Wednesday, 4 November 2015

Unraveling the numbers


There are so many numbers to learn during an infertility cycle it can be a full time job. Now that I am trying to get back to everything, I am trying to understand how I am performing according to my previous numbers. At least for now I am concentrating in 3 numbers, AMH, FSH and LH.

What is Follicle Stimulating Hormone (FSH)?
FSH is a hormone released by the pituitary gland. In women, FSH helps manage a women’s cycle and stimulates the ovaries to produce eggs. When a women goes into menopause she is running out of eggs in her ovaries. The brain senses that there is a low estrogen environment - and signals the pituitary to make more FSH hormone. More FSH is released from the pituitary in an attempt to stimulate the ovaries to produce a good follicle and estrogen hormone.
In conclusion, the lower the FSH the better. According to this web site recommended in many infertility forums, less than 9 is normal, between 9 and 11 is fair, 11-15 is reduced ovarian reserve, etc. Another thing to keep in mind is that the higher the FSH is, it tends to indicate lower quality of the eggs, and that your FSH is as bad as the worse result, a lower number in different cycles is not a sign of getting better.

What is Luteinizing Hormone (LH)?
LH is a hormone released by the pituitary gland. In women, an increase in LH level at mid-cycle causes release of eggs (ovulation). On day 3 (when the FSH is measured) a normal LH level is similar to FSH. An LH that is higher than FSH is one indication of PCOS. If your FSH level is much higher than your LH level, then this suggests poor ovarian reserve.

What is Anti-mullerian hormone (AMH)?
AMH is a substance produced by granulosa cells in ovarian follicles. Since AMH is produced only in small ovarian follicles, blood levels of this substance have been used to attempt to measure the size of the pool of growing follicles in women. Therefore, AMH blood levels are thought to reflect the size of the remaining egg supply - or "ovarian reserve".

These are my numbers in previous cycles:
* February 2014: FSH - 8.4. LH - 4.6 (Investigative)
* June 2014: FSH - 7.2. LH - 4.9 (IUI)
* July 2014: FSH - 6.4. LH - 2.7 (IUI)
* November 2014: FSH - 10.6. LH - 3.9 (IUI)
* March 2015: FSH - 6.7. LH - 4.3 (IVF)
* June 2015: FSH - 11.5. LH - 5.2 (FET)
* August 2015: FSH - ? . LH - ?. AMH - 5.8pmol/L (Investigative)

Putting it all together:
* My worse FSH (that I know) was 11.5
* My FSH to LH level is between 1:2 and 1:3
* My AMH came back as low ovarian reserve

With all these numbers it shows I don't have that many eggs left and the ones I do have don't have a really good quality. When I was at my other clinic they knew my FSH and LH levels, indicating low quality and never said anything about that, plus refused to run the AMH test to confirm! The third IUI should not have happened either, I think it was a money grab given the numbers. The FET I can understand because we didn't care about my eggs at that point. It's frustrating that some clinics won't give you the whole truth :-(

Well, next week I should have my blood tests again and we shall see what my FSH and LH are (did they get worse?), but at least I am going to this IVF with open eyes, chances are low, but there is hope!