small follicles in each ovary. How is this interpreted in terms of fertility?
        Thanks

      • Commenter says:

        Dear Dr. Karande! I am 40.5 years old. My FSH is 7.4, LH 5.4, Prolactin 12.8 and Estradiol 58 (on day 3 of menstruation). AMH 0.6. Six small follicles in each ovary. Do you think I will be able to conceive despite my age? Thanks

  50. Commenter says:

    Correction: I meant 6 follicles TOTAL (not 6 in each ovary).
    Dear Dr. Karande! I am 40.5 years old. My FSH is 7.4, LH 5.4, Prolactin 12.8 and Estradiol 58 (on day 3 of menstruation). AMH 0.6. Do you think I will be able to conceive despite my age? Thanks

    • Yes, you can indeed conceive. Your blood test results are in the normal range. Your age, however, is an independent variable that must be taken into consideration. You do not have any time to waste. My recommendation to someone in your age group, generally, is to pursue pregnancy aggressively. If your tubes are open and your partner’s sperm count is normal, please discuss injectables with intra uterine insemination (FSH/IUI) with your fertility specialist. The pregnancy rate is around 12 – 15% per cycle with this option. Another option is to go directly to IVF where the pregnancy rate is around 15 – 25% per cycle for your age group.
      Good luck!
      Sincerely
      Dr V Karande

  51. Commenter says:

    Dear Dr. Karande,
    I am 36 years old and I have 2 living children that I conceived when I was in my teens. My husband and I have no biological kids together. We’ve been together for 16 years. I was pregnant in 2011 and miscarried. The child was healthy, but between this fibroid and the medication the hospital gave me I miscarried. The doctors are requesting a hysterectomy to remove the fibroid or going in and cutting me again, but they can’t promise my womb would be strong to carry a baby. I want them to shrink the fibroid and then remove it laparoscopic. My AMH is at .6 I was told. My uterus is healthy. I just want to give my husband a baby. I believe this is possible. Can you give me other options. Thank you

    • I am so sorry for your loss. You have not specified the size, number and location of your fibroid. I also do not understand what “medication” the hospital gave you. Your suggestion to shrink the fibroid (with Depo Lupron) and then doing a myomectomy seems to be reasonable. Please get a second opinion from a experienced laparoscopic surgeon to see if your case is suitable for laparoscopy.
      Good luck!
      Sincerely
      Dr V Karande

  52. Commenter says:

    I am 43years and 3 months old. My AMH is 0.16. My firtility specilaist is suggesting using an egg donor. I would prefer to get pregnanat with my own eggs .Is this possible. Will DHEA help me in anyway. What are my chances of having a successful pregnanacy

    • Sorry, but I agree with your fertility specialist. Keeping your age and AMH level in mind, your chance of getting pregnant with your own eggs is less than 1%. With an egg donor, the success rates are closer to 70%! DHEA will not hurt, but I doubt it will help.
      Sincerely
      Dr V Karande

  53. Commenter says:

    Dear Dr Karande,

    I would like to donor eggs for my sister who is 42. I am 41 and just had a AMH and my result come back at 1.21. The Fertility specialists say that I am too old and that my AMH is low to donor an egg. I have had 3 children (including twins) and have never had any fertility issues. My younger sister was about to donor to my older sister, but she has just fallen pregnant with twins at age 39 (she already has 3 children)and her AMH was 2.57. I feel that even though my AMH is slightly below the 1.5 AMH, I would still be a good candidate due to the fact that I have not had any fertility issues. What do you think? Should I go and do a Antral follicle scan to get a better idea of what is actually there in terms of egg reservoir? Do you think I have missed the boat in terms of donating?

    • Your sister is VERY LUCKY to have you as her sister and I applaud your wanting to donate eggs for her! You indeed may be able to get pregnant on your own without any problem. However, egg donation is a different ballgame altogether. At age 41, the success rates for IVF are about 10%. Age is an independent variable that needs to be considered irrespective of the AMH level. At your age the chance of a miscarriage is 33 – 50% and there is an increased risk for having a baby with Down syndrome. Most Reproductive Endocrinologists will agree that you are not a good egg donor candidate.
      Sincerely
      Dr V Karande

  54. Commenter says:

    Additional note – I have regualar menstual cycles every 26 days. Thanks for your help.

  55. Commenter says:

    Dr. Doctor
    I am 27 yrs old. My AMH level is 2.47 ng/ml and my egg size is 13mm on Day 14. Pls tell me Wat are my chances of conceiving and wat should i do?

    • Your AMH level appears to be normal. Most women will ovulate when the follicle size is closer to 18 mm in diameter. With a 13 mm follicle on day 14, it probably means that you are still a few days away from ovulating. Please consult with a Board Certified Reproductive Endocrinologist to get specific advise on what you should do next. You are welcome to call InVia fertility Specialists and get an opinion.
      Sincerely
      Dr V Karande

  56. Commenter says:

    Dear Dr

    My Daughter age 26 has AMH 3.1 ng/ml and FSH IS 13.1 and LH is 6.1 with Prolactin is 15.4 is it o k or she can be termed as pt with poor ovarian reserve Pl reply

    • Her AMH level is reassuring. The FSH seems to be elevated. I am presuming it was drawn on day2 2, 3 or 4 of the cycle. Is she trying to get pregnant? What is her antral follicle count (usually done with a vaginal ultrasound)? Please have her consult with a Board Certified Reproductive Endocrinologist to get a specific answer. We at InVia Fertility Specialists would be happy to see her at one of our four locations.
      Sincerely
      Dr V Karande

  57. Commenter says:

    Thanx Doctor for replying my doctor advised me iui. My egg size became 13 mm on 16 day she is giving me hmg injection. Is iui safe
    kindly help

  58. Commenter says:

    Hi, I am 32 years old and have a little boy who is 3, last year I feel pregnant in June after not having a period for 3 months with twins, this pregnancy wasn’t meant to be. At the time I had a FSH test done and my GP said the results were fine.
    I have since been to see a fertility specialist as I wanted to see about folicle tracking to avoid multiples again due to being so unwell.
    After being pregnant last year my periods returned to normal, every 28 days. Yet I haven’t had one now since January.
    The Dr at the fertility clinic has done blood tests and my FSH is now very high (94) and my AMH has come back as 0.6. He has just told me that I am menopausal.
    Obviously I feel completely overwhelmed and heartbroken and have no idea what to feel or think now? I have no other symptoms of menopause. It seems crazy as I was pregnant only a year ago. both pregnancies happened quickly, within 2-3 months of trying?
    Please I would appreciate any type of advice or help? I feel desperate.
    Many thanks
    Caroline.

    • Unfortunately, your history and blood test results are indeed consistent with Premature Ovarian Failure (POF). POF can be secondary to chromosome abnormalities (Turner syndrome or its variants or Fragile X syndrome). It can be secondary to your immune system developing antibodies against your ovary. Other causes include chemotherapy, radiotherapy, surgery on the ovaries, toxins and viral infections. Your fertility specialist should be able to run the above mentioned blood tests.

      I have, over the years, had several patients in your situation get pregnant on their own. If there is no correctable cause, then you may have to consider the use of donor eggs to complete your family.

      Bone loss is another issue that needs to be considered as your estrogen levels will be low. Please discuss this issue with your gynecologist.

      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you for your reply, on the test results it says
        Serum 17 Beta Ostradiol is 164, on 1 test and 2 weeks before it was 138. Is this the estrogen level? This wasn’t discussed, so is this level low? Now I’m worried about my health.
        Thank you.

        • I do not have enough information to give you specific advise.
          Please discuss this level with your physician.
          If you would like a second opinion, please schedule one at InVia. We will be happy to see you.
          Sincerely
          Dr V Karande

  59. Commenter says:

    My amh is .45 and I am 34 years old. My fsh was unde
    r 10 and ovarian ultrasound the doctor said she sees lots of follicles., I’m still worried about the low amh and need to delay reproduction for a year. Would you recommend egg freezing?

    • Please have them repeat your AMH level. Are you on birth control pills? A recent publication suggested that AMH levels get suppressed after 8 weeks of birth control pill use. I have no way of predicting what your fertility will be a year from now. Egg freezing is a good insurance policy but is not cheap. There is no harm done if you do choose to freeze your eggs.
      Sincerely
      Dr V Karande

  60. Commenter says:

    I am currently 38 years old and have had 3 miscarriages(no living children). My most recent labwork following the D&C showed Trisomy 3. I have been seeing a RE and have had many blood tests. My FSH is 6.4; E2 was 24.2; my most recent AMH was 1.0ng/ml. I had another AMH drawn one month ago at the same laboratory and my AMH was 0.54ng/ml. I know the AMH level is low in both cases, but in your experience, have you seen AMH rise? I have no problems getting pregnant, but have difficulty carrying the pregnancy (most likely due to chromosomal issues). Do you have any insight regarding my numbers? IUI has been suggested but my OB suggested considering IVF.

    • AMH levels do vary. Please read my blog on this issue. If your work up is negative, we may be dealing with “recurrent aneuploidy”. This is a condition where you may be repeatedly making embryos that are abnormal. IVF + screening of the embryos (pre-implantation genetic screening) is a reasonable option to consider.
      Please contact us at InVia if you wish to pursue this option. We would love to have you as a patient.
      Hope this helps.
      Sincerely
      Dr V Karande

  61. Commenter says:

    Dr. Karande, I just saw my Endocrinologist and he told me my AMH was 0.21 .. I am 33 years old and I’ve been trying to get pregnant for 3 years. I recently had surgery to remove endometriosis and endometriomas from my uterus and ovaries. My labs were drawn about a week after the surgery. Would that affect my AMH results? Also, is there a chance for me to get pregnant with that number? The doc told me my only option was a surrogate :(

    • There is always a chance to conceive on your own. You had surgery for severe endometriosis and now have diminished ovarian reserve. There is no harm in getting a repeat AMH level. My suspicion is that it will again be low. Depending on how much ovarian tissue remains, you may be a candidate for IVF, but the chances of success will be low. If your IVF results are negative (poor response, poor egg quality), you may require an egg donor. I do not understand why you were recommended a surrogate.
      Sincerely
      Dr V Karande

  62. Anonymous says:

    hello sir.i m siri.age of 26.got married before 2years.recently i got a problm of irregular periods and heavy pain.i consult doctor for the same and children also.doctor said that u have a problem of water bubbles.she gave a course for 3 months.and my AMH result came with 0.13. and LH is 2.90. so pls tell me did i conceiv naturally and any medicine to
    overcome this.thank u

  63. Anonymous says:

    hai sir. i got result of TT4:9.7 and TT3:92.31.FSH:8.77.LH:2.90.prolactin:18.58 and E2:21.22.AMH:0.13. doctor said that no chance to get pregnent.please suggest sir did i conceiv naturally.

  64. Commenter says:

    Dear Dr. Karande, I am 31 with severe endometriosis (choc cyst on both my ovaries now, earlier only on right ovary), I have had 1 surgery and 2 laproscropy’s since 96 to treat the choc cyst i have, due to which a lot of adhesions have been created.
    I got married in 2010 and have been trying to conceive since 2011 July, but unsuccessful at it naturally, I was told to go through IVF, March beginning after a 2nd cyst aspiration after September last year, i took 5 days of ovulation stimulation injections, but after the 5th day of injections there was no follicle seen so the cycle was stalled.
    Now my AMH is 0.56; FSH-14.31 LH-21.24 E2-135.50 P2-0.63 (all mid-cycle).
    Most fertility specialists i have consulted are telling me I would have a better chance of success with donor eggs and I should get my ovaries removed to do that (to avoid the increase of my endometriosis).
    Do you think it is worth going through another cycle of IVF with my own eggs considering my AMH and my extensive endometriosis or just go the donor egg method? Kindly advise.

    • It is difficult for me to give you specific advise since I do not have ALL your details. You have diminished ovarian reserve and are not responding to ovulation stimulation injections. This is probably secondary to your ovarian endometriosis and previous ovarian surgery. If they have not used the maximum dose of medications (generally 600 units daily), you can try again with your own eggs. Even if they retrieve few eggs, there is still a chance of success. If you are not responding to a maximum dose of medications, you will need to consider using donor eggs. There is always a chance you can conceive on your own. I do not understand why they want to remove your ovaries prior to an egg donor cycle.
      Hope this helps
      Sincerely
      Dr V Karande

  65. Commenter says:

    Dear Dr Karande,

    I would like to ask you about my chances to get pregnant. I am 36. I had 2 IUIs, the 2nd one was succesful but after 12 weeks I had a miscarriage. Now I had a blood test again/ day 4 of my cycle and my FSH is 12,6 UI/L, LH is 8,7 UI/L, AMH is 2,80 ng/mL and 27,85 pmoI/L.
    I am a bit worried that my eggs are not good enough anymore. I am sure I will have to go through IUI again or maybe IVF.
    I have one more question. Is it possible that if I take Clomid and Gonal-F infections before IUI that the AMH is dropping down faster, FSH raising up faster?
    Can AMH mean that my eggs are not so good anymore and they can carry a genetical problem? Maybe I lost my first baby bc of a genetical problem. I don`t know, we guess bc I was 12 weeks pregnant.
    Thank you very much for your time and answer
    Monica

    • Hi Monica
      I am so sorry your pregnancy resulted in a miscarriage. Did they send the products of conception for chromosomal analysis? Your FSH level may be a bit elevated but your AMH level appears to be normal. You do have a reasonable chance of getting pregnant. Ovulation induction medications do not increase or decrease your ovarian reserve. Proceeding with more IUI cycles or IVF is the way to go. Good luck!
      Sincerely
      Dr V Karande

  66. Commenter says:

    I am 43 yrs and recently had an AMH test done 0.7. Can I still go through IVF with my own eggs? Is there a possibility of having ovaries stimulated?

    • Current SART statistics (www.SART.org) suggest that your chance of having a live birth with IVF is about 5% per cycle. You can definitely go through IVF with your own eggs as long as you are made aware of the low chance of success. There is also an increase in the incidence of having a baby with a chromosomal problem (e.g. Down’s syndrome).
      Sincerely
      Dr V Karande

  67. ….Dr. Karande: I am 41 years old and recently had surgery for severe endometriosis. They didnt remove any organs. My LH is 3.6 and FSH is 7.3 but my AMH is .16. Can I still conceive naturally? Also will chlomid help me conceive? .

    Hi Rebecca
    You can indeed still conceive naturally. At age 41 with severe endometriosis and an AMH level <0.16, pregnancy rate with IVF is < 5%. Clomid will not hurt, but I seriously doubt it will increase your chances versus tryig on your own.
    Sincerely
    Dr V Karande

  68. Commenter says:

    Dr., thank you very much for giving your time to provide this service. Your advice is a blessing for all the women who have posted.

    I am being strongly encouraged by my Dr. to undergo IVF, but I am not completely comfortable with the reason I’ve been given. I’m only 33, but once my Dr. saw low AMH levels he said that my ovarian reserves were low and that I needed to do the IVF as soon as possible. However, my follicle count has been in the average range. I wonder if I should not be taking the AMH level as gospel that my ovarian reserves are low when the follicle count is average. My Dr said that the follicle count has been between 12 and 14. The AMH levels showed as .60 on my first test and .67 on my second.

    My husband and I have been trying for 18 months. We have not undergone any fertility treatments yet.

    Should I rush into the IVF thinking that time is of the essence because I have a low AMH level? Or should we try a more conservative treatment first.

    Thank you so very much,

    • Commenter says:

      Also, I’ve read that AMH levels can correlate with obesity. I am a healthy weight.

      Also, I should have shared that my first Dr diagnosed me with endometriosis based upon an ultrasound that showed shadows. My second Dr (the one who’s pushing IVF) completely dismissed the endometriosis diagnosis.

      Again, thank you so very much,

      • Commenter says:

        One more piece of information that might be helpful for you (sorry for the repeated posts!). With the endometriosis concern, they checked to make sure my tubes are clear. The tubes showed no blockages.

    • I am presuming that everything else is normal (tubes are open, husbands sperm count is normal, hormone levels are normal). I do not think you HAVE to go to IVF directly. It is reasonable to try a few cycles of intrauterine inseminations (IUI)with clomiphene citrate prior to considering IVF.
      Good luck!
      Sincerely
      Dr V Karande

      • shruti says:

        Hi.. I am a 22 yr oldn hav been diagnosed with pco 6 months back. My gynaec has advised amh lh and fsh test on 3 rd day of my cycle. N my results are fsh at 8.1 mIU/ml and lh at 4.4mIU/ml and amh at 3.05 ng/mL.. I have no plans of geting married or pregnant for another 3 yrs.. Please throw sum lights on the test results and advise if i wuld be able to conceve naturally

      • Commenter says:

        Hi Dr.Karande, I got married at the age of 40 (2009) and till date am trying to conceive but no luck. I did my AMH/MIS test recently and the value is 0.10 ng/ml. But my Doc suggested to go in for Donor eggs, my question to you is
        1. Can the AMH value increase by any medication ?
        2. Considering the age factor (now my age is 43) what’s the best way to conceive ?
        3. What other tests needs to be done if any ?

        Thanks for your advice in advance.

      • Commenter says:

        Hi Dr.Karande,
        I got married at the age of 40 and now am running 43 and being trying conceive but no luck. My doc suggested to go in for Donor eggs as my AMH / MIS levels are 0.10 ng/ml. My question to you is
        1. Can I conceive with this levels.
        2. Can the AMH levels be increased by any medication ?
        3. Is there any other tests that show other organs are good to conceive naturally other than donor eggs.

        Please guide me. Thanks for your advice in advance

      • Commenter says:

        dr
        i am 38 i have one child i had 3 miscarriages 2 chemical and one on 2.5 months.
        my AMH now is 2.3
        i am trying to conceive..
        anything to take or to do?

        • You need a complete work up for recurrent miscarriages.
          Please consult with a Board Certified Reproductive Endocrinologist to get specific advise. We will be happy to see you as a patient at InVia.
          Sincerely
          Dr V Karande

  69. Commenter says:

    hello dr,
    I`m 28 y
    ihave pcos syndrom
    try to conceive for 3 y
    my amh 13.5 ng
    prolactin 20 ng
    i`m 68 kg
    can i have normal pregnany easily soon
    thanks alot

    • I do not have enough information to give you specific advise. If you are having regular menses, you should be able to get pregnant. See a doctor if you are not pregnant after one year of trying. If your periods are irregular or absent, please see a Board Certified Reproductive Endocrinologist to discuss treatment options.
      Sincerely
      DR V Karande

  70. Colleen says:

    I had chemotherapy last year for Non-Hodgkins lymphoma stage 2. I have responded well to treatment and am in remission. I am still receiving a biological called Rituximab via IV every 3 months for the next 2 years. I have a son who is 15 months old and I am 34 years old. My gynae did some tests to check if my ovaries were affected by the treatment and my FSH levels are normal but AMH very low (0.16). When looking at my ovaries via ultrasound, my gynae said that the left ovary is smaller than normal for my age but the right ovary is 3cm which is apparently around the normal size for someone of my age. The gynae said that the Rituximab could possibly be affecting my AMH levels and lowering them when in fact I have one ovary which is still functioning normally and does not have low egg reserve. Do you know whether Rituximab affects AMH levels at all and whether my chances of falling pregnant are any good using the information that I have provided?

    Many thanks.

    • I am so sorry about your diagnosis. I do hope with the treatment you are receiving, you will beat the cancer. Your AMH levels are indeed concerning. It is possible that the chemotherapy may have damaged your eggs. I am not aware of any data that says that Rituximab (which acts against CD 20 lymphocytes) affects AMH levels. Please consult with a Board Certified Reproductive Endocrinologist to discuss specifics regarding your chances of getting pregnant.
      Sincerely
      Dr V Karande

  71. Commenter says:

    Hi Dr.Karande,
    I got married at the age of 40 and now am running 43 and being trying conceive but no luck. My doc suggested to go in for Donor eggs as my AMH / MIS levels are 0.10 ng/ml. My question to you is
    1. Can I conceive with this levels.
    2. Can the AMH levels be increased by any medication ?
    3. Is there any other tests that show other organs are good to conceive naturally other than donor eggs.

    Please guide me. Thanks for your advice in advance

  72. Commenter says:

    In 2012 my RE ran some blood work to check some of my levels. At the time I was 22 years old. Everything came back normal except for my AMH level which was <0.16. He then wanted to run the test again a coupld of days later, and the results were the same <0.16. When doing an ultrasound my RE saw good size follicles which is why he does not believe the blood work. He says that the blood work and what he physically is seeing does not match up. As a cause of that my husband and I decided to do IUI, which then turned into 2 failed IUI attempts. My RE does not appear to be worried about my past blood work, I on the other hand believe that the low AMH is a huge factor. This RE is not giving us any answers as to what could be the problem. We are not very satisfied with this doctor, therefore we made an appointment with a new RE in order to get a second opinion. In your opinion do you believe that I could have a diminishing egg supply even though follicles are present. That blood work seems pretty accurate to me.
    Also, my husband and I have the same exact MTHFR gene mutation pattern. The RE seems to not be concerned about that either. Should I be concerned?
    Thank you so much for your time!

