So i had my AMH re-tested in March, but had to wait 3 months to be told the results. When really i would have liked to know straight away if my AMH had changed at all, from undetectable(!) in August last year. Finally! the time for the appointment rolled around. It was a little frustrating, a little bit of a pleasant relief and a lot confusing.
Frustrating, because my doctor was reluctant to share my actual results with me. Yes, i would like your job, but don’t worry i think it’s safe (is what i should have said to her). In the end i asked for a print out, and had to pore over the actual numbers in my car after i left the clinic. In the consulting room i got her interpretation of the results, put here into my own words for brevity: your fertility still sucks, you’d better watch your calcium intake (take supplements, make sure to get the ones with vitamin D), i’d advise – do nothing, we’ll run the tests again and see how you’re going, don’t forget time is running out if you want to consider donor eggs, and even more so, if you’d like to adopt. Oh and she forgot that i was married to a man, because when i was asking questions about hypothetical donor eggs she interrupted with ‘well, you need a man!’. I guess sometimes i dress like a lesbian? Anyway, i don’t blame her for forgetting which patient i was, she’s only seen me three times in 9 months, and doesn’t think there is anything much she can do for me. At least when i asked about DHEA , she admitted that she doesn’t know much about it, but gave me a referral to another doctor who may know more.
The pleasant relief was that i wasn’t urged to go on HRT (hormone replacement therapy). 3 months earlier in March this was suggested as something that I might have to take to maintain my general health, even though it might mean dropping my chance of pregnancy from 5% to 0%. I still got the talk about calcium supplements and osteoporosis, and got asked if i was feeling menopausal (ugh. not a pleasant question to have to answer, even when the answer is no). So i was surprised when i looked over the results myself later that my oestrogen (oestradiol to be precise) looked much better than it did in August, at 138 pmol/L (normal range 90-3000, depending on stage of menstrual cycle; mine was
And the confusing part, of course, is the one i was really curious about, my AMH test. The doctor distinctly said “you have had two readings of 1, which is not good”. But the print out she gave me stated 0.2. At this point the rollercoaster kicked in. There is no point denying it, and no point being ashamed but i initially got quite excited about that result. My initial thoughts were “Oh, they must have switched to the other unit of measurement. Odd. But, hooray! 0.2 is still very low, so i shouldn’t get excited really, but it is an increase!”. Australian labs use the pmol/L unit, whereas US labs use the ng/mL (or microgram/L), the conversion factor (based on the molecular weight of the AMH protein) is about 7.14. In fact, i got so excited that i drove to my husband’s work to meet him on an early lunch break and explain the news. That’s where the rollercoaster took a dive, as i noticed the ‘pM’ next to my result. See what excitement can do? It makes you miss important details that might mean that the result is not as exciting as you thought. I was explaining to hubby that they must have switched units, then i pulled out my old results and saw that the previous unit was pmol/L (in my excitement i had forgotten which one was used here!). ‘pM’ can stand for ‘picomolar’, which is another way of saying pmol/L (picomole per litre). So then i was deflated but only actually for a brief moment.
Firstly, the limit of detection in the AMH assay is higher than 0.2 pmol/L, that’s why I was told i had an undetectable result, which was stated as 30 pmol/L). The March result was followed by “3.1-34”. Huh? This isn’t the correct range using either unit of measurement!! I guess the most likely explanation is that a few typos have crept in somehow. Maybe my result was actually 2 pmol/L?!? (this would still be very low, but even higher than 0.2 ng/mL, which is still only about 1.4 pmol/L).
The only place left for the rollercoaster to go, was to roll back to where i had started, on even ground. I’d been waiting for months to look at this little number and then wonder what it meant. Now, what it means is even less clear than i thought possible, but actually, i ended up looking uphill. Because the whole confusion confirmed for me that the doctors have no idea either, and perhaps the AMH test isn’t going to help me that much, and i should just carry on carrying on 🙂
Oh, and my FSH (follicle stimulating hormone) looked better 🙂 51 in August, 42 in March (i also had a result from last July; 44, and the July result was the only one tested on the correct day 3 of a menstrual cycle). So perhaps some of the healthy living is paying off? I’ll save that full discussion (what i’m doing to try and be healthy etc) for the next blog post!
* http://humrep.oxfordjournals.org/content/27/10/3085 doi: 10.1093/humrep/des260