12 replies to this topic

[schlepp]

Hi!

 

New to the boards. I'm 38, my partner had a vasectomy 10+ years ago and we've been investigating our options. Urologist gave us a 50% chance if we reverse but would have to give it 18 months, making me 40 when/if we find out it didn't work. RE says I have a possible blocked left tube (but won't investigate as he thinks IVF/ICSI is our obvious choice). My FSH is 7-8, AFC is 20 and I just found out my AMH is 1.45/ng. RE said based on my AMH and possible blocked tube we should go straight to IVF. That he thinks I have DOR. 

 

When I google 1.45/ng can be in the normal range. I am almost worried I'm being sold on IVF because that is what they sell. We don't have any evidence that I can't get PG as we haven't been TTC due to the vasectomy. 

 

Anyone else have experience with interpreting the AMH scale? It is so costly to do IVF and even with one govt funded cycle I am worried that will just be the springboard to us feeling like we have to keep investing in IVF rather than trying a reversal. Even my blocked tube might just have been a tube seizing up as he wasn't sure from the results. 

 

My identical twin has had three kids, her last she easily conceived at 36. Another sister had her second at 37. I am worried this is all a bunch of panic for nothing but can't be sure without spending and potentially wasting money on the reversal which will be $5500+.

 

For now we are waiting for a government funded IVF round which we were told should happen this year. 

 

I'm just finding this all super confusing and expensive. Like I'm buying lotto tickets without a crystal ball and maybe I already have a winning ticket or maybe none of these options are winning tickets. 

[autumnmarie]

How does the RE think you have a blocked or partially blocked tube without investigating? I am pretty sure it's just an HSG which isn't a hard test or uncommon. My first RE ordered it as a standard component of my intitial work up.

 

If you are not comfortable, I would suggest getting a different opinion at a different clinic. You have to be comfortable with your doctor and their team, I would encourage to shop around and meet different clinics and doctors if you aren't sold on this one.

 

I really love this line because it sums up a lot of what I have felt before -  "I'm buying lotto tickets without a crystal ball and maybe I already have a winning ticket or maybe none of these options are winning tickets"

[schlepp]

Thanks autumnmarie. They did an HSG and couldn't confirm seeing the solution go into the left tube. I was having some pain on the left going into it, super late in my cycle for that and it felt like a cyst. They confirmed in the earlier ultrasound that I did have the cyst that month and maybe the fluid didn't go in because of either a block or my tube cramping. The HSG was quite painful and I was sore for two days from it so my guess is more likely the tube seized up. The RE doesn't want to investigate because it doesn't impact IVF. I do see the RE's reasoning as a  vasectomy reversal, if it doesn't work, leaves me in a tougher spot as I'll have lost 18 months. And those 18 months count for a lot at this age. 

 

I might be traveling to South America in the summer so my partner and I were not planning on trying until the fall as, due to zika and travel, I would not want to travel PG. So we have some time to think about things. Although thinking about all the options is what is making me slightly nuts. 

[CdnHockeyGal]

Hi schlepp - it doesn't sound like a hydrosalpinx but a hydro, which is a blocked, fluid filled tube...would absolutely impact IVF results as the fluid from the tube is toxic and spills into the uterus killing the embryo. So...I would want that question answered beyond a shadow of a doubt.

As for AMH - your numbers would suggest you have a diminishing ovarian reserve (as opposed to diminished.). Here are some things to consider...when AMH starts falling...no one knows how quickly it will progress. Mine went from 1.2 to 0.5 in 6 months. After age 36...regardless of reserve...approx 60% of our eggs are aneuploid...so while we may still have a reasonable number of follicles to work with...the quality reduces significantly.

At 40 I believe only 20%(ish) of your eggs would be euploid.

IVF w ICSI is certainly your best chance at a take home baby. I don't know what your urologist's success is with vasectomy reversals but most of the women and men here don't seem to have too much luck with them and wind up going IVF. If it were me...I'd much rather go to IVF at 38 with a normal ovarian reserve than at 40 with what would almost certainly be DOR.

Good luck with your journey!

[EverHopefull!]