    • Your AMH level is indeed low for a 22 yo. You should have it repeated, just to be sure. Your antral follicle count is apparently normal. Please consider other tests such as a “clomiphene citrate challenge test” to further evaluate your ovarian reserve.

      You have not told me about how long you have been having unprotected intercourse. Women with low AMH levels, do conceive naturally and I have just written a blog about it.

      You may want to discuss the option of pursuing pregnancy aggressively with IVF. You will probably produce few eggs even with high doses of medications. However, you are so young that you may conceive.

      Good luck!

      Sincerely
      Dr V Karande

  73. Commenter says:

    I m 35 years old. Married since 3 years. tubal laprotomy in Dec 2010, blighted ovum in Jan 2012 for which D&c was performed and a pregnancy in Apr 2012,not confirmed whether it was intra uterine or extrauterine and methrotrexate doses of 25+25+50 was given. I recently found my amh to be 1.19, FSH-4.68, LH 5.42 on day 3 of cycle, TSH-4.87, T4-6.4. HSG normal. What are my chances of conceiving normally without any fertility drugs? or do i need to have them. If yes Which drugs do u suggest?

    • Your TSH level is a bit elevated (we like it to be closer to 2.5) and you probably need to take Synthroid. The rest of your blood tests seem to be normal. 60% of women who have had a tubal pregnancy will subsequently have a baby on their own. The chance of a repeat tubal pregnancy on your own is 6 – 16% (with IVF the number is closer to 3 – 5%). You could try on your own for the next 6 – 12 months. However, at some point you may need to consider IVF. We will be happy to see you as a patient at InVia!
      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you Doctor for your time and advice.
        Since I live in India visiting your clinic may not be possible in recent future,do you suggest to see an endocrinologist for FSH levels. Also is ovarian stimulation a good option in my case or should I try without it.
        Please advice.
        Thank you.

  74. Commenter says:

    Hello Doctor
    I am 35 yrs old. I was married in 2010. first pregnancy in dec2010 was ectopic rupture and rt tube was rmoved. second pregnancy was blighted ovum jan 2012, D&c was done.third pregnancy was chemical pregnancy loss and methotrexate was given. I recently came to know that my amh values are 1.19ng/ml. FSH- 4.68, LH- 5.42 on day 3 and TSH 4.87. I want to know my chances of concieving normally without drugs? My weight is 62kg. do I need to drugs like clomid etc..or not? In my second pregnancy i was given clomid for two cycles.

  75. Commenter says:

    Dear Dr. Karande,
    I am a 34 yo Korean female who is trying for baby #2. My daughter is now 27 months and healthy, she was very easy to concieve. My husband and I have been trying to have our 2nd for over 6 months. My labs on day 3 of menses were as follows: FSH 12, LH 3.5, Estradiol 10, Testosterone 7.5, free testosterone 0.3. My AMH was 0.66. My Ob placed me on metformin hoping to induct ovulation. My transvaginal US showed a 3x3x2 cm complex R ovarian cyst. I have put on some weight in the last year, BMI is 27 and under significant stress (work full time as a physician, my father had a stroke, etc.) What could cause my low AMH? Age, weight, R complex ovarian cyst, stress? I am seeing an RE next week, but would like to know what things I can do to increase my AMH on my own. Thank you! Your expertise is much appreciated!

    • Your FSH level (12) and AMH level (0.66) both suggest you may have Diminished Ovarian Reserve. The complex ovarian cyst needs to be investigated further — it probably is an old corpus luteum. The AMH level reflects the pool of eggs that remain in your ovary. Since there is no known way to put fresh eggs back in your ovary, it is not possible to increase your AMH level. We have had several pregnancies with your numbers both with ovulation induction as well as IVF. I am glad you are scheduled to see a RE.
      Good luck
      Sincerely
      DR V Karande

      • Commenter says:

        Great to hear that there is still hope, made my day. Thank you Dr. Karande for your expert opinion. I am now more optomistic.
        Best,
        JL

  76. Commenter says:

    Dear Dr

    My AMH came back at 1.1 pmol/L. I am 42 and know this is a very low score. Is this high enough to retrieve eggs for IVF and what would be a ‘normal’ score for someone who is 42?

    • I have written a blog on AMH and age. Here is the link http://www.inviafertility.com//anti-mullerian-hormone-amh-and-age. Hope you find the information useful.
      It is not possible to give a specific opinion on whether or not you should pursue IVF with your eggs based on an AMH level alone. This requires a combination of a day-3 FSH level, antral follicle count, BMI and previous ovarian response to stimulation medications. Please consult with a Board Certified Reproductive Endocrinologist to get specific advise. We would love to see you as a patient at InVia.
      Sincerely
      Dr V Karande

  77. Commenter says:

    I had my AMH and FSH levels tested last Sept. 2012 while I was on the sugar pills of oral contraceptives. I am 31. My AMH was 0.61 ng/mL and my FSH was 11. I was able to get pregnant 2 months off of birth control, but had a miscarriage at 7 weeks. I was told that I may have to use Letrezole in order to ovulate more than one egg to increase my chances of getting a quality egg to avoid another miscarriage.I had my AMH retested last week because I was curious if it would change since I have been off birth control and it came back at 3.13 ng/ml. Is it normal for these levels to fluctuate this much? Does this probably mean that my miscarriage was just a bad luck and it didn’t have anything to do with having diminished ovarian reserve?

  78. Commenter says:

    Anti millenarian hormone information is clear to me at present for
    management of fertility.
    In future Give me any further new information about in my mail Address.
    MY mail dr.ashia_khatun@yahoo.com

    DR.ASHIA KHATUN
    Assistant professor(Gynae)
    Shaheed Suhrawardy Medical College.

  79. Commenter says:

    Hello Doctor Karande,

    I ask on behalf of my wife. She is 32 yrs. old, her test results are FSH 8.48 mIU/mL ; LH 2.39 mIU/mL & AMH is 1.07. Our doctor has advised us to visit an ivf specialist.
    What I want to find out is, are these results poor for her age. We’ve got my tests done too and they’re normal (e.g. my count is 70 million).
    Is there still a chance that we can conceive naturally or through IUI.
    Honestly, IVF is something I would not want to consider unless nothing else is an option.

    Seeking your expert advise.

    Regards,
    Abhishek

    • Hi Abhishek!
      Your wife’s test results seem to be essentially normal. If you have been having unprotected intercourse for over a year, it reasonable to consult with a Reproductive Endocrinologist. I do not understand why you have been advised IVF. You have unexplained infertility and the next step (at InVia) would be ovulation induction with clomiphene citrate and timed inseminations (IUI).

      Good luck!
      Sincerely
      Dr V Karande

      • Commenter says:

        Many thanks for your support and advise Doctor. Your words of encouragement are truly invaluable. Thank you once again, I was desperate to hear such words!

        Very grateful to you.

        Regards,
        Abhishek

        • Commenter says:

          Just curious to ask you this doctor, with the above mentioned test results, is there still a chance of getting pregnant naturally?

          Kindly advise.

          - Abhishek

          • 85% of couples who conceive on their own do so in the first year of trying. Another 10% will conceive in the second year. Since I do not know how long you have been trying to get pregnant, I am unable to give you a specific answer.
            Sincerely
            Dr V Karande

  80. Commenter says:

    I have just had my AMH level tested. I am 24 and since 18 I have had problems with my period. They only appeared when I was on the pill and I have been to countless doctors and clinics for advise. My AMH test 6 months ago was around 14 pmol/l and I have recently had it checked again and it is now 21.9. Is this positive or is it still a low level?

  81. Commenter says:

    Hello!
    I’m 32 years old and my AMH is 10.9. Is this normal or not?
    Thank you

  82. Commenter says:

    Hi there,

    I am a 45 year old lady, who has already been through 2 donor cycles – the first cycle I had a twin pregnancy which failed at 11 weeks (twin blighted ovum – bad luck!) – and the next cycle, only 1 embryo was transferred resulting in our beautiful baby Charlotte.

    I am keen on a second donor attempt and after lots of searching for the right donor, have fallen in love with a beautiful donor. The donor is 30 – so the clinic sent her along for an AMH test which resulted in a score of 0.92. They say she is a ‘very low’ responder and recommend I do not proceed.

    In the bits of reading I have done 0.92 seems quite normal for a 30 year old. This lovely lady also has 3 children and conceived easily.

    I am wondering if ‘low responder’ is just the quantity of eggs in this case, and that we could view her eggs as potentially being ‘good quality’.

    I have an excellent lining (they tell me) – and in 2 attempts I achieved pregnancy.

    I would like to give this lady a go.

    What are your thoughts about a donor and myself in this situation?

    Would be really grateful of your thoughts!!

    • If your goal is to maximize your chances of success please do not “fall in love” with a particular egg donor. There is a good chance that with an AMH level of 0.92 ng/mL, this egg donor will produce few eggs and even if they are of “good” quality, the pregnancy rates are lower. At InVia Fertility Specialists, we like our egg donors to have an AMH level > 1.5 ng/mL.
      Sincerely
      Dr V Karande

      • Commenter says:

        Hello Doc,
        I have irregular menstrual cycle problem due to which my doctor advised me to test my AMH level.

        Following are my details.
        Age: 28 yrs
        TSH:2.77
        AMH: 0.5 ng/mL

        My doc has told me that I have low AMH level which could cause problem in conceiving.I have not planned pregnancy yet for 6 months atleast.
        Can you please tell me , whether I will be able to conceive naturally ?

        • It is reasonable to try on your own for a year (unless your cycles are very irregular or absent). At that point, you should consult with a Board Certified Reproductive Endocrinologist. To further assess your ovarian reserve, you should have your day-3 FSH/LH and Estradiol levels checked. An ultrasound exam to evaluate your antral follicle count is also useful. Other tests you may need include a hysterosonogram or hysterosalpingogram. Your husband should have a semen analysis.

          We would love to see you as a patient at InVia.

          Sincerely
          Dr V Karande

          • Commenter says:

            Hello Doc.Thank you very much for your prompt reply.
            Another information I missed to give is that as per the Sonography reports I have PCOD.
            Following was the outcome of Sonography report.
            - Both ovaries are bulky with few subcortical tiny immature follicles arranged peripherally.Suggests PCOD.

            Does this affect my chances of natural pregnancy? Also please suggest cure for PCOD. Does Yoga help?

            Another query, do you have centers in India?

            Regards,
            Priya

          • About 5 – 7% of women have polycystic ovarian disease (PCOD). If you have irregular or absent menses, you may require ovulation induction to conceive. The best treatment for obese PCOD patients is weight loss. Yoga can help with overall well being. There is no cure for PCOD — we can only control the manifestations. We do not have Centers in India.
            Sincerely
            Dr V Karande

  83. Anonymous says:

    Hello Doctor, thank you for all your information. I have a question. I am an identical twin. 28 years old. I have had a normal pregnancy and got pregnant quite easily at 25. My sister has not been able to get pregnant. She had a saplingectomy in December. She has attempted two cycles of Ivf but her estradiol has been too high so she was cancelled. Her amh is .80. Egg donor is now the recommendation. I would like to be her donor. I just received my amh and it is .65. We were shocked it was this low. Can we still give it a shot?? I have not had any other labs drawn yet. We are staying positive as we really want this to work. We are going through a very highly respectable fertility specialist but we would like another opinion and I came across your page and thought I’d ask. Thank you very much for your time.

    • My first comment is that your sister is very lucky to have you! It is great that you are willing to donate her your eggs. I do not understand what you mean by “your sisters estradiol level was too high”. Are you talking about a baseline (day-3) estradiol level? Elevated baseline estradiol levels can be due to functional ovarian cysts. Were the IVF cycles cancelled prior to starting stimulation? Did she fail to respond to high doses of medications. Your sister’s AMH level (0.8 ng/mL) is okay. I am not sure I understand why she was recommended an egg donor based on the information provided.

      It is well documented in the literature that pregnancy rates using a sisters eggs are lower than when an anonymous donor is uded. Whatever is causing one sister to have diminished ovarian reserve, is also affecting the egg quality of the sister (definitely in a twin!).

      You should also be aware that AMH levels do not predict your ability to conceive naturally. I have recently written a blog about this.

      Hope this helps.

      Sincerely

      Dr V Karande

      • Anonymous says:

        The ivf cycles were canceled after her baseline labs. She was never able to start stimulation. They did Lupron the first time and her estradiol Was 92.The second cycle they just used birth control becuase they had planned on a ganirelix cycle but her estradiol was again to high at 69. They said they believe her ovaries are failing fast and they don’t know why. They thought I would be ok to be a donor because we are sisters and I have had a successful pregnancy. I do want to have a child again but I want to get her pregnant first :) so based on all the info i can find I really am not a good donor candidate?? We really want this to work! thank you for your response and taking time out of your busy schedule to help people!

        • I am not sure she needs an egg donor based on the information provided by you. You should definitely get another opinion.

          As far as you are concerned, are you taking birth control pills? These DO suppress AMH levels. I have written a blog about this. We prefer to use egg donors with AMH levels > 1.5 ng/mL.

          Sincerely
          Dr V Karande

    • Commenter says:

      Hi. I just came across your question regarding your identical twin sister. I, too, have an identical twin, and I was able to get pregnant without difficulty, but my sister has not. She is currently attempting IVF, with no success as of yet. Her AMH level is low, and I am going to check my levels in January. In any case, I was hoping that perhaps we could chat more about this if you’d like, given that we have a similar situation. Thank you.

  84. Commenter says:

    I just turned 37, had a normal pregnancy and delivery at age 35 (got pregnant on 1st attempt), but now have had a prolonged period of post-partum amenorrhea (daughter is 20 months; stopped breastfeeding a little over 2 months ago). Given my age I am wanting to get pregnant again ASAP, so due to a FH of early menopause (early-to-mid 40s in mother and aunts) I requested lab analysis, with the following results: AMH 0.87ng/mL, FSH 2.8 IU/L, normal TSH. Any suggestions?

    • You should consult with a Board Certified Reproductive Endocrinologist.
      You were breast feeding till two months ago and that could be a possible reason for the amenorrhea. Your doctor will be able to do blood tests and check the uterine cavity with a hysterosonogram or hysterosalpingogram to rule out scar tissue as a cause of the amenorrhea.
      Your blood levels are okay. With your family history, you may want to consider having another child without further delay.
      We would love to see you as a patient at InVia!
      Sincerely
      Dr V Karande

  85. Commenter says:

    Sir
    I have low AMH(.26) I am 28.5 years old. Is any hope for natural pregnancy. My partner is 36 years old.I had TB treatment six years before.

    Regards puni

  86. Commenter says:

    hi, according to my AMH test its 1.9ng per ml…i m facing infertility prob.. so whts does it mean? my report is normal or nt? my age 31yr.
    Geeta

    • Hi Geeta
      Your AMH level is normal.
      It means you have plenty of eggs that remain.
      Please have a complete investigation for infertility to see if there is a definite cause for your infertility.
      Sincerely
      Dr V Karande

  87. I angela says:

    Hi i am 47 and have a AMH level of 1.0 what are my chances og getting pregnant naturally

    • Probably less than 1%.
      Although your AMH level is fine, age is an independent variable for assessing ovarian reerve.
      After age 40, fertility decreases regardless of the AMH level.
      Sincerely
      Dr V Karande

  88. Commenter says:

    Dear Sir,

    I am 30.. and i have got my AMH tested the value is showing 5.2 NG/ml.. just wanted to confirm is this mandatory to undergone the treatment of IUI… kindly tell wat is normal value required for conceiving.

    • Your AMH level indicates you have plenty of eggs.
      If you have failed to conceive on your own for a year and the tests are all normal, the first step is usually ovulation induction with clomiphene citrate and timed intrauterine inseminations (IUI).
      There is no definite AMH level above which a patient will conceive. We like the level to be > 1.0 ng/mL; < 0.6 is a bit low.
      Sincerely
      Dr V Karande

      • Commenter says:

        Hello Doctor-

        Thank you so much for taking the time to reply. I am 37.9 years old and am have been trying to conceive naturally since 9/13. I got pregnant naturally the second month we tried in October 13 but unfortunately miscarried in December 2013 at 11.5 weeks and had to have a D&C. The baby had Trisomy 18 and had stopped growing at 9 weeks. We have been trying again naturally for the last 3 months. My OB-GYN ran some tests and the results are: AMH 1.72 FSH 8.8 Estradiol 36 and TSH .87. We plan to give the natural way a few more months. If nothing by August, we plan to consult a RE specialist. What do you believe my chances of a healthy pregnancy are both naturally as well as via IUI and IVF? Thank you kindly for your reply. I am trying to educate myself as much as possible as having a family is the most important thing to me.

        • I am sorry you miscarried. I am glad they found a definite cause (Trisomy 18) for the miscarriage. Your blood test results are normal. Age, however, is an independent variable that needs to be kept in mind. We tend to be a bit more aggressive with a 39 yo than a 29 yo. The pregnancy rate with Clomid/IUI in your age group is around 6% per cycle. With FSH/IUI, it is around 15% per cycle. With IVF the pregnancy rate is in the thirties. If all other tests are normal, it would be reasonable to start with 3 cycles of FSH/IUI before attempting IVF.
          Sincerely
          Dr V Karande

  89. amy says:

    I am 25 and my amh is 4.1ng ml which is very good but on scan I only had 4 or 5 follicles in each ovary. Why so few follicles? Does this decrease my chances with ivf?

    • You probably have more than 4 – 5 follicles on each side based on your AMH level. I am not sure (do not have enough info) why you need IVF. YOur AMH level indicates that you should produce a good number of eggs.
      Good luck!
      Sincerely
      Dr V Karande

  90. amyamy says:

    I definitely just have 4 or 5 follicles in each ovary. But my amh is high at 4.5ngml. I don’t know what to think. Could it be a lab error? I’ve been Ttc now for 18 months with unexplained infertility. I ovulate every month and my tubes are open. I am going to start ivf in a couple of months.

  91. amy says:

    I definitely just have 4 or 5 follicles in each ovary but my amh is high at 4.1ngml. Could it be a lab error? I have been Ttc now for 18 months with unexplained infertility. I am starting ivf in 2 months.

    • Hi Amy
      4 or 5 antral follicles is normal. You should have a normal response to medications. Lab error is theoretically possible but unlikely. 4.1 ng/mL is a good number. You should do well with IVF.
      Good luck!
      Sincerely
      Dr V Karande

      • Commenter says:

        Hi Doctor-

        I am the poster above from May 31 at 2:25 pm with AMH 1.72. I am sorry for the miscommunication, but I am actually 37 years old, not 39. Are the probability you quoted for IUI and IVF different for a 37 year old? Thank you so much.

      • amy says:

        Thanks. Also my progesterone level was 31.8 mid luteal phase but my lh was at 23! It should be under 15 in the luteal phase. Why would it be that high? In a previous cycle it was 2.do u think it may be a lab error or it is accurate?

  92. Commenter says:

    Hello I am 41 yrs old and just started TTC. I went to a specialist and found out my AMH is 3.7 which she said is excellent for my age but my FSH level came back high at 12, Any idea’s?

  93. Commenter says:

    I am 43year old. My AMH levels were 0.52ng/ml, inhibin B-21pg/ml, FHS-8.6mIU/ml, estradiol- 329pg/ml.
    Any IVF treatment options available for successful pregnancy? DO not favor egg donation.

  94. Commenter says:

    I am 30 years old, and my AMH level is 9. Can I conceive normally. What does my AMH level suggest.

  95. Commenter says:

    Dr. Karande,
    I had cycle day 3 testing in April: FSH 7.4, estradiol 58.
    I repeated the test cycle day 3 today (3 months later) and FSH was consistent 7.5 but estradiol was 29. I wonder if this is a normal decrease in estradiol in just 3 months?
    Thanks

  96. Commenter says:

    Hi, wondering if you can offer any suggestions…will iui work for me or should I go straight to IVF?

    39 yrs, trying to get pregnant for 4 months (iui -2 months without superovulation drugs and one month with) had one pregnancy but miscarried at 7 weeks (iui, no drugs)

    Numbers are: AMH 6.8 pmol/L
    Fsh is usually around 6 or 7 on day 3 but one month was as high as 10
    Thyroid elevated post miscarriage to 5.07
    This past month had 18 follicles at start of cycle, took 50 puregon and ended up with two mature follicles measuring 1.9 and 1.8 respectively.
    Sperm count was 40M

    My bmi is within range, I rarely drink, don’t smoke and do acupuncture 2x/week.

    Based on this, what are my odds of a healthy pregnancy without IVF?

