I was doing some more reading about anti-mullerian hormone (AMH) and a phrase jumped out at me “Ultra-sensitive AMH test”. A quick google search confirmed that i was using old information. New formats of the AMH test are known as the ultra-sensitive AMH test, and the picoAMH test*. This new information made me sad. It was like getting my POI diagnosis over again. When i first saw the infertility doc, i wasn’t prepared for such a prompt and conclusive answer of ‘you won’t have your own children’. When i got my AMH re-test result i wasn’t prepared for it to be worse. And it’s only now, weeks after my appointment that i learnt that it is likely worse (I guess there is still room for a lab error?). I was looking forward to getting my AMH result because i thought it couldn’t be worse, at least on paper, because my previous result was ‘undetectable’ and therefore the lowest result possible. And of course i was hoping for it to be a little higher.
The new picoAMH test is much, much more sensitive. Whereas the old format could only measure down to 1 pmol/L, this new test has a limit of detection (LoD) of 0.0086 pmol/L. I was also confused about the different ‘normal range’ presented with my result but that is not so surprising when you realise that the AMH test is still fairly new. As more data is collected the normal range is modified. This is why i am a little dubious of studies that claim to treat ‘low ovarian reserve’ groups based on an AMH level of 0.4 ng/mL (~3 pmol/L; the stated normal range on my results was 3.1-34 pmol/L). This clinic admits that AMH levels do not necessarily define fertility: http://www.advancedfertility.com/amh-fertility-test.htm and that ‘normal levels’ are not agreed upon.
I guess i had been thinking of my <1 result as =1 but it’s 5 times lower than that at 0.2. Finding this out reduced the small hope i had to almost none. I cried. I cried when i told my husband what i was feeling, and that made me realise that i really do want my child. Infertility is so confusing when you aren’t even 100% sure you want kids, but are then told that you can’t. I’ve never felt ‘my clock ticking’, i don’t have overwhelming urges to bear children, i know i can have a full life without parenting. So i told my husband that i was frustrated because “I’m not even sure i really really want children, but i’m still sad”. He said “it’s ok to be sad, even if you’re not sure what you want”. It was so nice to hear. It’s one of the reasons i wanted to write this blog. Some expectations are so insistent, so dogged. We expected that we would have kids, it’s proving hard to shake that expectation. And then it’s like a dream that died. That sounds dramatic. It’s okay though, i cried a little, just for a minute as i once again said goodbye to ‘little me that won’t be born’**, and then i felt better and we’re shifting expectations, as always.
**and me/hubby blend, who would be really awesome