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Tertia
10-28-2008, 07:27 AM
Hello all

does anyone have info on the AMH reference range they use in South Africa? I know the States uses a different reference range and I wondered what the local range. I would appreciate any info / links you might have

thanks
Tertia

Suzanne
10-28-2008, 10:40 AM
Hi Tertia

Lancet do the AMH test & their range is 0.5-5.
Hope that helps!

Love Suzanne

Maritza
10-28-2008, 01:49 PM
At Vitalab, their avg. AMH count is 2 ng/mL - that is for an infertile community.

The max count they’ve seen in their clinic is 38 ng/mL…which was the count of an egg donor.

The avg. AMH count for the general population is 5 ng/mL

Essentially, everything above 1.1 offers good prognosis for pregnancy.

http://invivo.co.za/?p=185

I think Lancet is the only lab in SA doing this test, for an authorative answer you can phone them.

Maritza
10-28-2008, 02:40 PM
Ok, I was curious so I phoned Lancet.

Their very informative :rolleyes: technical comment:

"It needs to be 1.1 ng/ml"

So I ask 1.1 to how much?

"No, it only needs to be above 1.1 ng/ml"

If you really want some technical info on this we can ask Dr.V to confirm the averages in their clinic for a more meaningful interpretation.

I need to post some questions to him anyway, so for the sake of completeness I'll ask this one as well.

M

Suzanne
10-28-2008, 02:55 PM
Hi again,
Sorry, I didn't give more details in the last post...
According to the lab the reference range is 0.5-5 but they qualify this by adding the following statement:
"serumAMH levels obtained on CD3 of the menstrual cycle may be useful to predict response during ovarian stimulation for IVF, ans should be used in combination with FSH and antral follicle count(ultrasound). According to literature, serum AMH levels <1.1ng/ml on cd3 were often associated with IVF failure"

I have also read that AMH in PCOS patients can be 2-3 times the normal value.

I hope this helps? Unfortunately, as you have seen, Maritza, the people you talk to on the phone can't really give good info re results. For that reason they have a policy not to give results to patients over the phone! It just ends up with a disaster. I am in the medical field so have had first hand experience of this!!

:)

Sandy
10-28-2008, 06:11 PM
So why am I even considering IVF with my two little eggs??? :confused:

LEILAH
10-28-2008, 07:11 PM
'coz AMH is not the alpha and omega in Infertility Land. There are women who get pg via IVF with low AMH.

Maritza
10-29-2008, 08:20 AM
Thanks for that Suzanne, do you think an AMH of 38 is even possible, or am I smoking my socks here...it sounds a little out of bounds if the range is 0.5 - 5...but then again, I think SCY's was 8 (I stand to be corrected, but I know it was higher than mine) and mine was 6, so I suppose for an overly fertile individual 38 could be possible. I remember noting it down as I was talking to Dr. V, but now I'm not so sure. Maybe it should've been 28?

Anyhow, thanks for that info.

Sandy, I suppose tests are there to give us guidance and manage our expectations, but they need not be the be all and end all as Leilah said. Exceptions do occur. Maybe you should ask around for stories of members that have fallen pregnant with such low AMH's and also ask your FS how often this occurs in his practice. It remains however, a very sensitive subject (I can still remember how terrified I was before I got my results), and you must be having an incredibly difficult time dealing with the implications of your result. AMH is also a relatively new test so many of the low AMH conception stories still need to happen.

M:)

Sandy
10-29-2008, 08:56 AM
Thanks M,

It is a very confusing and frustrating time! Last night my DH, FIL and Dad said that even if I only had a 1% chance of falling pregnant we must continue doing it and between the three of them they will make a plan to cover costs, which is great and I do appreciate it a lot, but I don't think they realise the emotional side is so huge for me too. I can't keep doing one IVF after another with only a 5-10% chance for the next year or so (there wouldn't be much left of the original me). They think I should carry on doing it until my eggs really do run out and then go donor, but I don't think they really understand that only getting 1-4 eggs is running out (if one compares other ladies who get 10-15 out).

Anyway, we are not letting go of the two on board just yet. I guess you get even more attached when you know there aren't that many in there and we all probably take it for granted that there are thousands in there until we are told differently. I am now waiting to see what Friday's scan tells us.

Sands xxx

P.S. Just a quick one, do I have to take the Gonal F and Cetrotide at exactly the same time every morning? I was hoping to get my mind off things tomorrow and play 18 holes of golf in the morning!!! :)

Maritza
10-29-2008, 09:01 AM
Ur very brave to play golf on hormones! I'd break a club or two in the process, different strokes for different folks I suppose! :D

And yes, you can take the cetrotide with the Gonal.