    • Commenter says:

      I should also mention that in my last cycle my estrogen level on day 3 was 168, LH was 5 and progesterone was 2

    • You could try a couple more cycles of IUI before pursuing IVF.
      I know you conceived in a natural cycle IUI, but you were just lucky.
      IUI usually works best along with ovulation induction.
      Sincerely
      Dr V Karande

  97. Commenter says:

    HI,
    I am 27 years old.. here are my numbers
    FSH : 8.5
    AMH : 0.98
    I was pregnant twice , but a doctor now says i should be concerned and don’t have chances to be pregnant naturally… is that true?
    My mom had an early menopause at 36.

    • Not true.
      Please wait and read tomorrow’s blog, which is an update on AMH. Patients with low AMH do conceive naturally.
      AMH levels are good for predicting the number of eggs that will be retrieved during IVF.
      They do not predict ability to conceive naturally. The possible exception may be if they are REALLY low (< 0.16 ng/mL).

      Early menopause does run in families.
      You may be at risk for premature menopause based on this history.

      You have been pregnant twice, but you did not tell me when and what was the outcome.

      Based on your family history (and NOT your AMH level alone), it may be reasonable for you to consider having children sooner than later.

      Sincerely
      Dr V Karande

      • Commenter says:

        Thanks for your reply.
        I was pregnant first at 24 – aborted and
        at 26 – miscarried after 5th week .. both were unplanned pregnancies.
        We are planning to have family now. Do I have time to try naturally or should i right away try any option? Please let me know. Also the doctor i consulted told me that 10 years before menopuase it gets difficult to concieve so probably based on that since i am less than 10 yrs to 36 , do u think i should think about other ways.

  98. Commenter says:

    Hi, Doctor. I have gone through your replies and seen some hopes of getting pregnant. I am a bit scared as my AMH level measured is 1.6. Is it below normal. Can I conceive normally or I have to go for IVF

  99. Commenter says:

    Hi Doctor I am Sneha from India and I am 32 Yrs. old,
    AMH is .37
    FSH is 4.86
    LH is 2.27
    TSH is 0.11 (I am taking altroxin 100mg 2tabs daily empty stomach)
    ESTRADIOL is 53.41
    PROLACTIN is 10.36

    My Ultrasound of Pelvic 3D/4D shows:-
    Left ovarian Cyst of 15.3X16.1mm seen
    A spekled area of calcification at right cornual region of endometrium seen.

    I am 89Kgs with 5′.0″ Height

    I am fat from the age of 5 and I had a pre marital pregnancy in march 2010 which was aborted after completing 3 months with the help of medicines.
    I just got my D and C done and my HSG report says No Abnormality Detected.
    My blood sugar levels are all normal.

    I had no complication in my 1st pregnancy but now I am not being able to conceive since past 2.5 years, Went to a Infertility center where they did all this test and said my ovaries has aged before my own age which is not right and suggested for IVF, I wanted to check the posibblities of The problem and if IVF is the only solution? Please help as I am highly upset to find all this problem in myself..

    • Hi Sneha!
      I am a bit concerned by two things 1) You have been trying for a fairly long period and 2) Your AMH level is only 0.37 (I am presuming ng/mL).
      My first advise is for you to lose weight. Your BMI is almost 38. You need to lose at least 15 kg weight. Obesity is associated with low AMH and reduced fertility. Please work with a nutritionist on a diet and add regular exercise to your routine.

      You could try a few IUI cycles before going to IVF

      Sincerely
      Dr V Karande

      • Commenter says:

        Dear Doctor Karande

        I am a 36year old female with a history of laparoscopies due to stage 4 endometriosis.
        I recently attempted ivf however all three of my follicles collected yielded no eggs and the cycle was cancelled. My Amh was 0.16. I visited another doctor who read my file and with a ultrasound said that antrafollicle count is zero and I said that I have adenomyosis and my uterus will never carry a baby. He suggested I see a gyanae onchologist to discuss a hysterectomy to stop my occasional pain. I just don’t know what to do.please help.

        • Patients with adenomyosis can indeed carry a pregnancy. The exception to this if the adenomyosis is severe and there is hardly any normal uterine musculature.

          With your history, ultrasound and IVF response; you need to consider using an egg donor to conceive.

          If you fail a transfer or two with an egg donor (fresh + frozen) despite good quality embryos, only then will you need a gestational carrier.

          A hysterectomy is needed only if the symptoms are drastically affecting your quality of life and analgesics (ibuprofen, Advil) are not helping.

          Sincerely
          Dr V Karande

  100. Commenter says:

    Dear Dr. Karande,

    I am 38 years old, I only have one ovary due to removal of the left 3 years ago, it was due to an endometerioma 4.5cm , I had my AMH come back at…
    <0.16, FSH 3.6 and E2 264 ? but I also have a 4.65 cm hemorrhagic cyst septated with complex components on the remaining right ovary and normal looking ovarian tissue beyond the cyst w follicles. Have been getting a regular cycle every 26 to 27 days… Is it possible that the cyst can be affecting my AMH levels or is it accurate none the less?

    Not sure how to interpret under the circumstances..
    Thank you

    • Commenter says:

      Sorry I should mention I have have an active or symptomatic prolactin level for 6 years now have been taking bromocriptimide 5 mg level is currently at 2.9,

    • You have diminished ovarian reserve secondary to your surgery and the severe endometriosis.
      I doubt it is the cyst that is affecting your AMH level
      Please have your physician do the necessary tests to rule out cancer in the current cyst.

      You may want to pursue pregnancy aggressively with IVF.
      It is possible you may need an egg donor.

      You, of course, could get pregnant on your own — but the chances are slim.
      Please continue taking your bromocriptine.

      Sincerely
      Dr V Karande

  101. Commenter says:

    Hello Doctor,
    I am 31 yr old. My blood works are:
    HSG: Patent tubes
    FSH= 6.99 m IU/ml
    AMH= 1.72 ng/ml (Range: 2.0-6.8 ng/ml).
    Sperm count for husband (post wash during IUI): 50 million/ ml

    AMH level has decreased from 2.89 ng/ml in Sept 2012 to 1.72 ng/ml in June 2013, is this normal. I have undergone 4 IUI cycles and now my Hysteroscopy is due tomorrow and IVF in July 2013. I usually have AFC of 7(total in both ovaries).
    All other tests hormone etc turns out to be normal. I just want to know my chances of IVF success and am bit concerned of my AMH levels. Also I want to know whether FSH level indicates quality of eggs?? If so how is my FSH reading? For interpretation if you need results of any other blood work do let me know i’ll post in next comment.
    Thanks a ton.

  102. Commenter says:

    hello DR.
    Here is a rundown..
    2007 got a tubal ligation
    2012 tried to have a tubal ligation reversal through military. I was denied because my AMH result. 0.16. I didn’t know what that meant so I called the DR. that denied me. He said he didn’t understand why my levels were so low with my age. At the time I just turned 30.

    April 8, 2013 I got my tubal ligation reversal done out of pocket. I pushed for it because I was getting every symptom associated with PTLS.

    My question? Will I ever be able to concieve? I am 130 pounds and 61 inches tall. I do not have my hopes up, but would really like to know my chances.

    JNash

    • I too am puzzled by your AMH level. I am not aware of any data suggesting that a tubal ligation lowers AMH levels.

      I’m glad you had a tubal reversal. I am presuming you have had a HSG which confirmed your tubes are now open. It is indeed possible to conceive on your own with a low AMH level.

      If you are not pregnant within a year or two, you may need to consider IVF.

      Sincerely
      Dr V Karande

  103. Commenter says:

    Hi, i enjoy all your posts! I am 30 years old, have been trying to conceive over a year – within that time i had a miscarriage 7 months ago (and maybe 2 chemicals since then). when i was 25, i had borderline ovarian cancer on both ovaries – they removed the tumors, kept both ovaries and I did not undergo chemo. Since conceiving is going slow i had AMH tested and it was .86 (this was about day 20 of a regular cycle). on day 3 of the next cycle my FSH was 9.3. Also had HSG test and that was fine. i went back the following cycle for a full work up on day 3 — my AMH came back as 1.2 this time, FSH 11.9, antral follicle count was about 10. My E2 was 25. My day 21 progesterone has ranged 10-16. What do you make of all this? I am very healthy in weight and my husbands sperm is completely fine. The dr recommends taking the quickest approach, being IVF – also to reduce the exposure to meds month after month. I look forward to your thoughts!

    • Thank you for following the blog. I do hope you find the information to be helpful.

      You are very lucky your ovarian cancer was detected early!

      If you indeed have had three miscarriages, you should discuss having a work up for recurrent miscarriages with your physician.

      IVF indeed is the quickest option, with the highest per cycle pregnancy rate. However, it is also reasonable to do a few IUI cycles before proceeding with an IVF cycle.

      Sincerely
      Dr V Karande

  104. Commenter says:

    Can I get accurate AMH test results while breastfeeding?

  105. Commenter says:

    Dear Dr Karande,

    Many thanks for sharing this good and useful information for TTC people..

    I’m currently 30, with 45kg weight..have been TTC for past 7 years and diagnose thin PCOS..in 2010, my 1st IUI was failed due to severe OHSS

    now i’m trying to have 2nd IUI and my level of AMH result is very high 132..

    Thus, I need your advise on how should I proceed my IUI/treatment to conceive as i’m afraid in getting OHSS again..should I go for lower dose?

    Regards,
    Mrs Fath
    Malaysia

    • Dear Mrs Fath
      You indeed have a very high AMH level — I am yet to come across a patient with an AMH level of 132 ng/mL!
      You did not specify what medication you were taking.
      Perhaps clomiphene citrate with a 25 mg starting dose is a reasonable starting point.

      If you are not ovulating, you may be a candidate for “ovarian drilling”. This is a simple procedure done via laparoscopy.

      There are other medications such as metformin or myoinositol that may help you ovulate.

      Please discuss these options with your physician.

      Sincerely
      Dr V Karande

  106. Commenter says:

    Dear Dr. Karande,

    Thank you for this very informative article. I came across it as I recently had Day 3 blood work done and was told all of my blood values were normal. The PNP told me that my AMH was higher than normal and said I was healthy as a horse. I asked her if any of the tests I had done were indicators of PCOS and she said they weren’t. Looking online, I found that the tests I had were in fact used as some indicators of PCOS. Because of this, and because I have a sister with PCOS, I decided to look into my values a bit more, as I worry that I too may have this syndrome, since it is genetic. I also have a family history of hypothyroidism (mother) and Hashimoto’s (paternal grandmother).
    I am hoping you could look over my results and let me know if you think I should see a fertility specialist? I’m not really trusting what the NPN told me during my visit.

    27 years old, 130 pounds, 5 feet 6 inches tall
    TTC for 1 year
    AMH – 10.50 ng/mL
    TSH – 0.74 mIU/L
    LH – 9.9 mIU/mL
    FSH – 5.4 mIU/mL

    Thank you very much for your help!

    • Commenter says:

      Also, I should add I have regular cycles… 32 day average. Thanks!

    • To confirm a diagnosis of Polycystic ovary syndrome (PCOS), you need to have at least two of the following three findings 1) Irregular or absent menses, 2) Signs of androgen excess (excess hair growth, acne) or 3) polycystic appearing ovaries (more than 12 antral follicles).

      An elevated AMH level is often seen in patients with PCOS. This is because the ovaries have plenty of eggs. However, an elevated AMH level is NOT a diagnostic criteria for PCOS.

      You should get a second opinion from a fertility specialist. The information you have provided me is not enough to confirm or deny a diagnosis of PCOS.

      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you so very much for your response. I truly appreciate the time you took to provide me with some additional information!

  107. Commenter says:

    i am 33 years old and have not had any luck in falling pregnant. when i got to the FS he had run all necessary tests and they came back as no problem. we started IVF. the first IVF was cancelled due to the fact that i only had 4 follicles. the next round of IVF I had 6 follicles and they retreaved 7 eggs, but they were of poor quality and only 2 matured for tranfer. needless to say the transfer was unsuccessfull. the dr then did investigative surgury and had to remove cysts from my ovaries and growths from my uterus (the biopsy showed i have chronic endometritis). after the surgury when he did the internal scan he found my one ovary to be really small. and my uterus lining to be very thin. We again did around of IVF and this time i only produced 3 very small follicles, so it was cancelled again. The doctor re tested my AMH level and it came back as 0.16. I am currently taking DHEA but i do not know what the hope is for a succesfull cysle. What are the chances of expecting anything different from the last 3 cycles? is there anything else we can do?

    • Commenter says:

      I forgot to add in. We have been trying to fall pregnant for 14 years, and my hubbies sperm count is normal. my weight is also normal. and we’ve had failed attempts with normal AI, GIFT and ICSI. the doctor do want to test my FSH on day 2 of my cycle.

      • The duration of infertility (14 years!) is a big red flag in your case. You probably have diminished ovarian reserve. Based on your history, AMH level and IVF cycle data, it may be time for you to consider using an egg donor. Please get a second opinion from a Board Certified Reproductive Endocrinologist for more specific advise.
        Sincerely
        Dr V Karande

  108. Commenter says:

    Hello Dr. Karande,

    I am glad to see you respond to all the queries we post, thank you for doing so!

    I am 32 yr old, trying to conceive for the last 8 months. My CD3 reports show the following:
    FSH: 6.28 mIU/mL
    LH: 4.03 mIU/mL
    Prolactin: 29.56 ng/mL
    AMH: .97 ng/mL

    Do i look alright?

    Thanks
    RR

    • Dear RR
      Yes you do. I am assuming your prolactin level is normal for your lab.
      Good luck!
      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you for your quick reply! I am higher on the prolactin levels. The normal levels fall between 5.18-26.53. I am trying to get an appointment with my gyno but doesn’t look like i will have one until the next two weeks!

        Regards
        RR

        • Dear RR
          You need a fasting prolactin level to be checked. Please make sure your thyroid (TSH) level is also checked as it can effect prolactin levels. Most of the time a borderline elevated prolactin level will come back normal when repeated fasting.
          Sincerely
          Dr V Karande

  109. Commenter says:

    Hi Doctor Karande,

    I recently moved and had to find a new ob/gyn and recently went to see her for family planning. I told her that I was ready to start a family and she said she wanted to do all the needed fertility tests first before I start ttc.

    I met with her for my results and she said that my AMH was very low and that I would have to see a fertility specialist right away to consult IVF. She said she didn’t want me to lose more time by trying naturally because of my results and I should straight away look into IVF and gave me referrals.

    However, after getting home, I did some research, including reading this forum and your answers and it seems that my AMH is quite okay. Did she misread my AMH number or maybe the combinations of my results together were not good?

    We are trying to conceive naturally first and was wondering if my numbers as a whole are a good indicator? I know you stress age as a major factor and that could be the reason she wanted me to go the specialist right away also.

    I’d like to ask for your opinion of my results before seeing a specialist and also, what would my probability of natural conception be?

    Thank you for the wonderful service you are providing for us!

    Japanese-American, 42 years old, healthy weight, 29 day cycle.

    FSH – 8.48 mIU/mL
    Estradiol – 28 pg/mL
    LH – 3.88 mIU/mL
    TSH – 2.57 uIU/mL
    Progesterone – 0.45 ng/mL
    AMH – 2.0 ng/mL

    • Your lab levels are indeed normal. However, you are 42 years old! Age is an independent variable that must be considered. A 42 yo will NOT be as fertile as a 25 yo with the same (normal) numbers. If you have been trying for 6 months (some may say sooner!) it indeed is time to see a fertility specialist and pursue pregnancy aggressively.

      Good luck!
      Sincerely
      Dr V Karande

  110. Commenter says:

    Dear Dr.Karande,
    I have currently undergone all the tests in a fertility center and my FSH-7.4mlU/ml and AMH -1.9ng/ml. After HSG test, Dr informed me that i have 2 problems, one is my AMH level is not normal and other is my both tubes are blocked due to prolonged usage of condom. I am 30 now and i am clueless when i heard AMH is not normal. Could you please advise me if my AMH level is a problem for pregnancy and will usage of condom leads to tube blocks? Any remedy on this?

    • Your AMH level is normal.
      Prolonged use of condoms dose not cause blocked tubes.
      Please get a second opinion. We would love to have you as a patient at InVia.
      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you Dr.Karande! But what could be a major cause for both tubes block? and is there any other test do i need to take in order to make sure my eggs are good? I will surely make an appointment at InVia!

        • There are many causes for tubes to be blocked. The commonest are infections and endometriosis. It could also be due to “tubal spasm”. Please read my blogs on HSG and tubal catheterization for more information. We look forward to seeing you as a patient at InVia.
          Sincerely
          Dr V Karande

          • Commenter says:

            I almost read all your blogs related to TC, AMH and HSG. Really very informative! Thank you very much for your guidance on this. But I wasn’t told on what type of block I have in the fertility center. Moreover I have been given medication “Doxycycline Hyclate” and “vitamin C” tablets, will this help anyway on the blocks?

          • Doxycycline is an antibiotic that is given to prevent infection after the procedure. I do not know why the Vitamin C was prescribed. These do not help with blocks.
            Sincerely
            Dr V Karande

  111. Commenter says:

    sir, i am 36 years old women i am trying to conceive. my weight is 53kg and AMH is .75 can you please tell me the meaning of that AMH level and what will be the treatment. please guide me.

    • Your AMH level is okay. It indicates the number of eggs that are still left in your ovary(ies). Please consult with a specialist to get more specific advise. We would love to see you as a patient at InVia Fertility Specialists.
      Sincerely
      Dr V. Karande

  112. Commenter says:

    Hi Doctor,
    I’m 29 years old and trying to get pregnant since last 3 years.

    Doctor asked me to get a blood work done

    FSH level is 6.6 mIU/mL.

    I want to know if this FSH level is good since my blood was taken one week BEFORE my periods or it is very high?

    • It is a good level.
      However, for assessment of ovarian reserve, it need to be drawn on days 2, 3 or 4 of the cycle. Often, a concurrent LH and estradiol is also checked. To complete the testing, please have them draw an AMH level and ultrasound for antral follicle count.

      Sincerely
      Dr V Karande

      • Commenter says:

        Dear Sir,

        I’m 29 years old. Recently my cycle has become much longer but remains regular 38/39 days, compared to a previously normal 28 days.
        Following the recent change in my cycle, I was asked to undertake the blood tests which revealed the following numbers:
        Estradiol:43 picog/ml
        LH: 7,6 ul/l
        progesterone: 0,4 ng/ml
        Prolactine: 15 ng/ml
        FSH: 4,8 Ul/l
        TSH (3rd generation): 0,38 mUl/L
        AMH: 16,53 ng/ml

        The above results correspond with day 3. I understand that 16,5 for AMH is very high. My doctor says, and I have read in your previous posts, that it is not necessarily the PCOS, but I have doubts. How can I confirm? I’m not overweight, and have no signs of severe acne or hair growth. My period is now longer, but still regular?
        Could you please comment on my overall results?
        thank you very much in advance

        • Your AMH is indeed high. The rest of your labs seem to be normal.
          You do not meet the criteria to be diagnosed with PCOS.
          If you are still concerned, please discuss with your doctor about doing a 75 gram 2 hour glucose tolerance test to rule out hyperinsulinemia.
          Sincerely
          Dr V Karande

  113. Commenter says:

    hi, doctor i,m quite impress with this site..my wife has gone AMH test and it is 0.98ng/ml . she is 31 and her menses is normal.can she get pregnant normal pls suggest

  114. Commenter says:

    Dear Dr. Karande,

    I am 28 years old and my husband and I have been trying to conceive for the last 18 months. I’ve never been pregnant and ovulate regularly every 28-29 days. We consulted with a RE last year and my lab work revealed .78 AMH and 10.4 FSH. We were told these results were normal and proceeded unsuccessfully with 2 rounds of unstimulated IUI.

    We recently switched insurance and consulted with a second RE this year who ran the labs again. This time my AMH was .6 and my FSH was 13.2. I’ve had a normal HSG.

    I was told by my new doctor that I have a severely diminished ovarian reserve and she recommended we proceed with IVF using donor eggs immediately. However, when I discussed this recommendation with my first RE (from last year), she said that recommendation was completely wrong and that I still have a great chance of getting pregnant using IVF with my own eggs.

    I’m obviously concerned that I’m receiving advice that is so contradictory. Any advice or input you may be able to offer would be much appreciated.

    Thank you,

    Ashley

    • Hi Ashley!
      I agree with your first RE.
      You are very young, at age 28! This is a huge factor in your favor.
      With a low AMH level, you will probably produce few eggs even with aggressive stimulation.
      Your FSH level is elevated, but not to a point where you should use donor eggs immediately.
      Good luck!
      Sincerely
      Dr V Karande

  115. Commenter says:

    Hi Doc, My AMH level is 1.06 and I am 40 y/o never been pregnant and recently got married about 8 months ago. I have undergone HSG procedure and it’s normal. Doc, do I still have the chance to get pregnant?

