If you're new here, I'll quickly catch you up. I went to my OBGYN's office due to my amenorrhea or lack of monthly period after coming off the pill when we decided to start trying for baby #3 (I was on it for about a year after having our second baby). She requested a few labs to be completed and sent me on my way. I received by results via online portal on a Friday afternoon so no call from my doctor. I spent the weekend googling everything. Note: I DO NOT recommend doing this 😯 My OBGYN called Monday morning to review the results and let me know that everything came back normal except my AMH levels were low. She suggested I speak with a fertility specialist. Which in my mind, I was like "Ok, this isn't the end of the world, I am 38 but I'm sure we have options, maybe I get take some medication or we can do IVF?"
AMH is Anti-Mullerian Hormone. Fertility doctors use your Anti-Mullerian Hormone levels to determine your Ovarian Reserve or the amount of eggs you have left. Your AMH is expected to decline with age but at normal levels. My AMH at that time was 0.02 considered extremely low. A normal range is above 1ng/ml and a low-normal 0.7- 0.9ng/ml.
Here is a list of the other tests that were completed on this first visit:
TSH
Hemoglobin A1C
Insulin
Testosterone
HCG
17 Hydroxyprogesterone
I made an appointment with a fertility clinic which was telehealth because we are in early 2021 still in a pandemic. We discussed my concerning AMH levels, and that is when I learned my low AMH levels were telling us I had a Diminished Ovarian Reverse or DOR - which is a condition in which the ovary loses its normal reproductive potential, compromising fertility. She asked me about any symptoms I had been having and about my family history, but we'll get to this in another post.
She wanted me to come in THAT DAY to get my FSH tested. I had never heard of it?!
Follicle Stimulating Hormone or FSH is the hormone that stimulates the growth of ovarian follicles in the ovary before the release of an egg from one follicle at ovulation. We discussed the possibility of Primary Ovarian Insufficiency also know as Premature Ovarian Failure and/or Early Menopause but she wanted me to have two FSH tests done at least 4 weeks apart to confirm the diagnosis. So I completed the two FHS tests 4 weeks apart (still without getting a period) Both of my FSH results were elevated at 48mIU/ml. A normal level is between 4.7-21.5mIU/ml depending on your age.
Primary Ovarian Insufficiency (POI) used to be called Premature Ovarian Failure (POF) - it happens when a woman's ovaries stop working normally before the age of 40. It affects approximately 1% of woman. When this happens, a woman’s menstrual cycles become irregular and stop. Her ovaries stop making hormones such as estrogen and progesterone and she stops releasing eggs (ovulating) regularly or at all. This diagnosis is currently called “insufficiency” rather than “failure” because the ovaries can intermittently (occasionally) function, begin releasing eggs, and even result in successful pregnancy.
We also discussed possible reasons for POI/POF including a genetic condition called Fragile X Syndrome. After getting two elevated results of FSH I moved forward with the Genetic Carrier Testing for Fragile X. My results were negative. Some other possible reasons for POI/POF are toxins such as chemotherapy & radiation, autoimmune diseases, genetic disorders and family history.
Fast forward to May, I finally had a period! YAY! Who would've thought I would ever get excited about this? haha So I went back to my fertility doctor for another round of the Day 3 FSH labs (for third time), results were very similar at 42mIU/ml. At this time my doctor's only advice was to use an Egg Donor if we wanted to conceive and that I would have a 5% chance of conceiving naturally. She told me I was not a candidate for IVF - in vitro fertilization as my body would not respond to the hormones due to my Diminished Ovarian Reserve. She also said I "was lucky I had my second baby at 35" which at the time felt very insensitive, harsh, and unfair. I felt like I was being judged for how I saw my family. Now after more research (and time) I understand that she was right. Many woman are diagnosed in their early 30's or 20's or even teens before they're even thinking about starting their family. But this was most definitely a hard pill to swallow. Ultimately, I decided to get a second opinion from a new fertility doctor.
...to be continued in next post
Disclaimer: Some information shared in this post can be credited to: Cleveland Clinic.org
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