M

Suzanne
10-29-2008, 10:29 AM
Maritza, 38 sounds a bit high but in medicine you can get all sorts of results & sometimes we can't explain them.

Sandy, unfortunately in medicine nothing is completely 1 way or the other. As they said in the explanation, ivf failure is higher but it is not a definite. There are cases where it has worked and AMH was low. There are also cases where everything is perfect and IVF still fails. Don't lose hope! I will be sending lots of positive vibes to you & the 2 follies!

:)

Tertia
10-29-2008, 11:15 AM
Thanks gals. My AMH came back at 7.0. Not too bad for an old bat.

So, it seems that anything over 2 is considered 'good candidate for good response to stimulation protocol'.

According to Lancet, they want a score over 1,26 in order to have a decent chance at success.

Sharon
10-29-2008, 11:24 AM
Ok, so can I throw a spanner in the works? From my discussions with Dr G, anything between 2.5 & 6 is good, anything over 6 is indicative of PCOS?? That's how I understood it anyway, sorry, I could be wrong. But I do know that I was told that too low a count is bad and too high a count is also bad.

Ginger
10-29-2008, 01:28 PM
Well, I will be very interested to see Dr V's answer to this question.

Sandy
10-29-2008, 03:54 PM
Thanks Maritza, if I did them at 8am this morning does it matter if I do them at 6:30 tomorrow morning?

I need to get my mind off stuff for a while and the best way to do that is get outside into the fresh air and play golf because I play in a competition so I have to concentrate, but yes, it isn't easy and I often feel like I could break a club!

I am going to have hope for these two little eggs and put lots of positive energy into them because everything may be agaisn't them, but they are already loved so much and I hope that will be enough! I am going to hate it if I have to cancel this cycle, but I am not going to give up on them just yet!

Sands xxx

chrisenkate
10-29-2008, 04:17 PM
Hi

I find the fact that PCOS sufferers often have high counts very interesting and it would thus make it very difficult to use AMH levels in PCOS women as an indication of their possible IVF success. I also can't believe that a too high count is necessarily bad so am very interested in what the doctor says.
What is strange is that with a fairly small amount of stimulation (10 units of menopur, I think) I (32 year old) produced 24 eggs, which produced 23 embryos and there were still 12 on day 5. Now please, I am fully aware that most people following this thread are absolutely desperate to get more than just a few follicles, so I am in no way bragging or trying to make anyone feel bad. I am just proposing that perhaps it's the one area where PCOS people are actually at the better end of normal. There's enough other c%^p we have to deal with to make up for possibly brilliant AMH levels. So, what I'm thus saying is, is an AMH level above 5 necessarily a bad thing?!!!
Regards,
Katherine

Sandy
10-29-2008, 04:30 PM
Hi Katherine,

I think you are probably right, I would also like to rather be on that side of the scale and producing eggs, but I suppose I would then maybe have other issues!!!

Don't worry you don't make us feel bad, just jealous, I wish I could get even half of that, I don't think I have even produced 24 in all my years of treatment!!! :(

Take care, Sands xxx

Sandy
10-29-2008, 04:33 PM
This is off the website: http://www.tdlpathology.com/index.php?option=com_content&task=view&id=106&Itemid=223&limit=1&limitstart=1

Page 2 of 11

Lab Report Spring 2006 Main Contents

Fertility

Antimullerian Hormone and Ovarian Reserve

It is impossible not to notice the attention that is being given to Fertility, Infertility, Subfertility and Unexplained Infertility together with Sperm Health. Latest statistics now show one in seven couples have difficulty conceiving and the range of diagnostic tests being used to help clarify the causes for this is being continually refined.

Since a considerable proportion of subfertility is due to postponement of childbearing, measurement of ovarian reserve is of interest to women in general. Assessment of ovarian reserve (follicle pool) may provide insight into the remaining number of fertile years a woman has. New figures (ONS) shows that births from women over 40 have increased by 6% and more women now give birth in their 30’s than in their 20’s. So too has the average age of men becoming fathers increased with a third of all births in the UK being from men over 35.

Anti-Mullerian Hormone (AMH) is an endocrine marker for quantitative prediction of ovarian reserve, ovarian aging, ovarian dysfunction and ovarian responsiveness. Serum levels of AMH can be used as a marker for ovarian age, as they correlate with the number of antral follicles; AMH levels decrease in pre-menopausal women as the ovarian follicles decline with age. AMH levels are strongly correlated with the size of the follicle pool and because of the lack of cycle variation, the serum level of AMH is a good candidate for inclusion in a standard diagnostic procedure to assess ovarian function, and can help identify findings, such as premature ovarian failure.