    • Yes you do.
      You, however, do not have time to waste and I would suggest you pursue pregnancy aggressively under the care of a Board Certified Reproductive Endocrinologist. We would love to see you as a patient at InVia.
      Sincerely
      Dr V Karande

  116. Commenter says:

    My wife is 28year old & her F.S.H is 5.55 mlU/m. and AMH is less then 0.3.
    we have been trying for baby since last 1year but unfortunately it couldnt happend so we consulted gynaecologist and he told that we have to go for IVF.
    is there any other solution then IVF?
    AMH level cant be increased through Medicines?
    if yes the how much time does it take to increase the AMH?

    Kindly reply
    Thanks & Regards,
    PDS

    • Hi PDS!
      Your wife does have a low AMH level.
      She, however, is very young and that is a factor in your favor.

      There is no harm in trying a few cycles of ovulation induction with IUI before attempting IVF.

      Also, there is no way to increase the AMH level as there is no way to deposit fresh eggs in the ovaries.

      Sincerely
      Dr V Karande

      • Commenter says:

        Sir,i really oblige for giving me the suggestion and thank you very much for swift reply.
        Thanks & Regards,
        PDS

  117. Commenter says:

    I am just about to turn 37 and I have had a healthy pregnancy resulting in a 3 year old boy. Currently my AMH is 1.77, LH is 9.4, and FSH is 8.4. Are these results ok? My dr said they were fine but am still a little nervous.

    • Your results are indeed normal.
      Sincerely
      Dr V Karande

      • Hi Dr Karande,I am 31 and had my first child 2 years ago naturally (conceived in 3 months).I came off the pill 5 months ago to start with number 2 and my menstrual cycle hasn’t returned. First bloods FSH 53,LH 69 and Estrogen 381. Two weeks later more bloods FSH 86,LH 48 and Estrogen 170. Have been reading all these posts and thinking I should have AMH ested-if this were to be normal would there be any chance of IVF using my own eggs? I can only get an RE appointment in 1 month and I’m going out of my mind. Prolactin levels were normal and so were progesterone. Your replies are so appreciated to everyone looking for answers,thank you so much

        • Regarding the first blood levels. Your estrogen level is elevated. Also your LH level is high and greater than the FSH level. This could be a blood drawn at time of an LH surge i.e. you may have been about to ovulate.

          I do not understand your level two weeks later. This time the FSH level is greater than the LH level and the estradiol elevation is persistent.

          You may have a cyst that is functional (releasing hormones). You need a ultrasound to rule out this possibility.

          Please get back to me with a follow up.
          Sincerely
          Dr V Karande

          • Anonymous says:

            Hi Dr Karande,thank you so much for such a quick response! Can I ask you a question which may be related to your response?
            When I went to my gynae she did an ultrasound and she couldn’t see anything strange (ultrasound and bloods ruled out pcos)-but what she could see were nice sized follicles-one on top of each ovary (and that my lining was thin)-is this anything to do wih the functional cyst you are talking about?
            If not,would a functional cyst have been easy for my gynae to see and should I get another ultrasound?
            Would this cyst be able to stop my menstrual cycle?
            Thank you again for your responses,I feel like you are an angel that has been sent to help all us confused panicked women!

          • There is no reason to panic. Women develop functional cysts — they come and go!

            You should get another ultrasound.
            If your Ob/Gyn does not have an explanation for the elevated estradiol, please consult with a Board Certified REI. We would love to have you as a patient at InVia.

            Sincerely
            Dr V Karande

  118. Commenter says:

    I am a 42 yr old who married recently and we are trying to conceive our first child. I have an antral follicle count of 7. I am not overweight and very fit. I have a regular 28 day cycle and I just started charting. My temps show that I ovulate approx CD 11. I just received a call from my OB/GYN office saying that they received the results of my blood work. My AMH level is 0.16 and my FSH is borderline at 26.1. The OB/GYN is recommending that I see an fertility specialist. I’ve made an appointment with an RE but she is out of town and first available appointment isn’t for two weeks. Is it at all possible to conceive a child naturally with these figures? Is there anything that can be done to increase my AMH?

    • Your test results are consistent with a diagnosis of diminished ovarian reserve. In addition, your age is an independent variable that must be considered. Can you get pregnant on your own? Absolutely. However, the chances are low. IVF pregnancy rates with your numbers are dismal. Do consult with an RE. It is possible, you will be advised to consider using an egg donor. An AMH level reflects the number of eggs that remain in your ovaries. Since there is no way to add eggs to your ovaries, it is no possible to increase your AMH.
      Sincerely
      Dr V Karande

  119. Commenter says:

    If your request to use the comment was in response to me, you have my consent. However I noticed a few spelling mistakes, I give you permission to edit the response if this is possible. :)

  120. Commenter says:

    Dear Doctor. I am a 28 years old Swedish woman, but are currently living in the USA where I am studying.

    My FSH results on day 1 were 10,9 and my RE told me that they were elevated but fair. My AMH-results were also kinda low, 6,3 in pmol/l. My doctor said that they weren’t so conserned for the AMH level because as long as they were over 3 they reflect a woman in fertile age. I have a normal menstrual cycle (28 days), were I ovaluate regularly on day 14.

    My antral follicle count was 6 follicles on one ovary and 7-8 follicles on the other ovary.

    What do you think my chances are for conceiving naturally with these levels/results?

    Best regards,

    Stine

    • Hi Stine!
      I do agree with the interpretation of your test results.
      You should be able to conceive naturally with these results.
      You, however, have not told me how long you have been trying to get pregnant.
      If it has been more than a year, please consult with a fertility specialist (REI).

      Sincerely
      Dr V Karande

      • Commenter says:

        Hi Dr. Karande,

        My IVF Specialist basically told me that I have very little to no chance of conceiving with IVF. My FSH level is 11.14, I am 33 yrs old, and although I cannot remember what he said my AMH level was I remember him saying that it was detectable but barely. At my AFC ultrasound I only had 4 on one ovary and 2 on the other. I was devastated as I am in excellent health and fit. He said that we could try IVF but was concerned about the wait (it would be through the military healthcare system and the wait is over 15 months long). He seemed to stress going to a civilian provider as “time is of the essence” but to go outside of my insurance scope would be considerably more expensive. Given my bloodwork results, how dismal does it look for me if I choose to wait the 15 months until I come up on the list? On a side note, part of the reason he thinks it looks so bleak for me is that I am a Fragile X carrier. So, he says that if they were able to harvest all 6 of my eggs successfully, which he didn’t sound too optimistic about (given that I still have 6 to harvest in 15months time) he said that we can likely rule out 50% of those 6 as they will likely be affected by Fragile X and we can rule out 50% of the remaining eggs due to my age and chromosomal abnormalities, which would ultimately leave me with 1 egg and then its even a gamble on whether or not that egg would survive PGD, fertilization, and implantation. Would you consider this a fair assessment?

        Also, do my AMH and FSH levels affect my ability to get pregnant with a donor egg? I.e., if I wait the 15 months and I have no ovarian reserve left to try with my own eggs, will be decreased/non-existent AMH level and further elevated FSH level prevent me from becoming pregnant at all, even with a donor egg?

        As a side note, I have one son who I had before I knew I was a Fragile X carrier and he beat the odds and is a “typical” child. My doctor tells me that I may likely be able to get pregnant naturally now without too much problem but I am opposed to abortion should the fetus be found to be affected.

        • First of all please let me congratulate you on having a healthy boy. Regarding getting pregnant naturally, I am presuming you have received extensive counseling on Fragile-X syndrome. If not, here is a link that you may find useful. https://www.counsyl.com/diseases/fragile-x-syndrome/

          Based on what you have told me, I do agree with your IVF specialists’ assessment.

          You can get pregnant with donor eggs. Fragile-X will not affect your uterine receptivity.

          Sincerely
          Dr V Karande

      • Commenter says:

        Dear Dr. V Karande,

        Thank you SO much for your quick respons! :) We have “only” been trying for seven months, so we will try for a year (after your advice) before contacting a REI.

        Stine

        • Hi Stine
          You mean another 5 months (to complete one year)?
          At 1 year, 85% of couples who are trying to conceive will do so. In the second year of trying, another 10% will conceive naturally. What this means is that in the second year, the chances of conceiving are about 3% per month.
          Sincerely
          Dr V Karande

  121. Commenter says:

    Hello Dr Karande,

    I am 38 years old. I have a 2 year old son who was conceived naturally and have had 2 miscarriages within this past year.

    I am getting the recurrent pregnancy loss work up and here are the results of my hormone tests:

    AMH (not 3 day – this test was a few weeks ago) 1.63

    Day 3 FSH 5.60

    Day 3 LH 5.11

    Day 3 E2 42.8

    Do they look ok? The AMH shows “within range” on the quest lab report, but from what I’m reading, 1.6 is kind of low. Does that tell you anything about my egg quality and could it be the reason I keep miscarrying?

    Thank you

    • Your blood test results look ok.

      An AMH level of 1.63 ng/mL is also okay for your age.

      Other tests that may be done include: immune tests, TSH, prolactin, parental chromosomes, pelvic ultrasound, and HSG (or hysterosonogram or hysteroscopy).

      Recent recoommendations from the ASRM suggest that thrombophilia panel tests are now considered experimental and are not to be done routinely.

      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you so much for your response! I have had the other blood tests you mentioned and everything came out fine, including the thrombophilia panel (that’s the blood clot test, right?). My husband also had his chromosomes checked, along with a few other blood tests.

        I am scheduled for a hysteroscopy tomorrow. I know that I have a uterine anomaly from when I was pregnant with my son – I had thought it was a bicornuate uterus but they are checking for a septum.

        May I ask you – if my hysteroscopy shows no septum (or any other problem such as scarring from my previous C-section) will I still need an HSG? I conceived each pregnancy within the first month of trying, I just can’t maintain them. I know that the HSG primarily checks for blocked tubes. Could it determine anything else with my uterus that a hysteroscopy will not?

        Thank you again! Your website is very informative and I appreciate you taking the time to post this information!

        • In about half the cases with recurrent miscarriage, the work up will come back negative,
          In these cases we instruct the couple to try again and call with a missed period for early pregnancy monitoring.

          In couples where recurrent aneuploidy (abnormal chromosomes) is suspected, IVF + PGD can be discussed as an option. This, however, is controversial.

          A hysteroscopy can be used to treat an uterine septum. It is a simple procedure done under IV sedation and takes less than an hour.
          Sincerely
          Dr V Karande

  122. Commenter says:

    I am a 34 year old female who had an AMH level of 0.72 in June. I recently got retested and now it says 0.61. Why would it drop that much in a span of a month?!? I want to freeze my eggs which is why I was tested.

  123. Anonymous says:

    Dear sir, my wife is 30 yrs old, normal cycle, perfectly healthy normal lifestyle- doesn’t smoke/ occasional social drinker. We’ve been married 3 yrs and started trying ab an year back. Recently we started getting our tests done – all tests including hsg have been normal, fsh 7.1, serum lh-4.33, tsh 3.9,estradiol 53.8,prolactin-11 however the amh was
    0.9. There is also a vitamin d3 deficiency. Is there reason to be worried. Should one start moving towards Ivf or can we look at trying natuarally for some more time, then go for iui and if god forbid neither works an Ivf. Are d3 and amh linked in anyway?

    • If the work up is negative, the initial approach should be with ovulation induction using clomiphene citrate (Clomid, Serophene) and timed insemination.

      Day-3 FSH and AMH levels measure different parameters.

      A day-3 FSH level is indicative of your ability to conceive. If the level is above a certain number (> 10 mIU/mL at InVia) the chances of conception with IVF decrease. If the level is > 15 mIU/mL. the IVF pregnancy rates are dismal.

      AMH levels are indicative of the number of eggs that remain in the ovary (ies). An AMH level will predict (along with an antral folicle count) the number of eggs that will be retrieved during IVF.

      AMH and FSH levels can be discordant. I have written a blog on this issue recently.

      Sincerely
      Dr V Karande

  124. Commenter says:

    why do people have low AMH?

    • Anti-mullerian hormone (AMH) levels reflect the available oocyte pool (number of eggs) in a woman. They decrease with age. In some women, the biological clock is running faster than it should be. They end up with what is called as “diminished ovarian reserve” which is reflected in low AMH levels.
      Sincerely
      Dr V Karande

  125. Commenter says:

    hello sir MY ASH 8.78 ng\ml; T3 80.07; T4 6.60 ; TSH 8.91; FSH 4.86; LH 8.99
    I M 26 YRS OLD .what are the chances of conceiving for me . i m also suffering from pcos . kindly help me

    • Your TSH level is elevated. This means you have hypothroidism, for which you need to take thyroid pills (Synthroid, Levoxyl).
      You tell me that you have been diagnosed with PCOS.
      Please consult with a Board Certified REI to get specific advise on what to do next.
      We would love to have you as a patient at InVia.
      Sincerely
      Dr V Karande

  126. Noof Almarri says:

    I am 33 yrs old and my AMH level is 0.98. And 3-day FSH is 9. The doctor adviced me to take DHEA supplement 75 mg daily. And to prepare for IVF. What do you think?

    • I do not understand why you have been recommended IVF.
      Is there something else going on? Are your tubes blocked? Male factor? Have you failed several cycles of IUI?
      Some studies have reported increased ovarian response in poor responder patients with DHEA. A confirmatory prospective randomized trial with large numbers is yet to be published. Its use currently remains controversial.
      Sincerely
      Dr V Karande

  127. Commenter says:

    Hello Dr Karnade,

    Im 31 yrs old n trying to conceive since 1 yr, my height is 5 ‘ 8 n weight 80 kgs, below r my recent test values

    Progesterone- 10.39
    TSH- 3.2
    FSH- 4.62
    LH- 15.04
    Prolactin- 31.35
    E2- 256.5
    AMH- 0.52

    Pls suggest if I can conceive naturally? Or do i need to plan to go for IUI or IVF. My HSG test is due gir Aug 1st week.

    • Your progesterone level indicates that this blood was drawn in the luteal phase of the cycle.
      Please have a repeat blood for FSH/LH and E2 on day-3 of the cycle. Also have them do a vaginal ultrasound with antral follicle count.

      Please have them repeat a fasting prolactin level. It seems to be a bit elevated.

      We like the TSH level to be < 2.5. You may want to discuss starting 50 mcg of Synthroid with your doctor.

      The AMH level is a bit low for your age group.

      If you have been trying for at least one year, your tube(s) are open and your husbands sperm count is normal, it is reasonable to start with Clomid/IUI cycles.

      Sincerely
      Dr V Karande

  128. Commenter says:

    HELLO SIR ! I AM TRYIING FOR COCEVING SINCE LAST 1 N HALF YEAR I HAVE ALREADY ONE BABY OF 12 YR MY 2YR BABY BOY EXPIRE IN ACCIDENT IN 2009 . SINCE LAST 1 YR IAM TRYING FOR COCEIVING MY AMH LEVEL 1.5 IN THIS MONTH CYCLE MY OVULATION IS ON 16 DAY AT SIZE 25,30MM AFTER GIVING HCG ON 13 DAY .IT IS OVUM OR CYST? IT IS NORMAL?

  129. Commenter says:

    Dear Dr. Karande
    I’m 28 and half and I’m from Iran. I’m having trouble conceiving a baby according to m test results my F.S.H is 84.4 which I know is pretty high and near to menopausal but my anti Mullerian is about 1.02, I’m wondering if I have any chance to have baby through medical treatments or not.
    Thank you for your prompt attention

    Best regards
    Paria

    • Your FSH level is very high (84.4!). In fact it is in the menopausal range.
      Your AMH level is 1.02, which is almost normal.

      I have recently written a blog about the outlook when the AMH and FSH levels are discordant. You may find it to be useful.

      You could get pregnant on your own. However, the prognosis with IVF is not good. You may have to consider using donor eggs!

      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you Doctor, but I didn’t get it when you said I can get pregnant by my own, You mean by trying naturally I have the chance to get pregnant within a year or 2? or the chances are even lower?

        • I am not able to locate your previous post.
          I probably meant the chance of success with treatment and on your own is probably the same.
          Why go through all kinds of fertility drugs etc if there is no increase in pregnancy rate compared to trying naturally?
          Sincerely
          Dr V Karande

  130. Commenter says:

    Hello Dr Karnade.

    I’m 40 years old and been trying to conceive for a long time, I been pregnant four times naturally on the last 10 years but at 6 weeks embryo heart stops and I had miscarriages. Recently I change doctor and he told me that maybe even with IVF I will get the same results as previous pregnancies and ask me to take the AHM test and other for Diabetis and the result for AMH is 1.6. My question is the AHM affect also the development of the embryo? and if there any treatment for that?. Thanks in advance.

    • AMH reflects the number of eggs that still remain in your oocyte pool in the ovaries. It does not predict pregnancy outcome.
      You need a complete work up for recurrent miscarriages.
      Sincerely
      Dr V Karande

  131. Commenter says:

    I am 33 and have an AMH level of 47.6 (pmol/L). I know it’s above the normal range, but what does this actually mean?

    • AMH levels reflect the size of your oocyte pool (number of eggs in your ovary(ies)). A high AMH level indicates that there are plenty of eggs! High AMH levels are often seen in patients with PCOS. Patients with high AMH levels often are high responders to fertility drugs and are at risk for ovarian hyperstimulation syndrome. We will usually use low dose of medications and monitor very carefully to minimize hyperstimulation.
      Sincerely
      Dr V Karande

  132. Commenter says:

    did any one got pregnant with very low amh level .1 at age of 40

  133. Commenter says:

    Hi Doctor,

    I am 37 yrs old, almost 38. My day 3 FSH is 4.4 and my E2 is 75.9. AMH is 0.64. I was told by the nurse that this is not a good AMH and that my E2 is not good either. However, my RE says nothing to worry about. I am so confused. Would you shed more light on this for me? Is this a AMH level for my age?

    Thank you!

    Kelly P.

    • Your AMH level is on the low side, but not terribly low.
      The E2 level is a bit elevated (we like it to be < 50 pg/mL). An elevated E2 indicates that you may be recruiting a dominant follicle early in the cycle. This is one of the early signs of peri-menopause (where you also ovulate early and have short cycles). The E2 level in turn may be suppressing the FSH level.
      I agree with your RE.
      At the same time, there is no harm in repeating the bloods after your next cycle.

      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you for the speedy response and hopeful answer! As for the E2 levels…. I have been reading that caffeine and alcohol consumption can greatly affect these levels and cause them to be high. Do you find this to be true? If so and the E2 is elevated due to the consumption of both would the FSH level be considered a true read if the E2 is slightly elevated due to diet? I am repeating blood tests on my next CD 3 and have had the hopes that a change in diet will show improvement! Thank you again for you more than helpful response!

  134. Commenter says:

    Hi,
    Dr. Vishvanath Karande

    I am 32 year old from INDIA.
    My both tubes are totally blocked.
    My AMH level is 0.08,but after scaning Dr. said I am able to produce up to 6 eggs. AMH level affects the Quality or the Quantity of the egg or both, Please tell me.
    My TSH was 213 but now it is in Normal range.
    Dr. I have no other option then IVF ,this AMH level cause any problem in my IVF.
    Will this AMH level cause any problem in implantation of egg also.
    AMH level affects the Quality or the Quantity of the egg or both.

    DR.PLEASE HELP ,I m in great confusion.

    • Your AMH level is indeed low for a 32 yo.
      You also had a very high TSH level. I have not seen one that high for a long time.
      It would have been nice to know your day-3 FSH level.

      AMH levels will give an idea of the NUMBER of eggs that will be retrieved.

      Even with aggressive stimulation, you will probably produce few eggs, but may get pregnant.

      Sincerely
      Dr V Karande

  135. Commenter says:

    I have a question.
    I had my day 3 labs done
    FSH 10.1
    AMH 3.97
    Prolactin 10.9
    LMH 11.1
    and my AFC was 29+ my RE said I have PCO – without the syndrome.
    I temp and it shows that I ovulate each month
    I did IUI in March when my labs were done and got pregnant the first time no medication. Unfortunately it ended in a Blighted Ovum and a D&C. I just had my first IUI after the D&C two weeks ago and am not pregnant. Do you think my chances are okay for the future. I’m 29 and have no children. I was a light smoker but I quit after seeing my high FSH.

    • Commenter says:

      Also,
      I have very regular cycles. DO you think that my FSH means that I have poor egg quality since I was a light smoker ( less than 5 per day)

    • Your blood test results are okay. Your FSH level is borderline elevated. However you have excellent AMH and AFC. I am therefore not too worried about the FSH level.

