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Thursday, August 16, 2012

The DHEA and AMH paradox


I have seen many women who ask the following question in infertility bulletin boards – I have low AMH levels, what can I do to increase it? Since women with poor ovarian reserve have low AMH level they believe that increasing their AMH level might solve the problem of poor ovarian reserve. But this notion is not correct! Increasing your AMH level cannot increase your ovarian reserve. If it is that easy, the pharmaceutical companies will be producing and selling AMH at an enormous price. You just have to buy it and inject inside your body : ) On the other hand, can increasing ones ovarian reserve lead to an increase in AMH level? Theoretically the answer is YES, but, until now there are no proven ways to increase the ovarian reserve of women.

What is AMH and how is it connected to ovarian reserve testing? The AMH story is not yet clearly dissected out scientifically. But there are some well-known facts about AMH which I will try to summarize below: 

Anti-Müllerian harmone is secreted by the granulosa cells of primary, pre-antral and small antral follicles. Antral follicles are considered to be the primary source of circulating AMH as they contain a large amount of granulosa cells. AMH is preferentially and constantly secreted by the small  (4-6 mm) rather than large follicles (8mm and above). AMH expression disappears in follicle of increasing size and is almost lost in follicles larger than 8 mm (PMID:16388003) Small antral follicles are usually 4-8 mm in diameter and can be seen, measured and counted via vaginal ultrasound. Women with high ovarian reserve will have more AFC in their ovaries. Since these small antral follicles secrete the maximum amount of AMH into the blood stream, AMH testing is used as an indirect measure of our ovarian reserve. AMH can be measured at any time during the menstrual cycle due to insignificant intra-cycle variability which is a great advantage in clinical practice. Whenever you do an AMH test to measure ovarian reserve please insist that you should know your AFC counts too! AMH level is measured in blood and although this test is considered to be pretty accurate there can be chances of laboratory errors, so it is always wise to compare your blood AMH levels with your AFC count! A recent report suggested that, the method used to store the blood samples for AMH measurement can make a difference in the results obtained and they have suggested that caution should be exercised in the interpretation of AMH levels in the clinical setting (PMID:22777530).

High AFC count can contribute to increased AMH level but increasing the AMH level cannot increase our AFC count or ovarian reserve. Actually, increasing our AMH level via artificial means (for example injecting AMH in your body or using substances that can actually increase the AMH expression in your granulosa cells) can lower AFCs. Addition of AMH to neonatal ovaries invitro inhibited primordial follicle recruitment and thusby decreased the AFC count. When primordial follicle recruitment is inhibited there is less depletion of follicles from the ovaries – theoretically this means increasing the AMH level in our body artificially can preserve ovarian reserve. Slower recruitment of primordial folicles = longer reproductive period. Ovarian reserve preserving can become a therapeutic option for women, who wants to post-pone child-bearing and use of AMH for such purposes will be explored in the future.

What will happen if you decrease AMH level (decrease AMH signalling) artificially? Mice lacking AMH gene answers this question. AMH null mice showed increased rate of follicle recruitment from primordial follicle pool. This led to the premature exhaustion of their ovarian reserve. Since AMH null mice have low levels of FSH, and yet increased number of growing follicles, it has been hypothesized that follicles are more sensitive to FSH in absence of AMH. Does it mean women with dysfunctional AMH gene due to certain mutations can deplete their ovarian reserve sooner? I found a single study which talks about AMH and AMHRII polymorphisms in normo-estrogenic and normo-ovulatory women with unexplained infertility ( (PMID:19539910).

Do women with low AMH have poor egg quality too? AMH is not an indicator of egg quality but of egg quantity. But women with poor egg quality can have low AMH (aged women will have poor egg quality and they also have less ovarian reserve!). Egg quantity and quality are two different processes which are mutually exclusive. So younger women, with low AMH level doesn’t necessarily have to have bad egg quality. Women with high AMH level can also have poor egg quality too. As an example, consider women with PCOD, they have high level of circulating AMH (because of high AFCs) but not necessarily good quality eggs.