If your RE doesn't want to investigate but you're not ready to move to an IVF without an answer, find an obstetrician/gynecologist to investigate.  Then you can be sure that no one is trying to sell you anything.  I would want that answered first as well.

 

In case it helps with your decision, my clinic gave me this scale for AMH:

 

Optimal: 4 - 6.8

Satisfactory: 2.2 - 4

Low: 0.3 - 2.2

Very Low: 0.0 - 0.3

 

Your AMH number of 1.45 is normal for your age, but with respect to getting a take home baby you fall into the Low category.  So my clinic would recommend IVF for you as well. 

 

And if it was me, I would do the IVF. 

 

Keep in mind that my choice is coloured by years of TTC and my personal regret that we didn't move to IVF sooner.  We wasted 2 years TTC on our own, and then 2 or 3 more years doing IUI's before we finally tried IVF.  Only the IVF was successful.  If I could go back in time I wouldn't have wasted all that time on other things, I would have just done the IVF. 

 

Whatever choice you make, good luck!!

[schlepp]

CdnHockeyGal - thanks! I have to follow up with my family dr to get my rubella immunization redone and I'm going to ask her if she can reorder the sonohysterogram. I'm also going to ask her to recheck my AMH. I am in denial. And willing to spend more money on another AMH just to have that denial wiped away. 

 

Everhopeful! - This is great advice and echoes what I heard from a friend that did IUI. She had a number of friends try everything before IVF and said they all said they just wished they'd jumped to IVF sooner. My friend got really lucky with IUI but even she admitted that odds were low. She said just do what gives you the best odds. Which is IVF.

[Cassandra_Angela]

I would double check the AHM scale though because there seems to be differing opinions on what a decent level is.

My AMH at 33 was 5.23 which my clinic says is low but according to Everhopefulls clinic that would put me in the optimal range. It really is all such a stressful gamble

[schlepp]

Cassandra_Angela - maybe your measurement is in pmol? EverHopefull! is using the ng scale where the numbers and range are lower values. That is what my AMH test was in. 

[CdnHockeyGal]

Yes - I think that measurement is using the Cdn scale rather than the US scale. :-)

[EverHopefull!]

The pmol/L scale looks like this:

 

Optimal: 28.6 - 48.5

Satisfactory: 15.7 - 28.6

Low: 2.2 - 15.7

Very Low: 0.0 - 2.2

[Hopeful Cdn]

I have seen a different Pmol scale that puts:

 

0-1.1 = Very Low

1.1-6.9 Low (reduced response to Stim)

7.0-20something normal

higher than that considered PCOS

 

The lab that did mine used this scale... my AMH was 6.6 and they say I am only just below normal (at the top of the low range). If I went by the other scale posted above, I'd be really upset. But there ARE several assays... and they use not just different scales (pmol vs ng) but there are different means to get the result using different antibodies or so I have read...

[returnable]

From what I understand, AMH is really a function of age, and how much "time" in terms of eggs you have to have a baby. I just posted a summary of what I have learned so far for AMH:

 

https://ivf.ca/forums...it-explanation/

 

My clinic provided the following age appropriate AMH:

 

<25 years   15.1-37.4 pM/L

26-30          12.2-37.6 pM/L

31-35          7.2-29.9 pM/L

36-40          4.3-18.4 pM/L

>41             0-9.1 pM/L

[schlepp]

An update to this. I got retested, different lab and scale, plus I have been taking supplements since February (vit D, CoQ10, folate)

 

December 2015 - 1.49 ng/ml or 10.63 pmol (RE incorrectly told me 1.45 the first time and in a follow up I saw the actual result and it was 1.49)

July 2016 - 1.96 ng/ml or 14 pmol

 

Small bit of relief about this as it puts me in a normal range for my age. Although it feels like at this point I should be using this as a push to get on with it before it drops sharply. My AMH and AFC are not well aligned as I'm anywhere from 21-26 AFC. The results from my cycle would suggest I'm in an okay position although it took a lot of drugs for me to produce 13 mature eggs. Some of that might be my height/size as I'm 6 feet tall but definitely age is a factor.