      The high AMH level correlates well with your AFC (> 12 antral follicles per ovary) — you have polycystic appearing ovaries. If in addition you have at least one of the two a) irregular or absent menses or b) excess hair, acne (hyperandrogenism) — only then is a diagnosis of PCOS made.

      I am sorry you had a miscarriage. You should have a cavity check (HSG, HSN or hysteroscopy) prior to attempting conception again.

      I’m glad you have quit smoking.

      Your prognosis is good.

      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you for your expertise. I am going to consult my dr about having another HSG. I haven’t had one since my miscarriage. My husband and I are seeing an RE due to his ED. So I am hoping that given our results and history, we will be blessed with a child of our own.
        I have a regular cycle, no excess hair or acne and my weight is only 112lbs. So I’m hoping that I don’t have PCOS.
        Also, My RE recommends 6 unmedicated IUI cycles before further evaluation since it is an issue with my husband. Do you agree with this? I am not sure if he wants me to have 6 more after the miscarriage or 6 total including the miscarriage.

        • Your RE’s recommendation seems to be reasonable especially if the ED is so bad that you are not able to have intercourse.
          If that is your only issue, you should be able to have a child of your own.
          Good luck!
          Sincerely
          Dr V Karande

  136. Commenter says:

    M 32 yrs currently 9yrs married with no baby.Tried IUI 6 cycles..all were failed. .My AMH is 0.88 and FSH is 4.84 and LH is 3.93.Kindly guide me can i be pregnant ever in my life?

    • Yes you can. With 9 years of trying, however, you do need help.
      Please discuss doing IVF with your doctor.
      We would love to see you as a patient at InVia.
      Sincerely
      Dr V Karande

      • Commenter says:

        I am 38
        Last month my fsh was 31
        Amh 0,6ng/ml
        This month
        Fsh 7,8
        Amh 7,00 ng/ml
        Please dr healp me

        • This does not make sense.
          One of these tests results is wrong.
          An ultrasound with antral follicle count may help decide which test is accurate.
          Getting a third blood test on day-3 of the cycle is also a good idea.
          Sincerely
          Dr V Karande

          • Commenter says:

            Tanks you so much Dr V Karande
            yes I will do tomorrow the third test Day-3 of cycle

            The first text was Day 5 of cycle 18/06/2013
            Fsh 31.07 mUI/ml
            Estradiol 29.0 pg:ml
            Hormone anti-mullerienne 4,4 Pmol:l
            0,6 ng/ml
            Day-15 of the cycle 27/06/2013
            FSH 11,8 UI/l
            LH 18,0 UI:l
            17BETA OESTRADIOL 120 pg:ml

            The last text on Day-3 of cycle 13/07/2013
            Oestradiol 32 picog:ml
            LH 4,3 UI/L
            Progesterone 0,2 ng/ml
            prolactine 13 ng/ml
            FSH 7,8 UI/L
            TSH 0,83 mUI/l
            T4 17,8 Pmol/l
            T3 4,7 Pmol/l
            AMH 7,00
            when i did this last test i took homeopathie Progesteronum 9ch from Day-12 of cycle up to Day-25 of cycle this can be give a false result?
            Sincerely
            TG

          • I am not familiar with the medication. Please consult with your doctor, but it may be wise to discontinue the medication so that your next day-3 bloods will be accurate.
            Sincerely
            Dr V Karande

          • Commenter says:

            Hello Dr V karande,
            Thank you so much for your help!!
            TG

      • Commenter says:

        Thx for reply….Sry it will be my dream to be in ur hospital….as m in India it’s not possible for me…pls advice me how to find gud dr….related to my.Prob…..as its a great market …

  137. Commenter says:

    hello Sir,
    i am currently 32 yrs and 9 yrs past not concieved a single time…presently my
    FSH is 4.84,
    LH is 3.93,
    E2 is 31.00,
    TSH is 1.49,
    AMh is 0.88
    My Fallopian Tubes are normal and in last year i gone through 6 IUI cycles (FAILED)
    pls guide me is their any success rate of IVF if i go for this process??

    Also one Dr. advised me for laproscopy and other advice me straight to go for Egg donor…m confused..pls help me
    Tani

    • Hi Tani
      I am presuming your husbands test results are normal.
      I am also presuming your uterine cavity is normal.

      A laparoscopy is a reasonable option. It, however, is unlikely to increase your chances of getting pregnant.

      Your best bet is to try IVF next. It will be the first time anyone will have seen your eggs, egg-sperm interaction and embryo development. If there is nothing wrong with the gametes, you will have an excellent chance of conceiving.

      Sincerely
      Dr V Karande

  138. Commenter says:

    Hi Doctor,

    I have checked all yours blogs and replies. Was really impressed and happy to see some positive response. I am attaching my results. Please suggest shall I go for IVF since my doctor is telling my reports are normal i need to keep trying only. But I am trying for long more than one year.
    AGe- 29 years
    AMH Level- 1.61 ng/dl
    T3 – 6.8 ug/dl
    TSH – 1.53 ulU/ml
    Weight – 63kgs, height – 5’2″
    Prolactin level -32.49ng/ml.

    My husband sperm count is showing as 58 Millions Sperms/ml and total number as 116 Millions per ejaculate. 54% of sperms are abnormal spertmatozoa.

    I have gone through internal showing the progress of follicle as follows:
    Day 14: Right Ovary F1=17mm, F2=15mm, Left Ovary F1=15mm, F2=10mm
    Day 16: Right Ovary F1=20mm, F2=17mm, Left Ovary F1=16mm, F2=10mm
    Day 18: Right Ovary F1=Ruptured, F2=21mm, Left Ovary F1=18mm, F2=15mm.

    Does my reports sound normal. Should I proceed for IVF or try normal.

    Reagrds,
    Monika

    • Hi Monika
      I am glad you have checked the blogs and replies. I do hope you have found them to be useful.
      You have not told me whether or not you have had any treatment so far.
      We usually start with ovulation induction using clomiphene citrate and timed intrauterine inseminations as an initial step. It would be unusual to start with IVF.
      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you doctor for your reply.My doctor is telling after seeing my reports that I can conceive naturally without clomiphene citrate and timed intrauterine inseminations or IVF.
        Just wanted to know whether my reports are normal or not.
        Does internal sonography detect any bloackage in fallopain tube??

        • Commenter says:

          Just wanted to know for second opinion that my reports are normal or not

        • Hi Monica
          You indeed can conceive on your own. However, please be aware of these facts.
          85% of couples will conceive in the first year of trying.
          Another 10% will conceive on their won in the second year of trying.
          The chances of conceiving on your own in the second year are about 3% per month.
          A lot of couples who have tried on their own for a year will proceed to Clomid/IUI at this stage.

          Routine internal sonography does not detect tubal blockage. However, if color doppler or special solutions are used, it is possible to evaluate tubal patency.

          Sincerely
          Dr V Karande

  139. Commenter says:

    I just turned 43 yrs old & received my anti-mullerian hormone results 0.78 ng/ml. Are my results good or bad, what does this mean? Your advise would be much appreciated.

    • The result is normal for age 43.
      I have stated this many times before, AGE IS AN INDEPENDENT VARIABLE THAT MUST BE CONSIDERED.
      Please do not waste any time and pursue pregnancy aggressively.
      Sincerely
      Dr V Karande

  140. Commenter says:

    sir i am 39 years of age my amh is .67 and fsh is 12.64 and ultrasound showed i have 4 follicles in left ovary and 5 follicles in right ovary i had my first baby in 2006 with iui i have consulted the same doctor and she hs suggested iui this time too will it help me in getting pregnant as i am trying for the second time.last i had conceived aftr delivery was on dec 2010 and jan 2012 bt due to certain crisis i had aborted them. kindly help
    regards yasmeen

    • Hi Yasmeen
      I do not understand what your question is.
      Sincerely
      Dr V Karande

      • Commenter says:

        dear doctor
        i ahd my first baby in 2006 with iui and nw i am planning for the second baby i got my blood test done on 1st august and my amh level is 0.67 and fsh level is 12.64 and on the same day i did my ultrasound sonography and the reports were that my ovaries are normal and left ovary has 4 follicles and right ovary has 5 follicles i also did my hsg on 5th august on 7th day of my periods and the reports were that both fallopian tubes are visualised with both spillage …. my doc has told me to do the progestrone test on 20th august …and after that the doc i hv consulted said will do the iui in the next cyles my husband reports are normal. my question is will i be able to concieve agan with my low amh level and high fsh level am worried about it kindly help
        regards yasmeen

        • Commenter says:

          in response to the above question … doc i forgot to mention my age i am 39 years old….

        • Your test results indicate there is diminished ovarian reserve. At the same time, they are not terrible. We have had many pregnancies in patients with similar test results.
          Here are a couple of suggestions: 1) The pregnancy rate with clomiphene citrate/IUI in your case will be about 6% per cycle. A better option will be fertility injections (gonadotropins, FSH, hMG) with IUI with a 15% per cycle pregnancy rate.
          2) After three IUI cycles, the next step should be IVF.
          Please do not waste time and continue to pursue pregnancy aggressively.
          Good luck!
          Sincerely
          Dr V Karande

          • Commenter says:

            thanks alot doctor for youor advise ….. what i did not understand is that do you mean that with Clomiphere Citrare/iui i just have 6% chances of getting pregnant and with fertility injections my chances of getting pregnant are 15% and another thing i want to know is what must be the progestrone level on 21st day of the menstural cycle to confirm ovulation

          • Greater than 3 ng/mL.
            Sincerely
            Dr V Karande

          • Commenter says:

            thanks a lot for your advise i will keep you informed about my progestrone levels which i will be doing on the 20th august … once again thanks

  141. Commenter says:

    my wife 30 years old, AMH level 0.15ng/ml, can possible for pregnancy.

  142. Commenter says:

    Hello Doc,

    My Age is 26 years,We are trying from past 1 year.My husband has problem with sperm count(2 millions) and not a good morphology.

    my reports:

    FSH-6.91
    LH- 4.03
    Prolaction-11.4
    TSH(3rd Gen)-2.590
    and
    AMH-10.5 (they write normal range as 2.0 – 6.8 ng/mL

    BMI- 26

    Doc could you please advice as whether we should go for ICSI with high AMH and what precautions we need to take before and after treatment.

    • You have a high AMH and are at risk for ovarian hyperstimulation syndrome (OHSS).
      Your physician will probably stimulate gently, monitor closely and decrease the dose of medications as required. If you are at risk for severe OHSS, they may use Lupron trigger (instead of hCG) and/or freeze all embryos.

      With a count of 2 million, ICSI is definitely indicated. I am presuming your husband has been evaluated by an urologist and any correctable problems have been ruled out.

      The prognosis in your case is excellent and I would like to wish you good luck with your cycle!

      Sincerely
      Dr V Karande

      • Commenter says:

        Thanks Doctor for your reply and guidance.

        My husband did his seman analysis again 13ml and Motility as 30% (20%grade A) and Morphology as 40%.

        Can we go for IUI before ICSI…..as count increased by 6 time and do we suppose to wait?

        I have started to take birth control pills as part of ICSI treatment so can we stop this treatment in between as medicine are working for my husband.

  143. Commenter says:

    Hello Doc,

    My Age is 26 years,We are trying from past 1 year.My husband has problem with sperm count(2 millions) and not a good morphology.

    my reports:

    FSH-6.91
    LH- 4.03
    Prolaction-11.4
    TSH(3rd Gen)-2.590
    and
    AMH-10.5 (they write normal range as 2.0 – 6.8 ng/mL

    BMI- 26

    Doc could you please advice as whether we should go for ICSI with high AMH and what precautions we need to take before and after treatment .

  144. Commenter says:

    Hello Doctor,

    I am 28yrs and my BMI is 26.5. Am married since 2 yrs and planned for pregnancy after a year and ended up with ectopic. After abortion I had to plan for pregnancy from this Jan 2013.
    I have PCO and myoma

  145. Commenter says:

    Hi Doctor,
    i just received my Test Result, My FSH level is 12 at the age of 29 and AMH level is 2.8 (According to my doctor AMH level is healthy as it should be >2.5 and <3). they also found that i'm in gray zone of Fragile X's. i just want to know whether i should go for IVF or not as my RE is not very hopeful that i would be able to conceive with these result.

    • Please speak to a genetic counsellor about your Fragile X result. There is a blog on this very topic posted recently that you may find to beuseful.

      I am not sure why you need IVF. Have other simpler methods failed?

      You do qualify for IVF. We would love to see you as a patient at InVia.
      Sincerely
      Dr V Karande

      • Commenter says:

        Hi Doctor,

        i married 1 year for now, not gotten pregnant. in Fertility center mhl result is 0.5 and my age is 27. Can you please provide the possibility to get pregnant and any treatment to increase mhl levels.

        • Commenter says:

          Hi Doctor,

          i married 1 year for now, not gotten pregnant. in Fertility center amh result is 0.5 and my age is 27. Can you please provide the possibility to get pregnant and any treatment to increase amh levels.

          sorry its amh.

        • You can get pregnant but may need help.
          I am not aware of any way of increasing AMH level. Weight loss in morbidly obese women will help.
          Please consult with a Board Certified Reproductive Endocrinologist.
          We would love to see you as a patient at InVia.
          Sincerely
          Dr V Karande

  146. Commenter says:

    Slightly confused about test results when determining if I can and how I should become pregnant… Would you be so kind as to shed some light on the following test results, considering I am 47, 5’3”, approx. 105 lbs., Caucasian female.

    - Day 3 TSH 2.35 mU/L
    - Day 3 FSH 18.1 U/L
    - Day 3 LH 15.5 U/L
    - Day 3 Estradiol 114 pmol/L
    - Day 3 Progesterone 1.5 nmol/L
    - Day 9 AMH 0.200 ng/mL

    Many thanks for your assistance!

    • Age is an independent variable that MUST be considered.

      With these same numbers, my advise to a 25 yo and a 47 yo will be different.
      At age 47, the pregnancy rate with IVF using your eggs is zero.
      Your chances of conceiving with donor eggs/embryos remain good.
      You could get pregnant on your own — however, the chances are really slim.

      Sincerely
      Dr V Karande

  147. Commenter says:

    Can I get this test done at my regular doctor or do I need to see a fertility doctor?

    • Most commercial labs will run an AMH level.
      You can get the test done at your regular doctor. However, it is the interpretation of the test that is important. Your fertility doctor may be better equipped to do this.
      Sincerely
      Dr V Karande

  148. Commenter says:

    Hi Dr Karande,

    I am 38 years and 5 months old. These are my test results:

    AMH : 0.6
    FSH: 6.4 IU/L
    Estradiol: 318 pmol/L
    LH: 3.9 IU/L
    TSH: 2.4 mIU/L

    3 day Antral follicle count was 3 in right ovary and 0 in left ovary
    In addition they found a cyst in my left ovary.

    two months ago it was 3 + 2

    RE thinks my numbers are looking very poor for my age and that the high estradiol is masking my FSH to a false normal.

    I have been put on birth control pill to reduce the cyst. I will start IVF later this month if the cyst resolves with buserelin 0.5, Gonal F 450 units and Nuveus 150 units.

    Do you think I would be able to conceive with my own eggs? The RE has suggested one cycle of IVF and if that does not work to go for donor eggs.

    Could you kindly advice what my chances are?

    Thank you !

    Regards
    namita

    • Hi Namita
      I agree with your RE.
      You could conceive with your own eggs but the chances are low compared to someone your age without diminished ovarian reserve.
      Please ask your RE if you can benefit from pre-treatment with testosterone (Androgel or DHEA).
      Good luck.
      Sincerely
      Dr V Karande

  149. Commenter says:

    very informative one,i am 27 yr old,my amh is17.1 ,second day fsh is 10,estradiol-43,prolactin-134,tsh normal,normal body weight,trying to have a baby for last 1 yr,is there any problem with me,kindly answer my question doctor.

  150. Commenter says:

    I am confused by my results, so my amh was low in Feb 2012 (2.1 on a scale where 7 – 15 is normal) but my fsh is 5.2, low estrogen, lh 2.7 and i am hypothyroid. Does this mean I should be able to conceive with treatment?

    • Commenter says:

      Forgot to mention I am 28 years old, bmi 21

      thank you

    • Commenter says:

      also, an ultrasound came back with the comments ‘normal size, several immature follicles on each ovary’ (no specific numbers given. HSG normal with no blockages and the progesterone challenge test did not produce bleeding. I stopped birth control last July and had no period. I started 100mg levothyroxine in May and had one period 24-28 July, but none this month and not pregnant.

      • Commenter says:

        thank-you for your help. Would I be a candidate for treatment?

        • Your AMH is low, you are 28 years young, your FSH level is normal, your AFC is adequate, and the hypothyroidism is being corrected. Yes, you would be a candidate for treatment. We would probably start you on clomiphene citrate 50 or 100 mg for 5 days with timed IUI as an initial step.
          Sincerely
          Dr V Karande

          • Commenter says:

            Thank-you for your reply. It’s great to hear that there is something that could be done as it’s quite depressing to hear at the age of 28 that the menopause is looming! We were thinking of starting to try again in February (when finances will be better), in your experience is it best to not waste any time? (I have had two opposing views from two different doctors with very different opinions about AMH tests). Thank-you

          • The sooner you start the better it will be.
            Good luck!
            Sincerely
            Dr V Karande

  151. Commenter says:

    Dear Dr Karande,
    I am 40year old, my amh is just 0.2 so there is any chance I can improve my amh and get pregant with my own egg?

  152. Commenter says:

    I am 23 and just had an AMH test which came back 5.7 ng/mL and next to it Ref. Range 1.00-10.00
    I don’t understand if that’s good or bad or if I should be worried about something.

  153. Commenter says:

    I am almost 28 years old. I was tested for my AMH levels due to my application for egg donor and was told I have an AMH level .36. I have been on birth control for many years. Should I consider freezing my eggs? I am not ready to have children yet.

    • Your AMH levels may have been suppressed by the birth control pills.
      You may want to use barrier contraception for 3 months and then get a repeat AMH level.
      I will not be surprised if it comes back normal.
      The decision as to whether or not you should freeze eggs is a tricky one as you may be able to conceive on your own even if it turns out that your AMH level is persistently low.
      Please keep me posted.
      Sincerely
      Dr V Karande

  154. Commenter says:

    I am 41 years and 6 months of age. In 1997 I had Filche Clip sterilization. In October of 2012 I had a successful reversal anastamosis performed. Recent labs are as follows: AMH 0.3, FSH 8.9, E2 68. My husband’s SA indicated 4.5 count, 1% morphology, 46% motility. Your professional opinion, please!

    • The following issues need to be addressed — your age, severe male factor and diminished ovarian reserve.
      You have now failed to conceive after almost 10 months of trying naturally (did you get a repeat HSG to confirm tubal patency?)
      You could try IVF + ICSI next. The pregnancy rate in your situation is quite low (10%).
      With an egg donor, however, the pregnancy rate will be > 50%.
      Please consult with a Board Certified REI to get specific advice.
      We would love to see you as a patient at InVia.
      Sincerely
      Dr V Karande

  155. Commenter says:

    please help me determine my results and next steps. I am 35 (also BRCA1+) my AMh is .23 and FSH 26.5 Do I have any change of having a baby?

    • The numbers are not good.
      I do hope you have seen a genetic counsellor to discuss your BRCA1 status.
      I have patients with these numbers that have conceived naturally.
      With IVF the pregnancy rate will be practically zero.
      You could get pregnant using an egg donor.
      Please consult with a Board Certified REI to get specific advice.
      We would love to see you as a patient at InVia.
      Sincerely
      Dr V Karande

      • Anonymous says:

        I’m confused by your answer. You say you know people that have conceived naturally with these numbers but there is zero chance with IVF? So what we need is a miracle?

        • I’m sorry my answer has confused you.
          Let me try again.
          Tests of ovarian reserve are useful for predicting outcomes with assisted reproductive technologies (e.g. IVF).
          They are not necessarily useful for predicting inability to conceive naturally.
          I have had patients with high FSH levels that have conceived naturally while waiting for a suitable egg donor.
          The chances are low, but it can happen.
          With a FSH of 26, most experts would agree that your chances with IVF are less than 1% (if not zero).
          Hope this helps.
          Sincerely
          Dr V Karande

  156. Commenter says:

    I’m 37 and my AMH is <0.16. My Dr says my other hormones are good though. I'm through child bearing; can I d/c birth control and not end up pregnant?

    • Commenter says:

      I forgot to mention that my BC method is Mirena IUD that I have had in place for 4 years, if that makes a difference with my AMH level.