Now the DHEA and AMH story – DHEA has helped some women with diminished ovarian reserve to produce more eggs during IVF. I have used DHEA for 9 months and my AFC count increased significantly. I naturally expected my AMH levels to go up too. But my AMH level dropped from 3.5-4.7 ng/ml (different time point measurements; spanning over a period of one year) to 1.8 ng/ml (measured twice, the initial measurement is 1.8 ng/ml and the next in a different lab which showed an AMH level of 1.9 ng/ml). Yet I got 24 eggs out of that cycle. The mechanism by which DHEA increases egg yield is not yet known. Can DHEA decrease AMH production in granulosa cells and thus by increases the recruitment of follicles from primordial follicle pool? This can't be true because PCOD women have high DHEA levels and also have very high AMH and high AFC. There are studies which show that DHEA increased AMH levels in women who took it (PMID:20638339). Is anyone out there who took DHEA and had higher egg yields? Did your AMH level change (increase or decrease) after taking DHEA? I would be happy to hear from you. I did a brief search in google and found many women reporting that their AMH leve became worser after taking DHEA !!!

Points to remember

1)   AMH is an indicator of ovarian reserve. When doing test for ovarian reserve it is wise to interpret AMH levels along with our AFC count.
2)  Low AMH levels don’t necessarily mean you have poor egg quality too. If you are young womenwith low AMH and if your ovaries can produce some eggs in response to gonadotrophin stimulation, your chance of conceiving a baby via IVF is still bright.
3)  Artificially increasing your AMH level will not increase your ovarian reserve or egg quality.

63 comments:

  1. Hi, great blog and just to answer your question:

    In June 2012 my AMH was 1.68ng/ml
    I started taking 75mg DHEA that same month and had a poor response so cancelled (only 4/5 follies where I've had 10-12 eggs on previous, same-protocol cycles).
    Tested my AMH again and it's now 0.56ng/ml

    Just to confuse matters further my FSH which had been around 11/12/13 earlier this year (with correspondingly high E2 - 200pmol/l +) is now 6 or 8 (E2 around 120pmol/l). I'm happy of course, but fast losing faith in all this measuring!!

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    1. I know this was written in 2012 but not to confuse other readers that find this blog I think it needs a response. The eggs will increase over months, so actually IVF dr recommend a minimum of 3 months before collecting eggs.

      Delete
  2. Dear Commenter,

    Thanks for responding to this post. It is interesting to know that you also had a fall in your AMH levels after taking DHEA.I haven't checked my AMH level for a year now. I should check it and see how it is ! May I know your age please ? You should not worry about these numbers.Your age and your AFC count are a better indicator of your cycle outcome. I wish you lots of good luck !

    Manju

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  3. Ah yes, that crucial detail - I've just turned 40! My AFC at the start of the disastrous, latest IVF cycle was 9 total ... not great and probably more in line with the lower AMH score. It's a shame my follicle count didn't go up like yours!

    Out of interest, in the cycle where you got such a bumper crop of eggs (think it was 24?!), how many fertilized?

    Claudia

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  4. Claudia, I had 20 mature eggs, 17 fertilized. Had 10 good quality embryos which are good enough to be trasnferred.

    Your age is the limiting factor here. You have to find that single good quality egg that will become your baby. Lots of good luck !

    I took DHEA continuously for 9 months ! Hope this information helps. AFC count of 9 is not bad for your age. When you got 10-12 eggs how many fertilized, how many embryos you got ?

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  5. Thanks, Manju.

    First cycle 5/10 eggs fertilized - 2 x 3 day embryos transferred (BFP but blighted ovum)
    Second (ICSI) 6/12 fertilized - 2 x blasts transferred (BFP but lost at 9 weeks due to Turner's Syndrome...of all things after such a long journey, heart breaking)
    So only 50% hit rate both times which suggest ropey eggs - I'm on project 'Great Quality Eggs at the moment' - low GI diet, no sugar, no refined carbs, only goat's and sheep's dairy, no booze, no coffee, supplements: COQ10 600mg daily, Vit D3 2000mg daily, Esther C (2000mg daily), Omega 3/6/9, B6, B12 etc . Fingers crossed!

    BTW Dr Malpini helped with some of the supplement advice via his free help service on his www - he is amazing and a truly generous soul.

    What's your next step? I wish you baby dust and luck on your journey!

    Claudia

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  6. Dear Claudia,

    You had both the time implantation and that is great. Nice to hear about your project. If I can tell my view here - there is nothing which could increase egg quality ! Sorry, I am not trying to discourage you. I hope you understand. You can increase your general well being by having a good diet and perhaps with some supplements but you can't reverse egg cell aging Claudia. But women of your age still produce good quality eggs (genetically normal embryos)but the percentage is less. The implantation potential of your uterus seems to be excellent- I wish you soon find that good embryo. The only secret ingredient here is persistence. I hope you get lucky soon. Please do not make drastic changes in your diet before your IVF cycle. It can affect many other things. Be moderate in everything, that will help. When is your next IVF try?