AMH Levels
Optimal Fertility: 28.6 pmol/L – 48.5 pmol/L

Satisfactory Fertility: 15.7 pmol/L – 28.6 pmol/L

Low Fertility: 2.2 pmol/L – 15.7 pmol/L

Very Low/Undetectable: 0.0 pmol/L – 2.2 pmol/L

High Level: > 48.5 pmol/L
? Polycystic Ovarian Disease
? Granulosa cell tumours

In instances of Polycystic Ovary Syndrome (PCOS), one of the most common endocrine disorders in women of reproductive age, it would be recognised that the two or three fold increase in the number of growing follicles would be reflected in a two or three fold increase in the serum AMH levels. It would seem that serum AMH represents one of the best endocrine markers to assess the age-related decline of reproductive capacity*.


Sands xxx

SCY
10-29-2008, 05:09 PM
Just to put my 2 cents in my AMH was 10.8 and when Dr V explained it to me he said that at VL they consider anything from 1.1 as workable for a viable pregnancy and anythign up to 6 was good. He did tell me that anythign above 6 was an indicator of PCOS (so my diagnosis was spot on). He did mention to me and I stand to be corrected as it was over 10 months ago that he had a PCOS patient with an AMH of 35....

Joni
10-29-2008, 05:32 PM
Hi All

I have PCOS and my AMH is 3.2 at least it was in April, Dr V said we would re-test in Jan and I suppose depending on the result decide our POA (more medicated cycles) or IVF! I however only produce 1 follicle on 6 amps of menopur over 6 days....

Would be be interested to see his response and my new result!!!

Tertia
10-29-2008, 06:06 PM
Just a note that South Africa uses a different measurement range than the US. We use the European version.

These are American ranges:

AMH Levels
Optimal Fertility: 28.6 pmol/L 48.5 pmol/L

Satisfactory Fertility: 15.7 pmol/L 28.6 pmol/L

Low Fertility: 2.2 pmol/L 15.7 pmol/L

Very Low/Undetectable: 0.0 pmol/L 2.2 pmol/L

High Level: > 48.5 pmol/L
? Polycystic Ovarian Disease
? Granulosa cell tumours

Maritza
10-29-2008, 06:33 PM
ANTI MULLERIAN HORMONE
Optimal Fertility 28.6 pmol/L - 48.5 pmol/L
Satisfactory Fertility 15.7 pmol/L - 28.6 pmol/L
Low Fertility 2.2 pmol/L - 15.7 pmol/L
Very Low/Undetectable 0.0 pmol/L - 2.2 pmol/L
High Level 48.5 pmol/L - suspicion of Polycystic Ovarian Disease/Granulosa cell tumours


When measured in nanograms/milliliter (ng/ml):
0.3 or less - low
0.7 - borderline low
0.7 - 3.5 Midrange
3.5 - borderline high
5 or more - high (Consistent with PCOS)

See: http://www.repromedix.com/pdf/AMHbL17CF181.pdf

http://www.fertilicare.co.za/forum/showthread.php?t=244

chrisenkate
10-29-2008, 06:35 PM
Okay, so this is getting interesting. Thanks for your input, Joni.

I wonder then, perhaps it is still of value in PCOS people but mostly in terms of how it changes. Now, once again, I don't want you to feel bad, Joni, but how can a "normal" AMH level in a PCOS person be interrupted? Is it a good sign (perhaps indicating you won't be affected by OHSS - a pure thumb-suck) or does one want to see it above 5, if one definitely has PCOS. The other issue of course (and most likely explanation) is that people with PCOS have such a huge range of symptoms and all respond so differently to various medications, that perhaps not all have increased AMH just like some don't have IR. Boy oh boy, I'm sure glad I'm not a fs!!!!!
I haven't had mine tested, but will at some stage and will let you all know.
Katherine

Maritza
10-29-2008, 07:11 PM
This is such a great article, I decided to load it to fertilicare so it doesn't disappear in future:

http://www.fertilicare.co.za/downloads/AMH.pdf

Tertia
10-29-2008, 08:40 PM
Maritza is a clever girl. [Maritza edit] Is good at googling.

We have had three of our donors tested recently on specific request, all young women under 30 years old and their AMH scores came back at 7, 6 and 2.something. I wouldn't say that anything over 5 is necessarily indicative of PCOS, but I do think PCOS patients tend to show higher AMH scores.

An interesting question for Dr V. 'if you had to choose between two donors, equal in age, would you want to choose a donor with the higher AMH, or does it not matter if the AMH score is over 2?'

In other words, is there a direct correlation between the increase in AMH level and the success rate (measured in clinic pregnancy rate, not response to stimulation medication). Is a 7 donor more likely to give you a pregnancy than a 2 donor? A 3 donor?