    • Oh please do not stop using birth control, unless you don’t mind getting pregnant.
      AMH levels predict the number of eggs that will be retrieved during IVF.
      They do NOT necessarily predict your ability to conceive naturally.
      I wonder why your AMH level was checked in the first place.
      Sincerely
      Dr V Karande

  157. Commenter says:

    my amh is 0.3 would there be any chance of pregenacy

  158. Commenter says:

    Very informative. Clears most of the basic concepts

  159. Commenter says:

    I recently was diagnosed with POF. Lab values in Aug. FSH 68, LH 32, Estradoil 27. Trans vag US per Dr. office normal in August (said they were looking for cysts. Values in sept FSH 40, estradoil 112, AMH 0.08. I have always had a normal menstrual cycle. We had a baby in 2011 and ever since then my period has not been normal. I was bleeding heavily at one point and was put on birth control containing estrogen/progesterone. I was on that for 3 months dec-feb 2013 then we decided we wanted to have another baby….is there any hope. I am so distraught.

    • Commenter says:

      Guess I should have mentioned in post that I am 36 years 10 months old.

    • I am sorry but your lab values are consistent with a diagnosis of premature ovarian failure. You should have them check your chromosomes and for Fragile-X syndrome. Please talk to your Ob/Gyn doctor about medications that can prevent bone loss. I have had patients in your situation that have conceived naturally. IVF pregnancy rates in your situation are practically zero. Donor eggs is an option you may have to consider.
      Sincerely
      Dr V Karande

      • Commenter says:

        My dr wants to start me on HRT (estrogen/progesterone)but am worried that will completely take away any hope of conceiving naturally? I am going for bloodwork for fragile X and have a bone scan scheduled for this month. How did your patients conceive naturally, my dr. said there was no chance and donor eggs or adoption were my only chances but I am NOT willing to give up hope that easily! Thanks so much for responding to my questions, I really appreciate it.

        • The problem with conceiving naturally is that in your situation the chances are low and it may or may not happen. Please discuss this with your physician, it is possible that if your bone scan is normal, he/she may put off starting the E2/P treatment by a bit.
          Good luck!
          Sincerely
          Dr V Karande

  160. Commenter says:

    Hi Dr,

    I am 33 yrs old, I have undergone 2 IUIs without success, my AHM level is 1.53, I am indeed desperate to have family now, My Gyn. suggested me to proceed with IVF, Please suggest me to have a child.

    Thanks
    Sai

    • I am presuming your work up is otherwise normal and you have “unexplained” infertility. We generally recommend 3 – 6 IUI cycles before proceeding with IVF. Your AMH level is normal.
      Sincerely
      Dr V Karande

      • Commenter says:

        Dear Dr,

        Thanks for the reply.
        I am sorry forgot to put it in the previous message that, I had Ectopic 2 yrs back and left tube has got removed. we are trying for the past 1 1/2 yrs to have a child. we have tried naturally for 10 months by taking medicine (Siphene – 50 mg for 6 cycles, then Recogon FSH for 4 months). Now undergoing IUI for the 3rd time. What will be the next step in case of unexplained infertility.

        Thanks
        Sai

        • You have tubal disease — based on the history of a tubal pregnancy. Approximately 65% of patients with a tubal pregnancy will conceive spontaneously. After 18 months of trying, it seems you are not in this (lucky) group. I do hope your third IUI works. If not, IVF is a reasonable next step. Regardless of how you conceive, please make sure you are monitored for a repeat tubal pregnancy.
          Good luck!
          Sincerely
          Dr V Karande

          • Commenter says:

            Hi Dr,

            Thanks for the reply, one week back I have consulted my fertility specialist, she did scanning and told me that endometrium is thick and have given tablets to shutdown the period properly, again after 7 days, I have got period, today is my 3rd day, my Dr has done scanning and told me to go with HCG kind of test, not sure the name of test, it stats with E, to check whether the right tube is normal, I told I have already done HCG 2 yrs back and the right tube is normal, she has advised me to go for the test coz, it may happen in these two years there may be chance of any issue, She has suggested to go for IVF from the next cycle.
            I am in dilama to go ahead with HCG kind of test. please suggest.
            Thanks
            Sai

          • I guess you mean hysterosalpingography (HSG). It is okay for you to go ahead and have one. Here is a link to a blog I wrote on HSG http://www.inviafertility.com//hysterosalpingography
            I hope you find it to be useful.
            Good luck with your IVF cycle!
            Sincerely
            Dr V Karande

      • Commenter says:

        Dear Dr,

        My 3rd IUI also not successful, i thought I should take a break for some time, took 2 months break, now I have experiencing weight loss and hair loss and consulted Dr, she suggested for TSH and Blood Sugar tests, Blood sugars are normal, but the TSH harmone is at 0.08, very afried to see this.

        Dr also suggested that for Laproscopic Surgery next month.

        I am really feeling depressed to see TSH levels, will it lead to any complexities?

        Thanks
        Sujatha

  161. Commenter says:

    hello,
    im 27 years old and i had ovairain cyst removed in 2004, my AMH is 1.1ug/l, is it normal? how you interrupt this result . got pregnanat last year but miscaraged, and trying to have a baby for a year but no use

    • I am presuming you mean 1.1 ng/mL.
      That is an acceptable level.
      I am sorry your recent pregnancy resulted in a miscarriage.
      My best advice for you is to consult with a fertility specialist.
      We would love to see you as a patient at InVia.
      Sincerely
      Dr V Karande

  162. Commenter says:

    Dr. Karande,

    I just found out yesterday that my Amh level is at .16. My husband and I have been trying for 2yrs. I am supposed to call a fertility specialist today. Is there any hope of us getting pregnant naturally? Is IVF even a possibility?

    Thank you

  163. Commenter says:

    Dr. Karande,
    I should have stated this in my previous comment. I am 36 years old and I am 5’5″ and weigh 105lbs. I eat healthy and exercise regularly. I do not know what my fsh level is.

    • Commenter says:

      Dear dr. Karanade,
      I am 43 years old, on 5 th day FSH was 21 and AMH was 0.16. Is it meaning that I have not expectation to be pregnant in future in natural way. Or maybe sometime happen miracles?
      Thank you very much!

      • Ovarian reserve tests (day-3 FSH, AMH etc) are good predictors of ovarian response and pregnancy with assisted reproductive technologies. They are not always good at predicting who will NOT conceive naturally. At age 43, with a FSH level of 21 (you mean day 3, right?) and a practically undetectable AMH level your chances of conceiving with IVF (using your own eggs) are practically zero. You, however, could get pregnant naturally. The chances are low, but it can happen.
        Your best bet at conception with IVF will be with using an egg donor.
        Sincerely
        Dr V Karande

  164. Commenter says:

    Dr. Karande,
    I want to thank you for such valuable information, both in your article but also in the responses you have left. Your article provided me the information I needed to talk to my doctor about my options after learning of my 0.16ng/mL AMH levels. I am 33 years old, I have irregular cycles (since the on sent of menses), endometriosis, and had been trying to conceive for 9 months. After going through ultrsounds, biopsies, and an SIS procedure my physician and I decided to try Clomid treatments before pursuing IVF. Admittedly I had little hope for Clomid, but to our surprise, I conceived during the first month of treatment. I am now 19 weeks and graciously thankful. I do wonder, however, how does someone with such an undetectable AMH level go on to conceive naturally (somewhat naturally)? I realize that the AMH research is still on going, but with the lifetime of menstrual issues I’ve had (cycles vary between 15-40 days with 14 days of bleeding), I hope to bring a glimmer of hope to those who are willing to wait a few extra months to try a fertility medicine before IVF.

  165. Commenter says:

    Dear Dr. Karande,
    I’m 37 and TTC over 24 months
    5′ 5″ , 150lb
    AMH – 0.37
    3rd day – FSH 8.4 & Estradiol 43
    21st day – Progesterone 5.68
    HSG test revealed no tubal issues

    Please advise if 2 cycles of Clomid and Ovidrel are appropriate? Also, do you suggest freezing eggs, since we are planning on having 3 children…Is it even possible in my case?

    Thank you for your time in advance,
    Stacy Sullivan.

    • Hi Stacy
      I am a bit concerned about the duration of infertility. 85% of couples will conceive in the first year of trying. Another 10% will conceive in the second year. After 2 years of trying, at age 37 I would recommend pursuing pregnancy aggressively.
      Your AMH level is low. That is another reason to pursue pregnancy aggressively.
      It is okay to start with Clomid for 3 cycles, but the odds of success are low. The pregnancy rate with Clomid in your age group is approximately 6% per cycle.
      Another option would be to start with FSH/IUI for 3 cycles before proceeding to IVF.
      If you do end up pursuing IVF, freezing eggs would be an option. But since you are in a stable relationship, why not freeze embryos instead?
      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you very much, Dr. Karande for the suggestion. We will first attempt the FSH/IUI for 3 cycles and see what happens.
        Best,
        Stacy

  166. Commenter says:

    Hi Doctor,
    I am a female, age 36. Planning for the first baby. Have gone thru all possible test, 5 IUIs but all in vain. In the first IUI, i got pregnant but it being a Polycystic pregnancy, so it was aborted. Post that 4 more IUI attempts were made by in vain.

    Earlier I got my AMH tested and it was 1.86 but I got my AMH tested again this week (29th sep 2013) and it is at an alarming level. Find the details below from the report
    AMH = 10.45
    TSH = 4.69
    Uric Acid = 5.5
    ESR = 51

    Now my doctor has suggested IVF in Nov 2013, but while studying on Internet, I found that such high levels are AMH are dangerous. Please suggest what should be our step.

    awaiting reply

    • A high AMH level indicates there are plenty of eggs (antral follicles) in your ovary. This is also common in patients with PCOS. You are at risk for ovarian hyperstimulation syndrome (OHSS). Your physician will probably use a gentle stimulation, monitor your ovarian response closely and use other steps (Lupron trigger, freeze-all embryos) to minimize the risk of OHSS.
      Your TSH level is a bit elevated (we like it to be < 2.5) and you need a thyroid pill (Levothyroxine, Synthroid).
      The good news is the pregnancy rates with IVF in this situation are good.
      Hope all goes well with your IVF cycle!
      Sincerely
      Dr V Karande

      • Commenter says:

        Thanks Doctor. AS I understand, my doctor has been using HCG fertigen 10000 iu injection before doing the IUI, so I believe that is one of the cause of elevated levels of AMH.

        Is their anyway we can get in touch with you or approach you for further consultancy ? cause the contact address mentioned on the site are out of India & I am residing in India (Delhi-NCR).

        my e-mail is alkavishnoi@gmail.com

  167. Commenter says:

    my wife’s age is 32 years and her AMH 1.9 ng/ml. Doctor advised for IUI, but we want natural pregnancy. Is there possibility for the same? Please advise.

    • If your testing has all come back normal and you have been trying on your own for a year, IUI is a reasonable next step.
      85% of couples will conceive in the first year. Another 10% will conceive naturally in the second year. This means, in the second year, your chances of conceiving “naturallY’ are about 3% per month. With Clomid/IUI, the pregnancy rate is about 10% per cycle.
      Sincerely
      Dr V Karande

  168. Commenter says:

    MY AMH LEVEL IS 1.2,HOW MANY CHANCE I HAVE TO GOT PREGNANT

    • Your AMH level is okay.
      If you have been trying for a year please consult with a fertility specialist.
      Sincerely
      Dr V Karande

      • Commenter says:

        my Dr.told me that its low & u need some treatment & after that she will give me iui treatment,i m trying from last 2 year but no result…i face miscarriage in 2009 after that i don’t conceive.what should i do now,i m 31 yr old…& too much depressed after taking long time treatment & still i don’t get any result.

        • So, your AMH level is low, you have been trying for 2 years, have had a miscarriage and have been recommended IUI.
          The one fact in your favor is that at age 31 you are still very young!
          I know, two years can be a very long time when you are trying to conceive.
          Please do not give up and also ask your doctor about more aggressive treatments such as IVF.

          You mentioned being depressed. That is not unusual in someone facing infertility. Please do not ignore this and seek help. At InVia, we work with a yoga instructor, acupuncturist, psychologist and a lot of our patients are taking anti-depressants. There is indeed a connection between mind and body. Having a positive attitude can help your chances of conceiving.
          Sincerely
          Dr V Karande

  169. Commenter says:

    Hi Dr Karande,
    My name is Mamata. I am 33 years old. TTC 18 months. My Dr who was treating me didn’t do the FSH, LH test..just the usual blood work. After almost a year and 2 failed IUI’s, I met with another Dr. My FSH is 9.2, AMH is 1.3, E2 is 27, AFC is 5 (2+3). The Dr said I have DOR but mentioned we can go for a couple of more IUIs and then IVF. What are the chances of success? Can I still go for one cycle of IUI before going to IVF or looking at my parameters, IVF should be done immediately. Basically, is it a lost cause or there’s still hope?

    • Hi Mamata
      It is definitely not a lost cause!
      I agree with your doctors recommendation.
      Try a couple more IUI cycles and then IVF.
      Good luck!
      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you so much Dr karande for your reply. It’s amazing that you take time out from your schedule and reply to everyone. I have been reading your posts and also the comments and your reply and it def gives me some hope.

  170. Commenter says:

    hi am am 48years old ,have PCOS and am obese but working hard on loosing weight.I also only have half of an ovary left after teratoma surgery.My AMH is .14,do you think there is any chance of getting pregnant naturally

    • It would take a miracle. But I do believe in miracles!
      I am glad you are losing weight.
      At InVia, we have helped women in your situation get pregnant with donor eggs. There are three additional requirements 1) You would need to pass a complete medical check up including a stress EKG. 2) We would have you see a high risk pregnancy specialist for a pre-conceptional consultation. 3) We would have you consult with a psychologist.
      Sincerely
      Dr V Karande

  171. Commenter says:

    Dear Dr Karande

    My wife is 45yrs old. Her AMH is 0.81 & FSH is 8.7.
    We have a child 6 yrs old conceived naturally.
    She has undergone IUI twice with medication but unsuccessful a year back.She has been having irregular periods since a year.
    Our doctor has recommended IVF with high stimulation drugs.
    Should. we go ahead with her own eggs or try a donor. We are very confused please advice .

    • The live birth rate with IVF at age 45 is around 1%.
      If that is an acceptable number, please go ahead and try IVF with high stimulation drugs.
      There is also a very high rate of miscarriage and having a baby with chromosomal issues (e.g. Down syndrome).

      Using an egg donor changes all this. The pregnancy rate with egg donation is easily greater than 50%. The risks to the baby will also be much lower. Your wife will need to have a complete medical check up including a stress EKG before pursuing pregnancy with donor eggs.

      Sincerely
      Dr V Karande

  172. Commenter says:

    I am 40 from UAE and trying to conceive my second child.
    I did my AMH test and result is 1.7 ng/ml.
    My doctor said it’s really low and without medication or some treatment I might not success to my dream and even with treatment the possibility is really low. I am desperated.
    Could you please enlighten me about my result, should I immediately begin medical treatment at least?

    Thank you very much

    • Your AMH level would be considered normal for your age at InVia.
      At age 40, please do not waste any time unnecessarily and pursue pregnancy aggressively.
      If other test results are normal, you should try FSH/IUI or go directly to IVF.
      Sincerely
      Dr V Karande

  173. Commenter says:

    hi doctor…
    i am 25/f and had a premature birth before 2 years as the babies kidneys were not fully developed so gave birth to 6 months baby prematurely..
    i am now trying to conceive since one 18 months but no positive result coming out…i done all my tests..
    AMH = 1.60
    FSH = 3.20
    LH = 1.77
    PROLACTIN = 15.94
    HB VALUE = 9.9
    HSG = normal study
    both fallopian tubes are filling and show good and prompt peritoneal spill of contrast.
    uterine cavity is normal
    no filling defects or any synechae shown…

    now am a really worried about my amh as my doc said u have very low chance and have to try getting pregnant asap other wise….

    can you suggest what to do??? please please please……..

    now there is one more problem that my husbands sperm count is low =1.4M/ML..

    will IUI work in my case????

    • Your AMH level is reasonable. I would not consider it to be abnormal.

      Please speak to a genetic counsellor about your babies problems. There needs to be a proper diagnosis so that you can be counseled appropriately about the chances of it happening again.

      You are anemic with a Hb of only 9.9 gm%. Please check with your doctor regarding starting and iron supplement.

      Your husband should have a repeat semen analysis and have his hormones checked (FSH, LH, E2, Total and free testosterone, TSH). He should consult with an urologist to see if his numbers can be improved.

      If severe male factor is persistent, you may need to consider IVF + ICSI as the best option. For IUI to work, we need the total motile sperm count to be more than 10 million.

      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you very much doctor..
        all the tests you mentioned for my husband are below
        FSH = 1.86
        TESTOSTERONE = 479
        SPERM CULTURE = no pathogenic organism grown after 48hrs incubation at 37 degree..
        SCROTAL ULTRASOUND = normal study..
        and my husband also repeated sperm analysis two times…
        ist time it was .. 1.2m/ml
        2nd time it was….1.4m/ml
        CONSULTED a urologist already in max hospital saket ..he gave medicine (androzyme and riconia) but unfortunately when my husband repeated the test after 15 days his count was even decreased to less than 1 million
        please suggest me what should i do

        • I am not able to locate your previous message.
          Based on the contents of this message, your husbands blood test results are normal, scrotal ultrasound is negative for varicocele and there is no infection.
          Your urologist prescribed vitamins and anti-oxidants with no improvement in 15 days.
          For severe male factor, in vitro fertilization (IVF) + intracytoplasmic sperm injection (ICSI) is an excellent option.
          For intrauterine insemination (IUI) to work, there should be at least 10 million motile sperm in the ejaculate.
          Please discuss with your urologist as to whether your husband should have genetic tests to find out why his sperm count is so low (chromosomes and Y-microdeletion test).
          Using donor sperm is also an option, however, most of my patients would prefer to use their husbands sperm.
          Sincerely
          Dr V Karande

          • Commenter says:

            thanks a lot doctor for your valued reply..
            actually my husband suffered from a lot of mental stress since three years…
            as i have already mentioned that there was problem with my baby’s kidneys which were very minor in size and dis-function so had to expel the baby at 6 months….
            i am shocked if i was able to conceive immediately with in 6 months after i got married then now how my husbands sperm counts have decreased to this limit..
            i think it means there is no genetic problem with my husband …..
            you can check above all the details which i have given you in my first comment…..

          • I understand your situation.
            Please seek help from a psychologist, psychiatrist or therapist for your husband. He may need to take an antidepressant. These are very useful to reduce mental stress, Yoga, acupuncture are also useful
            It is possible his sperm count was always low, and you were very lucky to get pregnant within 6 months of trying the first time around.
            Please also have your husband see an urologist.
            If his count cannot be improved, your best option will be IVF + ICSI.
            Sincerely
            Dr V Karande

          • Commenter says:

            DEAR SIR,
            MY HUSBAND TOOK HERBAL MEDICINES HI,SELVES AND WHICH GAVE GOOD RESULT WITH IN 2 MONTHS HIS SPERM COUNT INCREASED FROM 1.2 TO 3.2 MILLION.ML…
            SHOULD HE CONTINUE THESE MEDICINES OR WHAT?I M WRITING THIS MSG ON OUR CONVERSATION EARLIER SO THAT YOU CAN EXACT BE ABLE TO KNOW MY CASE…..WAITING FOR YOUR VALUED REPLY

          • I do not know much about herbal medicines.
            Your husband still has severe male factor infertility.
            There is a sample to sample variation in sperm count.
            This could be a possible explanation for the change in his numbers.
            We recommend IVF + ICSI in these cases.
            Please have your husband see an urologist specializing in male fertility.
            Sincerely
            Dr V Karande

          • Commenter says:

            thanks allot doctor for your reply.
            i would like to inform you that when my gyno doc suggested my husband semen analysis my husband did it from a reputed lab and after we found the sperm count is 1.2 we cross checked it by testing at a different lab which gave not difference 1.25 and then the 3rd lab 1.2 again so it is clear that the variation from 1.2 to 3.2 is because of medicine/exercise and health food,he is taking spemen Himalaya and kapikachu regularly two times a day.now he is going to repeat the test again on 15th feb and what if the result will be more then 4 milion/ml?
            as i earlier discussed with you that my husband suffered from a huge family stress which changed our lives so now we are getting ourselves out of it.i was lucky enough that i conceived after 6 months of getting married but i don’t think my husband’s count was low from the beginning as first 3 months my husband used to ejaculate outside and after that we decided to keep a child now so it happened with in three months… even there is no such problem in my husbands family..i m really worried doc. is there any hope that my husbands counts will increase to the normal within a year ????