    Yes Dr. Malpani is a very good Dr and a great human being : )

    In Jan perhaps - 5 embies waiting for me (frozen in time ! ). Thanks a lot for the wishes.

    Lots of good luck to you too !
    Keep in touch !

    ReplyDelete
  7. I am 42 nearly and have had my AMH tested three times while on 75mg DHEA, after 3, 4 and 6-7 months. The results were 1.5, 2.1 and 1.14 respectively. So yes, mine got worse. During this time I've been trying naturally with no result. Next month I'm doing a superovulation treatment with 7.5mg of letrozole. I have done this before last year without DHEA and I got 5 follicles, 2 or 3 of which would have been released at trigger. Will keep you posted about the coming month's results.

    ReplyDelete
    Replies
    1. Thank you so much for the info ! Lots of good luck but can I tell you something - please try IVF. You still produce good number of follicles. IVF might provide you with a higher chance of success.

      Keep me updated ! Did you know your AFC count ?

      Delete
  8. Thank you. I don't know my AFC count, sorry. Yes, IVF would be the better option, I know, but we can't afford it unfortunately and at my age I don't get it free on our NHS here in Britain. I'm also a bit scared of starting on down that road as I think it would be difficult to stop and we'd end up bankrupting ourselves! We have one son conceived naturally who is 4, and if we had no children I'm sure we would be doing IVF.

    ReplyDelete
  9. Hello,

    I am slightly confused by my AMH levels. I did a test last year around the same time and had AMH score of 2.91 ng/ml.
    I have done the same test now and got score of 7.88. What does that mean?? Is it good or is it indicating something else as we are planning to try for a baby soon.
    I had done regular scans of ovary also in the past and I did not have any ovarian cyst .
    Can you please help interpret the score . Since everywhere there is only interpreatation of low scores.

    Thanks a Lot in advance!

    ReplyDelete
  10. Hello

    I had done a AMH test an year back and got score of 2.88 ng/ml which seemed normal at that point in time.After a year did now and got a score of 7.88.What does this AMH mean?Is it good or is it indicating something else?
    I used to previously ovarian scans and never had any indication of cyst as well.

    Kindly help me to interpret the score since everywhere I find explanation of low scores.

    Thanks a lot in advance.

    ReplyDelete
    Replies
    1. Dear Jo,

      Please recheck your AMH again ? There can't be so much variation. Either your previous lab result had some problem or the present one. High AMH normally indicates that you have a condition called polycystic ovarian syndrome (PCOD). Women with PCOD have more antral follicles in their ovaries and hence more AMH in their circulation. Antral follicles are the ones which produce AMH. Are you ovaries of normal size and what is your antral follicle count (AFC). It is always wise to correlate your AMH lab result with AFC.

      Hope this answer helps you !

      Manju

      Delete
    2. And most importantly check the unit near 7.88 reading too. Is it ng/ml or pmol/L ?

      Delete
  11. Hi Manju
    Just to update you on my latest superovulation treatment. Last year, pre-DHEA I had 5 follicles, 2 or 3 follicles that would have been released at trigger. This year, post-DHEA, I have 6 follicles, 2 of which will be released at trigger. So I suppose a similar-ish result, but I suppose you have to take into account that at my age, nealry 42, a year is a long time! My lining was thinner this time, 6.57 compared with 7mm last year, although he said it looked nice with a triple layer.
    What I don't like with this superovulation treatment is the vaginal dryness, which seems to get worse towards ovulation, not better. I can't imagine any sperm being able to swim through my cervical mucous! I am using oestrogen pessaries but it doesn't seem to help.

    ReplyDelete
    Replies
    1. First, thank you so much for being so kind and updating about you ! Lots of good luck ! Hope you get what you want.

      I agree DHEA is not a miracle drug. Once the ovarian reserve becomes low there is nothing which can restore it. But when there are problems with recruiting follicles DHEA might help (just a guess !)

      The people who made DHEA (CCRM) famous published a paper saying that DHEA increases AMH levels. Recently, there is a publication from another group which says that DHEA does nothing to AMH levels ! As confusing as always ! No one can be as biased as researchers ! They see what they want to see and do not see the reality most of the time.

      For vaginal dryness you can try liquid paraffin. It lubricates and it does not affect sperms in any way.

      How is your little one ? Let this cycle bring him/her a sibling to play with !

      Good Luck ! Keep me updated.

      Love
      Manju

      Delete
  12. Thanks very much Manju. Could you let me know the recent research paper you are referring to please: I do like up to date with these things!
    My little one is very well, thanks. He is a very sociable child and I know he would love a sibling, so fingers crossed.
    Good luck to you too.

