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Dr. Tim, MD
Dr. Tim, MD, Board Cert. OB/GYN
Category: OB GYN
Satisfied Customers: 950
Experience:  General OB/GYN, complicated obstetrics, complicated GYN
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I'm a 24 years old girl who's stopped taking the pill in

Customer Question

Hello, I'm a 24 years old girl who's stopped taking the pill in April and trying to conceive (started one month ago).I noticed after stopping the pill my periods are very light and last only 2 days so went privately for a consultation. The doctor did a scan and later told me that I have an AFC of 10 and it's very low for my age. Then performed a test AMH (for which I paid quite a bit) and the results came back after more than a month saying it's 6.30 pmol/L. She says that I might risk early menopause and should start thinking about treatments, however I'd like to know if it's worth retesting in a while as she seemed very oriented to selling me something ( most of the conversation was about one of their pay 2 get 3 IVF offers) and she gave me some measurements in the scan that are completely incompatible with previous ones.
Submitted: 2 months ago.
Category: OB GYN
Expert:  Dr. Tim, MD replied 2 months ago.

Hello and thank you for the question.

First, I am going to give you some background on AFC and AMH that I am pasting from a reputable source:

1. Antral follicle count (AFC) — Ultrasound examination can be used to determine the number of antral follicles (defined as follicles measuring 2 to 10 mm in diameter). On transvaginal ultrasound, the ovaries are visualized in their transverse and longitudinal planes and the antral follicles are counted and measured...A low AFC ranging from <4 to 10 antral follicles between days two and four of a regular menstrual cycle suggests poor ovarian reserve...Although AFC is a good predictor of ovarian reserve and response, it is less predictive of oocyte quality, the ability to conceive with IVF, and pregnancy outcome.

2. Anti-müllerian hormone (AMH) — The AMH level reflects the size of the primordial follicle pool, and may be the best biochemical marker of ovarian function across an array of clinical situations. In adult women, AMH levels gradually decline as the primordial follicle pool declines with age...The AMH level appears to be an early, reliable, direct indicator of declining ovarian function...AMH >3.5 ng/mL predicts a vigorous response to ovarian stimulation and caution should be exercised in order to avoid ovarian hyperstimulation syndrome

I know that this is a lot of dense information, but my conclusion is that AFC is not a great predictor of anything and I think that conclusions about the number of follicles is not going to be accurate after just coming off of birth control pills. Also, your AMH being >3.5 suggests that ovarian reserve is excellent and that proceeding with IVF at this point would not be advised necessarily.

Let me know what you think about this information and we can continue this discussion to your satisfaction.

Dr. Tim

Customer: replied 2 months ago.
Hello Dr. Tim,Thanks for replying so quickly. The AMH says 6.30 pmol not ng. Would it be better to wait and retest and in the meantime try to conceive naturally?
Expert:  Dr. Tim, MD replied 2 months ago.

You are correct and I noticed that right after I sent my first answer. The conversion is 0.63 ng/ml. Here are the quotes related to this value:

1. AMH <0.5 ng/mL predicts reduced ovarian reserve with less than three follicles in an IVF cycle

2. AMH <1.0 ng/mL predicts baseline ovarian reserve with a likelihood of limited eggs at retrieval

This test is relatively new and used initially to determine how well a patient will respond to an IVF cycle related to egg recruitment. This value suggests that there might be limited success in this regard. That being said, I would state the following:

1. You are young and premature menopause at your age is rare

2. You recently came off of birth control pills (which might explain the initially light cycles) and I cannot find whether or not this would effect AFC or AMH, but it is possible, especially with regard to AFC

3. You have not been trying to get pregnant for very long at all. Many couples take up to a year to get pregnant with the success each month only being about 20%

4. I would NOT conclude that your chance of pregnancy is less based only on light cycles and a low AMH (or low AFC)

5. One way to further sort this out (and it should be paid by insurance) is to draw a DAY 3 FSH. This is historically what we have used to determine the health of early cycle egg recruitment. This is what I would draw next. If this test were normal, then I would tell you to go ahead and continue with attempts at conception and schedule a visit in 6 months if you had not conceived.

Does this help? Does this answer your questions?

Dr. Tim

Expert:  Dr. Tim, MD replied 2 months ago.

I am just checking to see if you were satisfied with the answer to your questions.

Dr. Tim

Expert:  Dr. Tim, MD replied 1 month ago.

Just checking to make sure that all of your questions were answered!

Dr. Tim