          • Only time will tell.
            Extreme stress is known to affect the reproductive system negatively.
            I, however, would like to suggest that he may benefit from seeing an urologist specializing in male fertility.
            Sincerely
            Dr V Karande

          • Commenter says:

            thank you very much doctor,there is a good news as i told you my husband is going to test for semen analysis on 15th feb. and the result came below:-
            sperm count = 10.00 ml/million
            total motility= 30%
            normal morphology= 25%

            now can you please tell what are the chances of conception ?
            are he didn’t went to any urologist and with in 1.5 months of taking herbal medicines his count increased from 3.2 to 10.00 and as you can also see in our previous conversation how it went up from 1.2 to 1.4 and then to 3.2.
            should he continue doing the same exercises and the yoga which he is continuing since last 5 months? as you also said earlier that IUI should have at least 8 million/ml now i think i come in this category..lets hope best to get the count above 50..then there will be much more chances of normal conception,yes i know the percetage motility should be at least 40% but he has reached 30% that is i am very lucky as in earlier reports the percentage was mostly dead spermatozoon seen & non motile… can you suggest any thing more now sir…please with your given info. till now i have learnt alot and have continued many of your instructions

          • I am not an expert on herbal medicines and therefore unable to comment on them.
            It is okay to try IUI, but the best results will be with IVF + ICSI.
            Sincerely
            Dr V Karande

  174. S says:

    Dear Dr. Karande,

    I am 41 (almost 42) and have AMH of 2.1. I have hirsutism so I think I have PCO but not sure. I used to have irregular periods for 20 years, but as soon as I left stressful school/job, it has been regular for past 5 years. Healthy weight. Questions: 1. Is this AMH level normal for my age if I have PCO? 2. I am not married, so considering egg freezing. If I do it, what are my chances of getting pregnant with frozen eggs in 1-2 years time? 3. Would a gestational carrier improve my odds of having a child with my own eggs?

    • Your AMH level is normal. I have written a blog on age and AMH that you may find to be useful. Here is the link http://www.inviafertility.com//anti-mullerian-hormone-amh-and-age

      Egg freezing works better in women under age 37. There are no data (that I am aware of) on success rates with freezing eggs at your age. This is an option worth pursuing for you as long as you realize that it may already be too late for you. Despite your (normal) AMH level, age is an independent variable that must be taken into consideration. Your chances of success are not as good as a 32 yo with the same AMH level.

      If you are healthy, there is no medical indication for a gestational carrier in your case. There are plenty of studies showing that the ability of the uterus to carry a baby is okay at age 42.

      Please discuss the possible diagnosis of PCOS with your Ob/Gyn doctor. If you do have PCOS, you may benefit by screening for hyperinsulinemia.

      Sincerely
      Dr V Karande

  175. Commenter says:

    Dr. My age is 21 year , my AMH is >25 ng/ml . How good/bad are my chances of getting pragnant 1st time . Pls suggest me .

    Thanks
    Anshu Sharma

    • Hi Anshu
      I do not understand why your AMH level was measured in the first place.
      A high AMH level means you have plenty of eggs in your ovaries. This is to be expected at your (very young) age.
      A high AMH level can also be associated with polycystic ovary syndrome (PCOS). However, if your periods are regular and you do not have other symptoms (increased hair, acne) there is nothing to worry about. Even if you do have PCOS, the chances of getting pregnant are good, but you may need help.
      Sincerely
      Dr V Karande

  176. Commenter says:

    Dear Dr. Karande,

    For a 44 year old with AMH 3.6, FSH 5.8, 27 antral follicles and completely regular periods, is there any concern with PCOS and the possibility that it is this that gives me the follicle count and AMH level and that it is not in fact a predictor of fertility? My mother went into menopause at 62. I have a partner who is nearly infertile and although we have considered IVF we cannot now do so and I am thinking of donor sperm. Is freezing eggs at this point even doable, for surrogacy? We are not in a rush, at all, but chronologically I have concerns. As I have some high risk issues other than my age, I am willing to freeze eggs and do surrogacy, and am becoming more comfortable with the donor sperm possibility as well. I have very mild PCOS symptoms like heavy periods and a few little hairs on my chin at times, but clearly no definitive situation as my periods are regular and I am 5’4 108-112 pounds. I am interested in your perspective, as you are very helpful to everyone.

    Thank you!

    • I do hope you will find my reply to be useful.

      At age 44, the live birth rate with IVF using your eggs is around 1.1%. Here is the link to the latest data (2011). Please go to page 24 for further details http://www.cdc.gov/art/ART2011/PDFs/ART_2011_Clinic_Report-Full.pdf

      It is possible you can beat the odds, and will never know if you do not try.

      You could also try a few FSH/IUI cycles. The decision to use donor sperm is a serious one and you and your partner may want to discuss this with a psychologist/therapist before pursuing this option.

      I am not aware of a single pregnancy reported with eggs cryopreserved at age 44.

      Please consult with a Board Certified Reproductive Endocrinologist to get more specific advice. We would welcome you as a patient at InVia.

      Sincerely
      Dr V Karande

  177. Lisa Grant says:

    Dear Dr Karande

    I am 33 yr 6 months, have had an ectopic at 22 and again last Feb at 31. In October 2008 had a twin miscarriage and then in Feb 2009 a further miscarriage. In October 2009 I fell pregnant again which turned out to be a normal pregnancy and I had my son in 2010. Anyway last February I decided to try for my second baby for it to be an ectopic in my right side which was same side as in 2002 so the tube was removed and in July of last year (2012) I decided to try again with no success. I attend my GP in July of this year to have ovulation tests ect. All came back as normal, my husband had semen tests again normal, I then attended hospital to check my left (remaining) tube to be told slight blockage but managed to disperse and now “patent”, consultant advised I try myself. Anyway I decided enough was enough and go for advice on ivf. I attended for assessments and then last night for consult to be told my amh is 8.9 which is low for my age? Why has this decreased so much? My bmi is normal. Do I still stand a good chance of conceiving?

    Many thanks

    Lisa

    • Hi Lisa
      Congratulations on having a son in 2010. It takes a lot of guts to go through what you endured to have him. I am happy your efforts resulted in a successful outcome. I agree, IVF is the best option for you. The chance of you having another ectopic if you tried on your own is close to 16%. With IVF, the risk is probably 5%.

      What units were used for your AMH level? What is considered a normal level for your age? We use ng/mL and a level of 8.9 ng/mL would be considered to be high!

      Patients with low AMH level will generally produce few eggs. Your doctor will probably use an aggressive stimulation protocol to try and maximize number of eggs retrieved. Remember, it is “quality” and not just “quantity” that matters. We have had several pregnancies in patients with low AMH levels. I wish you good luck and hope you have a positive outcome.

      Sincerely
      Dr V Karande

  178. Angela says:

    Hi doctor,
    I have been seeing a fertility specialist as I experience prolonged bleeding. I have had my first cycle of clomid. I recently received my amh levels and told they are quite low for my age 3.4pmol/l I don’t know what this is in ng/ml scale. I’m confused because there seems to be different interpretations of what is considered low. If my amh is really low what steps should I take next?
    Thank you

    • if you are ready to have a child, please pursue pregnancy aggressively. Seeing a fertility specialist is a correct first step.
      AMH levels reflet the number of eggs that remain in your ovary (ies). Since there is no way to add “new” eggs, it is not passible to increase your AMH level.
      Sincerely
      Dr V Karande

  179. Commenter says:

    Dr Viswanath,

    My Amh@Dec2012 was 1.8
    @Amh@April 2013 was0 .9
    And October 2013 is .o52.
    I AM ON OVIGYN D tab since Dec 2012.why still so drastic fall. Is it safe to go with same medicine for almost a year.I
    How can I increase ovarian reserve …any path.

    • Prolonged use of birth control pills can suppress AMH levels.
      You have not told me your age or whether you are trying to get pregnant.
      Why were your AMH levels measured in the first place?
      Sincerely
      Dr V Karande

  180. Commenter says:

    Dear Dr Karande,
    I would ask please behalf my wife, her AMH is 1.5 4 months before after that she is taking DHEA medicine from last 3 month after that today I got my report in that AMH level deceased to 1, is she has any
    chance to be pregnant, or are there any plane to treatment . her age is (37). Shall IVF be possible at this AMH level.

    Regards,
    Dinesh

    • Hi Dinesh
      We have had several pregnancies with an AMH level of 1 or 1.5 ng/ml. In addition to her age, her FSH level, weight and antral follicle count should be considered when formulating the stimulation protocol.
      Good luck!
      Sincerely
      Dr V Karande

  181. Commenter says:

    Hi Dr Karande,

    I am 38 yrs old, AMH = 0.6, AFC = 5; one blocked fallopian tube;
    FSH was 6.7

    i tried one cycle of IVF with
    gonal F 450; buserelin 05; luveris :150

    during ultrasounds they tracked 11 follicles (6 on right 5 on left)

    i was triggered when two biggest follicles reached 19mm
    they retrieved only 6 eggs out of which only 3 were mature
    and 2 fertilized using icsii
    2 excellent 4 cell embryos were transferred on day 2, none left to freeze
    i had a sudden onset of cold and mild fever around 5 days after transfer. It lasted 3 days.
    i took a HCG test day 16 after collection and it was negative.

    I am figuring out what my options are at this point?

    1. should I consider procedure to recanalize my blocked fallopian tube? or
    2. continue with IVF round 2 – if yes what are my chances with my own eggs
    what protocol should i use?
    i3. s there any benefit to trying IUI ?

    Do you think the sudden onset of fever 5 days after transfer could indicate an immunologic response against implantation?
    My blood type is negative.
    would it be useful to do genetic screening on embryos before transfer?
    Could aspirin help with IVF?
    what about accupuncture?
    I have read that DHEA can improve quality of eggs…

    Thank you for your answers in advance

    regards
    anika

    • Hi Anika
      The number of eggs retrieved is consistent with your AMH level (0.6 ng/mL) and your antral follicle count (five).

      If you try IVF again, you may want to consider using a “luteal estrace” protocol. In this protocol, we treat patients with estradiol tablets (2 mg twice daily) in the cycle prior to stimulation starting about 7 days after ovulation (day 21) till start of stimulation. I plan on writing a blog with the details soon.

      We have also been using Androgel 1% to try and increase the number of antral follicles and therefore number of eggs retrieved. Here is a link that you may find useful http://www.inviafertility.com/blog/ivf/drvkarande/testosterone-supplementation-and-ovarian-response-in-poor-responders

      Using a higher dose of medications may help (rFSH 450 + hMG 150 units)

      I do tubal catheterization to open up blocked tubes fairly regularly. You may want to consider this option, but at your age and with your ovarian reserve, doing another IVF cycle would be my recommendation. It is the more aggressive option with the higher pregnancy rate per attempt.

      The rise in temperature may very well have been secondary to your progesterone supplementation. It has to be > 100.4 degrees F to be considered as a fever.

      You are not a good candidate for PGD as you are producing very few mature eggs.

      Your blood type does not affect outcome.

      Hope you find my answers to be useful.

      Sincerely
      Dr V Karande

      • Commenter says:

        Thank you so much for you response Dr Karande.

        I wonder if the reason they only retrieved 6 total eggs (3 mature) from 11 follicles is because they triggered me to early?

        I started treatment at 450 Gonal F and they asked me to reduce the dose to 300 after they counted 11 follicles (ranging from 5 – 12 mm) on day 4 ultrasound….
        they triggered my when my two lead follicles were 19mm and the others ranged from 10 – 17mm.

        I live in canada…and the universal healthcare system here means long waits…
        i started seeing an RE in nov 2012 and my first IVF was last month… ..
        once again looks like its gonna be at least 3 months before i can do cycle 2…
        in the meantime…while i am waiting i thought maybe recatherization of fallopian tube could help… me get lucky naturally… especially while my body is still full of hormones…

        than you once again for your kindness in responding…
        it means a lot…

        I did my IVF cycle 1 at Mcgill University. i feel like we get treated like cattle here… none gives any answers…
        during treatment… i didn’t see my doctor even once after my calendar was decided… the nurse called to convey messages… and they never provided the reasoning…

        the information you provide on your blog and the answers you patiently give to so many questions is very very helpful…

        god bless you for your kindness…

        thank you once again
        anika

  182. Commenter says:

    Dear Dr Karande,

    I read your response to all the aspiring mother on this forum and I am very interested to know the status of my wife. Weve been leaving almost 10yrs and we have no change for a baby.

    My WIFE
    1. 30 yrs OLD, NO regular Menstruation
    2. We have undergo several test like FSH, AMH, Laporascopy, Paps Smear, Clomid, Glucopanse, Metformin, etc..
    3. She undergo 3x for IUI (all failed but it ovulates)
    4. Lastly her AMH is 9.365ng/ml (recent sept 9, 2013)
    5. She has a PCOS

    Our doctor specialist recommended us for IVF. Appreciate your comments and suggestion to our situation. We are having a hard time to have a baby. Looking forward to your response Doctor.

    By the way we are from Philippines, Manila. Hope you could give as an advise if we have a change for a baby. God Bless..

    Regards
    Jeff

    • Hi Jeff
      I agree, after 10 years of trying and failing 3 IUI attempts, IVF is the way to go.
      Your wife is young and with an AMH of 9.365 ng/mL she should produce a good number of eggs even with gentle stimulation.
      The IVF pregnancy rate in patients with PCOS is generally excellent.
      Good luck!
      Sincerely
      Dr V Karande

      • Commenter says:

        Thanks for prompt reply Doctor, Well try this IVF hopefully this will give us a success. Appreciate your advised Dr. God Bless…

        Regards
        Jeff

      • Commenter says:

        Thanks Doctor wll try for this one. Hope this will work for my wife. God Bless

        Regards
        Jeff

  183. Commenter says:

    Dr. Karande, first of all from one health care professional to another, excellent posts, a pleasure to read through.
    We would love your perspective on our situation. We wanted a big family, “6” was our number. I will be 39 y/o next mth & have been very blessed w/ 4 children (ages 8y, 6y, 4y & 16 mths). Aside from losing one twin at 20wks during my third pregnancy, due to twin to twin transfusion, no other problems. In Jan, when my youngest was 6 mths old I found a lump while breastfeeding, it was cancerous. Neoadjuvant chemo (taxol, then adriamycin & cytoxan) & mastectomy was recommended. We consulted a reproductive specialist prior to starting. Via u/s, I was told I had numerous eggs that were in a perfect state for harvesting at that point (due to BF). We decided against any procedures, but instead opted for Lupron (11.25mg/3 mths) during treatments.
    My last lupron was end of April, last chemo was end of May, surgery end of June. I have not menstruated since before becoming pregnant with my son (LMP 10/11). I also lost weight (~40lbs) & am now borderline underweight (5’9.5” & 128lbs). T my recent ob/gyn appt an AMH was performed with lowest possible detection (<0.03). We are surprised from being full of great looking eggs, to have no reserve at all.
    I have completed treatment w/ excellent prognosis (80-90% chance of no recurrence) & we are readdressing our family. We are still agreed that we are not interested in any procedures but would be otherwise amenable to pharmaceutical interventions. We have an appointment to see a RE in a couple of weeks & want to be prepared. Is there any chance of lingering eggs in need of fertilization? Will any pharmaceutical interventions help at all? Should we just be ready to go with our back-up plan of foster care w/ adoption?
    Thank you very much for your insight – very much appreciated!

    • First of all congratulations are due to you.
      Congratulations for having beaten the cancer!
      and
      Congratulations for having a beautiful family!

      The chemotherapy did good by destroying the cancer cells, but at the same time seems to have had a negative impact on your eggs.
      The AMH level is consistent with diminished ovarian reserve secondary to the chemotherapy.

      Your RE will probably do a vaginal ultrasound to assess the antral follicle count. If the ovarian volume is < 3 cc and there are hardly any antral follicles, your chances of conceiving with IVF are very low. In that case you may want to pursue your back up plan. Please discuss the option of using an egg donor as well.

      However, please remember there is a small chance that you could conceive on your own.

      Sincerely
      Dr V Karande

  184. Commenter says:

    Thank you so much Dr. Karande. Your insight is so very appreciated. And you are right, although I was disappointed about the AMH levels & its indications, the chemo has saved my life & I would do it all again. I am blessed. Just a couple of quick follow up questions.
    1) Would an ovarian stimulant be worth trying?
    2) Also even if I can’t conceive am trying to avoid going into full fledged menopause at 39, any secrets to doing so?

    Thanks again,
    Liz

    • Hi Liz
      It would depend on your antral follicle count. If there are hardly any antral follicles, your chances of conceiving with or without ovarian stimulation will be similar.
      I have proceeded with FSH/IUI cycles in your situation with the patient understanding clearly the low chance of success.

      I have no secrets regarding preventing menopause.

      Sincerely
      Dr V Karande

      • Commenter says:

        Hi Dr. V Karande,
        I recently underwent 1 IVF cycle and I am 37 years old my AMH is .53 and my FSH is 10.4. I had three embryo’s transferred two grade A and one grade B. Do you think the quality of my eggs are poor given the above info? How many cycles of IVF do you recommend?

        Lala

        • Hi Lala
          Your blood test results suggest you may have diminished ovarian reserve.
          I do not have enough information to give you specific advice on how many IVF cycles you should attempt.
          Please meet with your doctor and see what he/she says.
          We would welcome you as a patient at InVia.
          Sincerely
          Dr V Karande

      • Commenter says:

        Just wanted to leave an update. We have finally adjusted to the news that with an AMH at undetectable levels following chemo one year ago that any further natural pregnancies would be highly unlikely. Although I did begin taking DHEA to combat menopausal symptoms, we have moved on in our new phase of life & are greatly enjoying keeping active with our children.

        After nearly 2.5 years w/o menstruating, I was happily surprised to resume menstruating in April 2014, just to have it last only 1 & 1/2 cycles before stopping again. Well I went to the Ob/Gyn for a follow up on my cycle and low & behold positive HCG, ultrasound verified a 6 wk pregnancy with a strong heartbeat (corpus luteum even visible on the left). Shocking to say the least.
        We are deeply spiritual with a strong relationship God. While some would say miracle, we just say blessing from above.
        Hope this translates as a message of hope to all, anything is possible.

  185. Commenter says:

    Hi Sir , I am a 31 y.o unmarried lady 40 kg 145 cm and Don’t Have My period for 7 month and seldom have periods ( I did have sex ) my fts are high 63.6 MIu /ml tshs 12.289uiu/ml , Amh <0.14 ng/ml ,<1.00 pmol /L . I am single , I am really so afraid, am I menopause ? Can I pregnant if I get married later ? Can hormon therapy help me? Please I am really so lost , ur reply means a lot to me… Tks sir

    • You need to see a fertility specialist for a formal opinion.
      You do have diminished ovarian reserve based on your blood test results.
      With a high FSH level, low AMH and the fact that you have not had a period for 6 months implies that you are indeed menopausal.
      You need to be on medications to prevent bone loss.
      Please consult with a Ob/Gyn or REI.
      You could get pregnant but probably with donor eggs.
      Sincerely
      Dr V Karande

      • Commenter says:

        MY AMH LEVEL 1.6 ng/ml age 30 height 170 cm weight 57… what are the chances of her pregnancy through ivf ??? hope to hear some positive

        • Your AMH level is fine as is your BMI. Other factors that need to be considered include your day-3 FSH level, antral follicle count, age, previous response to stimulation, semen analysis report and uterine cavity status. Since I do not have all the information, it is not possible for me to give you a specific answer. We would welcome you as a patient at InVia.
          Sincerely
          Dr V Karande

  186. Commenter says:

    Hello Dr.

    I read through some of the comments. I guess everyone has a different issue. Please could you tell me what the following readings mean in my case and what should I do? I have just completed 45 yrs this month, got my blood result from midwife yesterday who said my AMH is 4.9 and I could not do the day 21 blood test being Sunday so, I had it on day 22 of my cycle which says 55 (is that test for progesterone, no idea what it means?) Dec 2012 the 1st day of my cycle blood result shows Progesterone 21.7, TSH 1.67, LH 3.5, FSH 3.1 and 3rd day cycle shows Testosterone 0.3, SHBG 36. My GP had said I am anaemic and my iron level is 11.4, T.I.B.C IS 75, TfS is 15. Still waiting to hear from the specialist. He has given me Clomid 50mg for 4 cycles to be taken from day 2 to 6 and wants me to go for IVF with donor eggs (which is expensive). my husbands result shows Progressive motility 65%, Immotile 30%, consistency pus like, count 999 10^6. We have been trying now for a year as we had no idea about the right timings. I do not want to lose hope and want to improve my levels both naturally and with medication if available. I want a natural way with my own eggs, is it possible? Thanx LORI

  187. Commenter says:

    Dr. Karande – I just want to say thank you. As a physician I know how difficult it is to answer questions with only a speck of information, but you do so in a thorough, responsible manner. You are helping both men & women by giving honest, yet hopeful insight on complex, emotional situations. Kudos to you & this blog !
    With deepest gratitude – Liz A.