    ReplyDelete
    Replies
    1. DHEA supplementation may improve IVF outcome in poor responders: a proposed mechanism.
      PMID:23312476

      You can go to www.pubmed.com, you will find the paper. Sorry for the delay in replying.

      Good Luck !

      Delete
  13. Thank you so much! And amazing news; DHEA seems to have worked for me! I got a positive test today!
    I also took l-arginine this cycle for the first time. Pregnant at nearly 42 and with almost undetectable AMH; I can hardly believe it.
    Good luck to you too Manju.

    ReplyDelete
    Replies
    1. wow! congrats
      how much l arginie did you take daily?

      Delete
    2. One should take 500mg daily for at least 3 months

      Delete
  14. Wow ! I am soooooo happy. I am hearing a positive news after so long and at 42 - great !

    I wish a very happy and healthy 9 months ! Take lots of care !

    Lots of love, hugs,

    Manju

    NB: Thanks for the tips, my lining is not growing for FET :

    ReplyDelete
  15. Thanks Manju; unfortunately the pregnancy only lasted 5 days, but I'm taking the positives from it as that is the first time I've conceived in 5 years. I was at a high risk for miscarriage anyway because I had 4 miscarriages before my son. I took prednisolone during my successful pregnancy and also for this cycle but not for other recent cycles.
    Re. the l-arginine: I gave it to my husband too and he now reports that he knew it was doing something to him because of its 'Viagra-like effects' which were waking him up in the night! I definitely think the l-arginine helped us this cycle, even though it didn't work out. Also, l-arginine is mainly found in meat and I am a strict vegan, so maybe I was lacking in it.
    Good luck with the FET
    xx

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  16. Actually, I spoke too soon! The dangers of relying too much on cheap pregnancy tests. I am still pregnant! For now, at least :)

    ReplyDelete
    Replies
    1. Don't worry, may you get what you want :) Take Care !

      Delete
  17. Manju, are you a doctor? Why are you advising people to take DHEA? Your comments seem ignorant (i.e. AMH level less important than age), so as gratifying as it may be, I suggest quit playing armchair doctor.

    ReplyDelete
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    1. This comment has been removed by the author.

      Delete
    2. No, I am not advising anything and I am not a doctor – I am an expert patient who is trying to educate others !

      What exactly did you find ignorant ? I’ll be grateful if you’d please educate me !

      Manju


      Delete
    3. It is very bad saying armchair doctor. Manju is a very good lady. she is educating other ladies with the knowledge she has. In this world there are many billions of ladies, just think who is doing like this. we should say thanks to Manju.

      Delete
    4. Thanks for the love and support ! There are so many other women who do a better job in educating others than me :) But thanks it does feel good.

      Delete
    5. Age is more important predictor of ability to conceive naturally (without assistive reproductive technology), or time trying till one conceives naturally. AMH and FSH levels are more important for IVF, as they are predictive of ability to produce multiple eggs with IVF cycle and therefore of a hopefully successful pregnancy with use of reproductive technology. From my readings as another educated patient, DHEA can be helpful with both natural and assisted pregnancy - however, most of the positive publications regarding DHEA originate from a single IVF center.

      Delete
  18. It's getting confusing with all these Anonymouses! Just to update you, that my pregnancy still seems to be going strong, as far as I know. I still haven't had a scan yet as it will be Easter at 7 weeks and my doctor is away so I've another 2 weeks to wait until 8 + 3. I just noticed another comment asking what does of l-arginine I took, and it was 1.5g. In fact, I'm still taking it.
    I would ignore that previous comment about your being ignorant. You have an appreciative audience here, and I can't imagine anyone is under the impression that you are claiming to be a doctor or trying to persuade anyone to take anything. I made up my own mind about taking DHEA after reading as many scholarly articles as possible; it seemed a no-brainer. Side effects were so few and the potential benefits so vast. The worst I can say about it is that I have acne scars: well worth it to have conceived another human being. But everyone has to make their own mind up, with medical advice if desired.

    ReplyDelete
    Replies
    1. I am so happy that your pregnancy is progressing well and it should. You give us lots of positive strength.

      Thanks for the kind support. Such comments sometime leave me baffled and bit angry too but when I have the right to write my view they have the right to say what they want to :)

      I actually feel acne helps me to feel younger. It takes me to teenage years :) So they are always welcome ! Acne scars are ofcourse nothing infront of the joy a baby would bring.

      Thanks for the valuable info you provide here and I am sure it will help many. Happy Easter and take care !