  188. Commenter says:

    Dr. Karande,
    I have a few questions. I became pregnant through an unmedicated iui in March. My husband as issues ejaculating so it was hard for us to try on our own, we actually used a syringe for 7 months to try to inseminate ourselves. My question is, I had my FSH tested twice once at 10.1 and most recently at 9.7. My amh is 3.97, my afc for one month was 30+ and this current month I had 15+ follicles on one ovary and 8-9 on the other. Also, let me add that I smoked about 6-7 cigarettes up until I was about 22 and then I cut back to 1 or 2 a day and now i’m completely done and i’m 29. My fear is that my cigarette smoking lead me to have high FSH which in turn lead to bad eggs and that i’ll never conceive with my own egg. My RE can’t tell me why my fsh is borderline, just that all of my other results are fine and that I have a lot of eggs. Is it possible for them all to be bad at 29. My BMI is 19.3, I eat healthy, exercise moderately. Im not sure if I’m battling infertility or if my husband’s issue is what Is holding us back. He generally can only ejaculate once per cycle and generally its about 3 days before I ovulate if not sooner. __ not sure why it works like that. so our only chance is the sperm from the iui. We are going to be doing 2 more unmedicated iuis before doing ivf in January. Any advice would be greatly appreciated.

    • I am sorry your pregnancy resulted in a miscarriage! Also, I am glad you have quit smoking completely. I do not think you should worry too much about your “borderline” FSH level. Your AMH level is fine and you have polycystic appearing ovaries (> 12 antral follicles).
      You could try natural cycle/IUI. A better option would be Clomiphene citrate /IUI.
      Why don’t you have your husband cryo-preserve a few samples? That way there will be enough sperm available for IUI and reduce any “performance anxiety” on part of your husband.I would consider IVF only if you have failed 3 – 6 cycles of Clomid/IUI.
      Sincerely
      Dr V Karande

      • Commenter says:

        I did try clomid this cycle but the iui timing was off. I ovulated the day before the IUI ( I temp). Also, The reason that my dr said to do IVF in Jan is because the clomid cycles cost around $2000 and success rate isn’t great. Would you be able to advice if FSH is indicative of egg quality and why at my age with my AFC mine is “borderline”. My RE said that smoking only affects your reserve and your eggs while you are smoking. Have you seen a 29 year old with a similar AFC with all bad eggs?

        • Commenter says:

          Also, just a side note, my husband can provide a sample on his own for iui with no problems. it’s when it comes to intercourse that he has issues. He says that it may be a sensitivity issue. His count is always good around 25 mil after wash. The RE did say that his volume was low which may be why us trying the insemination on our own did not work

        • I am not sure why you think your eggs are “all bad”.
          I do hope you have quit smoking completely.
          We usually recommend 3 – 4 IUI cycles with Clomid before considering IVF.
          FSH/IUI has a relatively low pregnancy rate and has an uncontrolled risk of high-order multiple pregnancy. We are therefore using less of this option and more of IVF as the next step (especially in young patients).
          Hope this helps
          Sincerely
          Dr V Karande

          • Anonymous says:

            Dr. V,
            Thank you for you expertise. I guess it is just my fear that my eggs are bad due to my dumb decision to smoke and because my first pregnancy ended in a blighted ovum. yes, I am completely done smoking. It wasn’t hard as I was mostly a social smoker for the past 5 years. Is fsh/iui meaning an iui with the injectibles?

          • Yes
            You start the daily sub cutaneous injections of follicle stimulating hormone (FSH) for 9 – 11 days starting on cycle day-3.
            The cycle is usually monitored with blood tests and ultrasound and ovulation is triggered with hCG 10,000 units with IUI being done on the next couple of days.
            Sincerely
            Dr V Karande

          • Commenter says:

            I was reading a study that showed AMH is more predictive of IVF outcome for younger women where FSH was more predictive for older women. Do you find this true? Also, are you able to give me some insight or advice as to why my fsh is high for my age but my AMH is consistent with PCO?

          • I am not aware of the paper you are reading. If you forward the reference to me, it will make interesting reading.
            AMH generally reflects the number of eggs that will be retrieved during IVF.
            FSH levels are predictive of decreased chances of pregnancy when they are above a certain level (> 12 mIU/mL at InVia).
            I have recently written a blog on what it means when FSH and AMH levels are discordant.
            Sincerely
            Dr V Karande

          • I have not read the paper and would appreciate if you can send me the link.
            An AMH level generally predicts the number of eggs that will be retrieved during IVF.
            FSH level predicts a decrease in the chance of pregnancy especially when it is above a certain level (> 12 mIU/mL at InVia).
            I have written a blog on what it means when the AMH and FSH levels are discordant.
            Here is the link http://www.inviafertility.com//what-if-my-fsh-level-is-normal-but-my-amh-level-is-low
            Hope you find it to be useful.
            Sincerely
            Dr V Karande

          • Anonymous says:

            Also, I saw that you said fsh is indicitive of Ivf success. Is there a cut off? Can you tell me how that correlate.

          • Each clinic has to determine the FSH level at which it sees a drop in pregnancy rates. The number will vary based on the assay used for measuring FSH.
            At InVia, we see a decrease when the FSH level is > 10 mIU/mL, a further decrease when it is > 12 mIU/mL and a steep drop when the level is > 15 mIu/mL.
            Hope this helps.
            Sincerely
            Dr V Karande

          • Commenter says:

            I just have another question.
            I read above that you said FSH predicts IVF success and AMH predicts the number of occytes retrieved. If this is the case, what do you think the prognosis is for me being that my fsh is 10.1? Also, can you tell me why it does not correlate with my amh?

          • Your FSH level would be considered borderline elevated at InVia.
            It is not unusual for there to be a discordance between AMH and FSH levels.
            Here is a link to a blog with further details on the issue
            http://www.inviafertility.com//what-if-my-fsh-level-is-normal-but-my-amh-level-is-low

            Sincerely
            Dr V Karande

          • Commenter says:

            Here is the study I was talking about. I have also attached two others that I found interesting as I am constantly researching this. I still don’t understand what exactly FSH measures and how it correlates with IVF success. Does it measure the quality of eggs? So even being 29, with my fsh of 10.1, I only have a fair chance to have my own child? Its very confusing to me!

            http://www.rbej.com/content/8/1/64

            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894827/

            http://www.lifecyclelaboratories.com/wp-content/uploads/Clinical-relevance-of-combined-FSH-and-AMH-observations-in-infertile-women.pdf

          • Thank you for sharing these papers.
            We will need other groups to confirm this finding.
            Sincerely
            Dr V Karande

          • Commenter says:

            Here is another study.
            This one says that elevated FSH in younger women <35, it doesn't seem to be an accurate predictor.

          • Commenter says:

            This is from your blog and im confused. In one paragraph it says:
            Women with elevated FSH who had a AMH level > 0.6 ng/mL, had twice the number of eggs retrieved, a greater number of day-3 embryos, a third of the cancellation rate, and a trend toward higher clinical pregnancy rates when compared with women with a AMH level <0.6 ng/mL.

            But then it says that someone with normal fsh and low amh will do better than someone with high fsh? Once again, i'm confused about this data?

  189. Commenter says:

    Dr. Karande,
    I have a few questions. I became pregnant through an unmedicated iui in March. My husband as issues ejaculating so it was hard for us to try on our own, we actually used a syringe for 7 months to try to inseminate ourselves. My question is, I had my FSH tested twice once at 10.1 and most recently at 9.7. My amh is 3.97, my estrogen was 43 and LH was 11 my afc for one month was 30+ and this current month I had 15+ follicles on one ovary and 8-9 on the other. Also, let me add that I smoked about 6-7 cigarettes up until I was about 22 and then I cut back to 1 or 2 a day and now i’m completely done and i’m 29. My fear is that my cigarette smoking lead me to have high FSH which in turn lead to bad eggs and that i’ll never conceive with my own egg. My RE can’t tell me why my fsh is borderline, just that all of my other results are fine and that I have a lot of eggs. Is it possible for them all to be bad at 29. My BMI is 19.3, I eat healthy, exercise moderately. Im not sure if I’m battling infertility or if my husband’s issue is what Is holding us back. He generally can only ejaculate once per cycle and generally its about 3 days before I ovulate if not sooner. __ not sure why it works like that. so our only chance is the sperm from the iui. We are going to be doing 2 more unmedicated iuis before doing ivf in January. Any advice would be greatly appreciated.
    I also had my estrogen tested on the day of my + surge last month and it was only 153 on the day I ovulated. Is that problematic?

    • Commenter says:

      might I add that I have had 4 unmedicated iuis since my miscarriage and I feel that the timing was off for them. After the first iui following my miscarriage, I had an hsg which showed some debris in my left tube and the dr flushed it out. so he said to disregard the first iui and so I guess we have done three since that were unsuccessful.

  190. Commenter says:

    Hi I am 40, my
    LH is 39. and
    FSH 37.
    What does it means I see that you mention numbers like 1.2 or .# how do I interpreted this results, I had the AMH test today so I will be getting the results next week. I had chemotherapy for breast cancer so I need to know how it affected my fertility since I was told I may never have a baby due to the chemo.
    Thanks

    • It is good to hear from you. The very fact that you are now pursuing pregnancy leads me to believe that you have recovered from the chemotherapy and have successfully beaten the cancer.
      The chemotherapy may have helped with destroying the cancer cells, but seems to have had a negative impact on your fertility.
      I am afraid the numbers are not good (if the blood was indeed drawn on day-3 of the cycle).
      It is a good idea to check your AMH level.
      Please discuss with your fertility specialist the options you may have to consider in order to have a baby.
      We would welcome you as a patient at InVia.
      Sincerely
      Dr V Karande

  191. Commenter says:

    I have been pregnant 8 times and have no children. 2 were ectopic with the tubes removed. My labs were FSH 6.3, AMH 1.6, Estrodial 22.6, and AFC 18. I’m feeling a little defeated….

    • I am so sorry that your 8 pregnancies have not resulted in you having a child.
      With the tubes removed, you do need some form of assisted reproductive technologies.
      I do not have enough information to give you specific advice.
      We, however, would welcome you as a patient at InVia.
      Sincerely
      Dr V Karande

  192. Commenter says:

    I am 35 and have been diagnosed with PCOS based on ultra sound and irregular menstration (progesterone was tested and is .5 and haven’t had a period in several months). I’m not on birth control or any other type of hormone/drug. I’m not the “typical” PCOS patient in that I am quite thin (5 foot, 4 in and about 116 lbs) and although I understand that many PCOS patients have reduced insulin sensitivity my blood sugar is only 86 (fasting). I’ve had all sorts of tests and everything comes back normal (no cancers, no prolactin issues, thyroid is fine, etc) but my amh test is 33. Everything I’m reading online says that amh levels are typically just over 1 or just under 1. What in the heck does 33 mean??

    • You do meet the criteria for a diagnosis of polycystic ovarian syndrome (PCOS). It is a good thing that you do not have hyperinsulinemia and/or weight issues.

      Anti-mullerian hormone (AMH) levels reflect the number of eggs (oocytes, antral follicles) that are present in the ovaries. Your AMH level is indeed very high. This indicates that you have PLENTY of antral follicles in your ovaries — something that can be confirmed on ultrasound.

      You are not ovulating on your own and will require medications to make you ovulate when you are ready to have a baby. Your physician will have to monitor you very carefully for ovarian hyperstimulation syndrome.

      I am delighted your blood tests have all come back normal. It makes sense for you to continue taking birth control pills so that your uterine lining is shed regularly.

      Sincerely
      Dr V Karande

  193. Commenter says:

    I am41 and I just did an amh test. I was told it was 1.02. no drugs. could I possibly not go on drugs to increase growth or stimulate more follicles.

    • The answer depends on how long you had been trying.
      If you have been trying for more than 6 months, then I would suggest you pursue pregnancy aggressively.
      At InVia, we would suggest you try FSH/IUI or IVF.
      Sincerely
      Dr V Karande

  194. Commenter says:

    Hello Dr. Vishvanath,

    First wanted to thank you for moderating such a wonderful, support and helpful blog. I have read most entries and find them very helpful in my quest in becoming a mother.
    Here is my story:
    I am 38 year old, recently met and married my husband in the last 2 years. My AMH level is 6.3pmol/L (I think that converts to .88ng/ml, FSH6 and antropholical count 5. I have stage 3 endometriosis, and have had 2 laporoscopy’s ( in my lifetime). Never been pregnant- never tried.

    Based on those numbers and my age, what is the likelihood of us getting pregnant naturally?

    If that is not successful, would I be a good candidate for IVF (based on my stat’s).

    Thanks
    Anne

    • Hi Anne
      You should pursue pregnancy aggressively without any further delay. If the work up is otherwise normal, I would recommend FSH/IUI or IVF as the first step.
      The following factors influenced my recommendation: your age, your Stage III endometriosis, and borderline okay ovarian reserve tests.
      We would welcome you as a patient at InVia.
      Sincerely
      Dr V Karande

  195. Commenter says:

    I am 40 years old and my doctor told me my AMH test was under 1, therefore I did not have any “viable eggs”. My FSH was 8. Other than my age, I am a healthy, non smoker/drinker. Is what my doctor told me accurate? Should I be asking for something more (more tests, more specifics)?
    Is IVF an option for me?
    Sincerely,
    Yvonne

    • Hi Yvonne
      I disagree with your doctor. I also think it is not right to deny treatment based on a blood test alone.
      We have had several patients with a low AMH conceive — both naturally and with assisted reproduction (IVF).
      You will produce few eggs and the pregnancy rate will be lower than someone with a normal AMH level.
      Please get a formal second opinion.
      We would welcome you as a patient at InVia.
      Sincerely
      Dr V Karande

  196. Commenter says:

    Sir,
    My amh value is 1.5 and fsh is 6.41. I am 35 years old. My fertility sp is asking me to go for donor egg. The option is not easy for me. Is there any hope for me ?.

    • I do not understand why your fertility specialist is recommending you use donor eggs based on the information provided.
      Your lab values are normal.
      Please get a formal second opinion.
      We would welcome you as a patient at InVia.
      Sincerely
      Dr V Karande

      • Anonymous says:

        Sir..
        We went for a second opinion where I was given menagon. Even after five days ther were only two follicles. The bigger one went uppto 3 unit s but did not rupture. Second one was too small to be considered.
        And now the second opinion specialist also gave egg donor as the option. I
        We are getting this treatment done in Mumbai. Is this the only way for me. . Request guidance.

        • I am unable to give you specific advice on such an important issue with the limited information provided.
          If you are not satisfied with the second opinion, please get a third opinion.
          There are many excellent fertility doctors in Mumbai.
          Sincerely
          Dr V Karande

  197. Commenter says:

    Hello Dr,
    I had tested AMH in April 2013 (Aged 30yrs in nov), it was 1.65ng/ml (Day9). My Dr told me to repeat the test in the month of Nov(Day2) it became 0.78ng/ml
    LH 9.81mIU/ml
    FSH 9.88mIU/ml – Now my Dr says its high time to think of IVF else you may not be able to use your own eggs.

    Im completely broken on hearing this. Can AMH reduce so drastically ?

    • AMH levels do vary. I have written a blog about this very issue that you may find interesting. Here is the link http://www.inviafertility.com//top-5-new-facts-about-anti-mullerian-hormone-level-amh-and-ovarian-reserve-testing

      The initial step usually is ovulation induction with clomiphene citrate and timed IUI. If you have failed 3 – 6 such cycles, then it may be time to consider IVF.

      Please get a second opinion. We would welcome you as a patient at InVia.
      Sincerely
      Dr V Karande

      • Commenter says:

        Hello Dr,
        Many Thanks for the reply.

        In addtion I would like to share the following with you ,
        We have been married for almost 3yrs & TTC only since Feb.
        In Feb, we consulted a gynae for folic acid,she prescribed me siphene along with folic acid (that time I was nt aware that it was a hormonal tablet).
        So even from the first month of ttc I took tablet, she gave me tablet since I was very anxious.
        Then clomiphene, ubhiphene, (FSH Injection + HCG in one cycle, we failed to intercourse due to som reasons).
        After all this went for 6months, I was tired running to labs & ultrasound. I told my Dr that I want to stop all these taking only folic tablets &
        try naturally. She told me to check the AMH & other hormones mentioned above.

        Thats when all these confusion started, can I try naturally or should I have to go for further treatment ?

  198. Commenter says:

    My AMH is <0.16. I have bad endometriosis. Many of my hormones are abnormala(progesterone, testosterone & DHEA) we think the abnormal hormones are making my migraines worse. Considering a hysterectomy. I'm 38(due to many health probs not gonna try for more kids) probably unlikely anyway with level so low?? I already have osteoporosis so apparently ovaries aren't doing what they need to. With the bad endo, hormone abnormalities and worsening migraines Would you recommend a Hysterectomy???
    My doctors agree with it guess I just need more reassurance that its ok to remove ovaries.

    • I am unable to give a specific recommendation without a complete history and physical and review of your records.
      You do have multiple issues with endometriosis, migraines and osteoporosis.
      Based on what you have told me, a hysterectomy may be indicated especially if other non-surgical options have failed and your quality of life is significantly compromised.
      You seem to be in good hands, but if you need to, please get a second opinion.
      Sincerely
      Dr V Karande

  199. Commenter says:

    hello dr
    im 30yrs. my amh-0.86ng/ml
    serum iron-37.30
    tsh-2.560
    fsh-4.64
    lh-1.96
    did have a ectopic preg what r my chances

    • Your chances are good but you may need help from a fertility specialist.
      You have a 6 – 16% chance of a repeat ectopic.
      Your lab work is otherwise okay.
      We like the TSH level to be < 2.5 mIU/mL. Please have them repeat the test and if it is once again > 2.5 mIU/mL, you may need low dose Synthroid.
      We would welcome you as a patient at InVia.
      Sincerely
      Dr V Karande

      • Commenter says:

        i have no children what are my chances to getting preg naturally .is it possible or do i have to consult a fertility specialist.my hsg reports show open normal tube

      • Commenter says:

        what are my chances of getting preg naturally without prob r there that im not able to concieve naturally

        • 1 in 7 couples will need help getting pregnant.
          85% of couples will conceive within one year of trying.
          When we do a work up, 40% of the time it is the male, 40% of the time it is the female and 20% of the time we find problems with both.
          If you have been trying for over a year (over 6 months if your age is > 35 y) you should see a fertility specialist.
          We would welcome you as a patient at InVia.
          Sincerely
          Dr V Karande

      • Commenter says:

        hello dr
        im 30yrs. my amh-0.86ng/ml
        serum iron-37.30
        tsh-2.560
        fsh-4.64
        lh-1.96
        did have a left tubal ectopic preg.
        i have no children what are my chances to getting preg naturally .is it possible or do i have to consult a fertility specialist.my hsg reports show open normal tube.weight is 58kgs.

        • I am sorry to hear of your tubal pregnancy.
          Your lab test results are okay.
          I am glad you had a HSG and have confirmed your right fallopian tube is patent.
          According to the literature, 60% of patients with a history of a tubal pregnancy will get pregnant and have a baby.
          There is a 6 – 16% chance of having a repeat tubal pregnancy.

          It may be reasonable for your husband to have a semen analysis.
          If his result is normal, you may want to try on your own for 1 – 2 years.
          If you are not pregnant by then, you may need IVF.

          Regardless of how you conceive, it is important for you to have early pregnancy monitoring (with serial hCG levels and ultrasound) to confirm that it is an intrauterine pregnancy and not another tubal pregnancy.

          Sincerely
          Dr V Karande

  200. Commenter says:

    My Wife have a 0.5ng/ml count in latest blood test.(test conducted on fifth day of circle).If the same was affect the pregnancy? What type of treatment should she have”.Pls explain and revert

    • An AMH level of 0.5 ng/mL is on the low side.
      Please consult with a Board Certified Reproductive Endocrinologist to discuss your various options.
      At a minimum, she should have a day-3 FSH/LH/E2 level and a vaginal ultrasound to check her antral follicle count.
      We would welcome you as a patient at InVia.
      Sincerely
      Dr V Karande

  201. Anonymous says:

    Hi Dr.

    I am 34 years old. AMH of 1.0 and my estradiol is on high side of 90. AFC of 9. Do you think I am a candidate for successful IVF?

    Thanks

    • The short answer to your question is “Yes”!
      I am presuming your AMH level is 1.0 ng/mL. Your AFC is normal.
      Why was your E2 level elevated? Was there a functioning cyst on ultrasound? What was your FSH level?
      Other factors that could influence your chances of success with IVF include your age, body weight, previous ovarian response to stimulation.
      This is presuming your other tests are all normal.
      Hope this helps
      Sincerely
      Dr V Karande

  202. Commenter says:

    I am 33 and I my AMH was 55.5 pmol/l (which I think is 7.7ng/l). I have had a pelvic ultrasound and blood test which my GP said means I don’t have PCOS. Can you please explain the implications of the AMH? I have read that I may get OHSS if I do IVF, but I am not sure about whether my actual fertility is affected. Will I have an increased difficulty with falling pregnant? Is it likely that I will need IVF. Should we be trying for a baby now?