      Delete
    2. hi congrat for your good news i have low amh level and my first cycle was failed in 2009 but those time my amh level is goood now i m taking dhea and coenzyme q10 of dr malpani, s prescription plz suggest me some tipis for healthy ivf cycle for me

      Delete
  19. I think as Manju has previously said, persistence is key. But I also think that giving up to the hands of the almighty, or fate, or however you frame things in your own mind, is key.
    This cycle I had given up, stopped fighting. I don't mean don't have treatment; of course have treatment. But my attitude had changed this time. I thought it would never happen, and really I was having treatment in order to say to myself, when it became too late and I was menopausal, that I had tried everything, so that I couldn't regret anything. I left it up to God and stopped fighting. I even gave away all my son's old clothes, toys and car seat.
    This also happened with my first child. The month I gave up, it happened.

    ReplyDelete
  20. I am taking 25 mg DHEA three times a day, 2000 mg Vitamin D, and coenzyme. Last year my AMH was .72. Now, 1.33

    ReplyDelete
  21. DHEA may work well for some women, but it may work poorly for other women. In fact, for some women it can really mess up their cycles and their systems. It's really just a crapshoot. And it's really just based on individual hormonal profiles. And besides, high AFC doesn't necessarily = high egg quality. Coq10 would be your best bet for higher egg quality-- but even that's kind of a crapshoot at this point. But at least Coq10 is harmless. DHEA is not. So why mess around with it when you really don't know what you're doing and if it really works?

    ReplyDelete
    Replies
    1. Thanks for sharing your point of view with us. I agree every body is different and what works for some may not work for others.

      Delete
  22. first of all congratulations on ur bfp ..i have been following ur blog for awhile now. after my ivf failed in april i had even msged u a couple of times on this blog. anyways my story goes this way..after the ivf the next month i conceived naturally which was great but soon it became a disaster that i lost the baby in 7 weeks...gather myself together and finally managed to start treatments again as i do beleive it would be easier to conceive but to my horror my checks up says otherwise ...i did my blood test and us it goes like this amh from 1.6 has fallen to 0.4 ,right ovary was anyways not fuctioning and now again a cyst on the left..i had taken dhea after the ivf until i found out i had conceived i stopped now agin i started after the dnc and i wonder if it could be the reason for the drop...just six months back it showed 1.6 hows that even possible ...i have been in a state of shock since then ...i have been pcod for years and was on glycomet 500 3 times a day i had stopped that for 2months thinking if my amh is so low i could not be pcod ...its been almost 2 yrs 2 docs i changed and no results infact things got from bad to worse :-( the only positive was i could conceive naturally but beyond i find everything bleek after my test

    ReplyDelete
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    1. Thanks a lot for the wishes !

      I know how painful a m/c can be (((( hugs))))

      You haven't said your age. That is the most important information you could provide me.

      If you are comfortable please mail me so that we can talk - manjupadmasekar@yahoo.com

      Delete
  23. i am 33 wil be 34 in oct ......i will email u in a few days right now my heads quite messed up to write anything.. need to come back to my senses ....tom is my docs appt besides i have to decide and take 2 more opinion...honestly i am tired mentally physically exhausted ....every stage has only dissappointed me almost loosing hopes ....besides i dont want to trouble u finally after all the effort u have what u deserve so take rest be happy and enjoy ur pregnancy pampper ursel and enjoy the pampering ....

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    1. Dear Anon,

      I feel your pain. Please do not panic ! I know this journey is very hard and panic makes it even worse. There will be a way out. Lots of good luck my friend !

      No, you are not disturbing me. Do you think 'we'(after going through infertility !) can enjoy a pregnancy ? Every day brings in new fears and it is very scary to be honest. But talking to women who are in a similar situation as I am helps a lot.

      Please know your AFC count! What is your day 3 FSH and e2 ? How did you respond in your previous IVF ? What is the reason for IVF ? Do you have thyroid issue and anti-thyroid antibodies ? What is your fasting insulin after stopping metformin ?

      Although m/c is painful it shows that you could get pregnant. Be persistent in your attempts and I wish you get success very soon.

      Lots of love,
      Manju

      Delete
  24. Hi Manju, I am 35 years Old. I got married two and half years ago.We been trying since then. I was diagnosed having multiple uterus fibroid 2 years ago. I underwent myomectomy for the removal of fibroids.After few months of natural attempts of trail under Doctor’s supervision & medications. It was observed that ovums were forming & growing well however were not rupturing even after HCG 10000Units dose. Same scenerio was observed in 5 instances. 2 natural cycles & rest IUI.The ovum would go upto 38mm on 14th day of the cycle.These are my medicle reports:
    I have only one Left tube & ovary absent from birth
    HSG Test – Right Tube fine, Hysteroscopy reports are normal.Semen Analysis reports are also normal.my AMH – 0.50ng/ml. Rest all seems fine. Now I am preparing for IVF. Currently I am taking DHEA & COQ for 3 months along with B-Cosyn & Astymin-Z. My husband – Antoxid, Vit E & Vit C.I took Decapeptyl 3.75mg on 5th days of my menses. 2nd dose of Decapeptyl 3.75mg on 28th days since the fist dose. Later on 17th day on will the IVF process start. Dr. Some of my friends underwent IVF from the same place, their doses & days of medication were totally differnt from mine. Could You pls tell me why I am given doses differnt.

    I have got sonography done for 5 cycles for almost 7 days each time. Everytime the sonography report showed Ovum ( good Volume) – 2 or 3 numbers. However did not rupture after HCG also. The AMH test showed low fertility. How can there be contradicting reports. Dr Manju What is your view on the same. Should I get AMH test done again.

    ReplyDelete
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    1. Dear Nancy,

      I know the pain of infertility and the feeling of insecurity when going through IVF. Nancy, I am not a doctor but I will try to answer your questions as far as my knowledge allows. Could you please mail me : manjupadmasekar@yahoo.com. It will help us to communicate better.

      What I understood from your query is, your left tube and left ovary is not present - was it removed due to some reason or you don't have it from birth ?

      Your problem is low ovarian reserve. If your follicle is reaching 38 mm on day 14, I don't think it is a follicle but a cyst and it might not carry any egg inside. This is due to poor ovarian reserve as shown by your AMH test.

      I couldn't understand what it means by sonography showed good ovum. I think you mean follicles of good size. Is the sonography done after ovarian stimulation with FSH ? And your question about IVF protocol you are on is difficult to answer. Will you please do one thing - send me your regimen for IVF which your doctor gave and also the previous sonography details.

      If you find it difficult to understand my questions, write to me, I will explain you in simple terms.

      Do you know the antral follicle count in your right ovary ?

      Please write to me with details, I will be happy to guide you.

      Love,
      Manju

      Delete
  25. Hi Manju,

    I have mailed you . Looking forward to hear from you soon.

    Best Regards

    ReplyDelete
  26. Hi, Manju, I feel lucky to find your blog. I also consider myself an educated patient. :)
    I am having hard time to decide if IVF is the necessity to me, considering 1) age, 2) finance, and 3) mental hardship -I'm afraid to develop an addiction to IVF if the first trial is not successful, and the impact to my work schedule.
    I'm 40 years old, Chinese. 13 months ago before I started taking DHEA and CoQ10, my AMH was 2.21, AFC was 16, I had normal response to Clomid per IVF specialist. So I decided to go on natural TTC without the IVF treatment. I use fresh donor sperm, which was shipped @5C degree to me overnight when I have LH surge. I used this method (home insemination with Softcup) for 5 cycles now and became pregnant twice but both times miscarried around week 5.
    My puzzle is: my new AMH level was 0.68, this result is after the 12 months of supplement of DHEA and CoQ10. It is odd to have such sharp decrease. However, the new AMH level was from a test right after the miscarriage. I hope you have more evidence on women who experienced lower AMH after the DHEA supplement, and the circumstances around the sharp decrease.
    I also would like to get an opinion from you or from your doctor, (seems Indian ancient medicine is as advanced as Chinese traditional medicine in fertility treatment). This is my case: I actually can feel egg bursting out of the ovary each cycle. But I am worried about the quality of the DNA in my eggs due to my age. That's the reason why I have been taking DHEA and CoQ10. In Traditional Chinese Medicine, the practitioner may diagnose me with the symptoms of "cold uterus", which means that my lower abdomen feels cold and my BBT is fluctuating without triphasic pattern. The cold uterus is not an optimal environment for nurturing a new life.
    Anyway, I feel that I need the holistic remedy of my reproductive system: hormonal balance via herbs, blood circulation via acupuncture, relaxation, positive attitude, relationship, etc...
    Have you heard any of such thing in Indian medicine? appreciated for your help!

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    1. Dear Commenter,

      Nice to hear from you. I am sure you are such a well-informed patient. I have no explanation until now whether the decrease in AMH after DHEA is a coincidence or it has something to do with DHEA intake. If DHEA increases egg yield then might be it quickly exhausts the ovarian reserve by some means and hence decrease in AMH. How was your AFC after DHEA ?

      In your case, the problem is not egg quantity but egg quality. Age is unfortunately not your side. To be honest, as per my knowledge, there is nothing you can do to alter egg quality. But, DHEA was thought to produce good quality eggs. I am really sorry, I don't have much info about Ayurveda helping with egg quality. But it is always wise to have healthy life style changes, like reducing stress, eating healthy and so on and see whether you could find that single good egg. I wish you lots of good luck in your endeavour to find that good egg and embryo which will become your baby. Since you ovulate on your own everymonth and get pregnant too, I don't think IVF is needed in your case. Anyhow doing IVF is not going to make the egg quality better !

      Manju

      Delete
  27. Ayurveda infertility treatment has the focuses on removing toxin, improve nutrition and balance the lifestyle. In comparison, Chinese Traditional Medicine does diagnosis according to blood circulation, energy flow and the symptoms. Just 2 generations ago, on average women were giving birth to their last child in their 40s, and very often after age 45.
    The purpose of taking DHEA is to improve the ovarian environment so the follicles can mature better. It's FSH, not DHEA, that recruits more follicles in the beginning of a cycle. The purpose of taking CoQ10 is to feed more energy to the matured egg (mitochondria), so when egg divides, the DNA may stay normal. Both DHEA and CoQ10 are for improving egg quality.

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    1. very interesting site to know about infertility. My question is i have NK 57 cells 70mm2. My doctor told that it should be 10mm2 for a fertile lady. I had one miscarriage. Is there any member on this blog know about NK cells and is this really causes infertile in women.

      Delete
  28. In 35 & had our first IVF treatment in September 2013. At that time my AMH was tested (October 2013) and was told my level was 0.5 I was able to retrieve 6 eggs, 4 mature for icsi, 2 made it to 5 day blast but resulted in a BFN.

    I did alot of research to find which vitamins can help with ovarian reserve. I have been taking the vitamins below for 4 months and as of this month my AMH is now 1.05! More
    than doubled. We plan on having our next IVF attempt in 2 months and I will continue the vitamins and test again to see if it increases again.

    Here are the daily vitamins I take:
    DHEA 75mg
    Royal Jelly 1000mg
    Prenatal Vitamin
    Folic Acid 800mg
    CoQ10 400mg
    L-Arginine 500mg
    Wheat Grass pill
    Vitamin D3 2000 I.U.
    Fish Oil 1200mg

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    Replies
    1. Dear Commentar,

      Thanks for sharing your experience ! Although an increase from 0.5 to 1 seems to be a great improvement, as you say it doubled, it is actually not. It can just be a mere lab variation. For example, if you give your blood for testing on different days you might have different values. I am not trying to be pessimistic but I am trying to help you understand the truth.

      Age is the only factor which determines quantity and quality. All the supplements you mentioned can help you feel good emotionally ( that you are doing your best ) but they do not have the ability to increase quantity or quality.

      Good thing is that they retrieved 6 eggs from you and you ended up with 2 blastocysts. I wish you lots of good luck !

      Manju

      Delete
  29. I feel very confident our next IVF will be better than the last. In a few months I will share with you if they are able to collect more eggs. :-)

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    Replies
    1. I am sure your confidence will do magic than those supplements and I am happy those supplements keeps you confident :) I will be very happy to hear about how your next cycle works - lots of good luck and prayers from me to you .

      Delete
    2. Please ask for your AFC. You will get better info about your ovarian reserve then.

      Delete
  30. Hi there Manju, I'm 33 and having to undergo IVF PGD to screen for a genetic disorder that our embryos are 50% at risk of - so we need a good quantity of eggs as well as quality. My AFC was 7 in November, and AMH was 0.92 on the US scale.

    My first cycle of IVF was not great (also because I had two cysts on one ovary): only 5 eggs, 3 fertilised, two made it to be biopsied - but neither could be used because they had the disorder. Next time I'm so keen to get more and am considering taking 75 mg of DHEA alongside my coenzyme Q10 and other vits.

    What do you think? I'm a bit concerned about the side effects but want to give myself the best possible chance of success...

    ReplyDelete
  31. Hi Manju, I'm age 33 and have AFC of 7 and AMH 0.92 (US scale). My partner and I are currently going through IVF PGD to screen for a disorder which our embryos have a 50% chance of having.

    We've just finished our first cycle and it didn't go so well. They got 5 eggs, 3 fertilised, 2 were biopsied and both had the disorder. I had two cysts on one ovary too, which probably didn't help matters. I was told by the embryologist that the egg and sperm quality are fine, but that we need higher numbers to give ourselves the best chance of getting to a transfer and hopefully pregnancy.

    I am thinking to self-prescribe DHEA (it's not used so much in the UK) as I'm so keen to have a better response next time. Do you (or others with experience of this) think it's a good idea? Or at least, can it be harmful? What dose would be a good level to take? I am also taking coenzyme Q10 but is there anything else that should go on my list?!

    Many thanks

    ReplyDelete
  32. Hi Manju, I'm age 33 and have AFC of 7 and AMH 0.92 (US scale). My partner and I are currently going through IVF PGD to screen for a disorder which our embryos have a 50% chance of having.

    We've just finished our first cycle and it didn't go so well. They got 5 eggs, 3 fertilised, 2 were biopsied and both had the disorder. I had two cysts on one ovary too, which probably didn't help matters. I was told by the embryologist that the egg and sperm quality are fine, but that we need higher numbers to give ourselves the best chance of getting to a transfer and hopefully pregnancy.

    I am thinking to self-prescribe DHEA (it's not used so much in the UK) as I'm so keen to have a better response next time. Do you (or others with experience of this) think it's a good idea? Or at least, can it be harmful? What dose would be a good level to take? I am also taking coenzyme Q10 but is there anything else that should go on my list?!

    Thanks

    ReplyDelete
    Replies
    1. Dear Hopeful,

      You can ofcourse try DHEA, use it at a dosage of 75 mg per day. I bought 25 mg tablets from Biovea ( you can buy online ) and took it for more than 5 months. It works for some and not for some. I didn't have any side effects. It is worth trying.

      To be very honest, there is no supplement which can help increase one's ovarian reserve.

      I wish you lots of good luck ! Hope you find success soon. If possible keep me updated.

      Manju

      Delete
    2. Hi Manju,

      If I wanted to take the DHEA supplement, how can I find out a more reliable brand to take in the U.S.? I've read that because it is not FDA-regulated, that some manufacturer's formulas contain anywhere from 0 to 150 mg of DHEA, while saying 75 mg on the bottle. The study did not publish the manufacturers of various brands due to concerns about litigation.

      Are there countries that regulate DHEA supplements, which are available by prescription only or countries that regulate their over the counter supplements? I've had not much luck so far finding the answer myself. Thank you!

      Delete
  33. Hello Manju, thank you for this blog. I am a little confused because my AMH was 1.8 ng/ml in nov 2013 and now as of last month it has risen to 2.21 ng/ml how is that possible and what can that mean? Thank you so much!

    ReplyDelete
    Replies
    1. Blood measurements of AMH is highly unreliable. AMH value can differ depending on the way the blood is stored before measurement ! So, AMH value can vary. If you want to make sense of AMH value, always interpret you AMH test results with antral follicle count.

      Delete
  34. I took DHEA for 3 months and quickly developed a breast cyst! Be careful with artificial hormones...u are already having enough with the IVF drugs! Luckily mine was non cancerous but now left with an annoying lump :(

    ReplyDelete
  35. I am a 38 year old woman, I have undergone Blood work 10 months ago where my AMH was 2.7, then in early June (5 months ago) it was 2.4 & all other tests were normal too, but last week it was .03, my FSH was at 12000, and I only had 3 mature follicles and 2 smaller ones! How is this possible? My IVF doctor (which is rated by independent source & CDC) has one of the highest success rates in the country for IVF (I am wondering now if he pads his numbers by only taking ideal patients) but he seems to think this is a valid because I have only 1 ovary & he thinks it is because it is working every month without a break to compensate for the removed one. I have had a single ovary though for 10.5 years and achieved pregnancy without even trying before.

    I told him for the next month I am gonna be still stressed out as I have a recently deceased relative (not even buried yet) and I am trying to study to take multiple state exams for a new job in addition to trying to do this process. I asked if stress could be a factor & if we should hold off for a bit but each time he did not answer. He told me to stop taking calcium supplement and prenatal vitamin. He only said I should take CoQ10 200mg 3 times a day and DHEA 25mg 3 times a day for a month then he would look at my follicle count. If low follicle count or AMH still then he would have me do it again a month later, and if no improvement that month too then he would not do IVF with us "as there is no point".

    What is the likelihood, based on your experience or knowledge, that my tests could be valid and have such varied & extreme range is such a short time? Have you heard of this? Also, is there any other supplementation you know of that can help with antral follicle stimulation? I have read on here D3 @ 2000IU, wheat germ, & coenzymes help but could taking any of them actually do harm if I do? Could stress affect my follicle count?

    Please email me response here: foxysdchic@yahoo.com
    Thank you.
    signed,
    Clueless

    ReplyDelete

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