Is it ovarian failure – high levels of FSH and AMH, irregular periods and missed miscarriage?

Dear Professor Winston,

I miscarried last October at 5 weeks. However, my body didn’t recognise until 10 weeks therefore it was classed as a missed miscarriage. A year on I suffer from irregular periods, 18 days light to heavy bleeding and then a 7 days break with no bleeding. I have had blood tests which have shown an FSH of 11 and my AMH level at 5.86 pmol/L .

Over the year doctors have somewhat messed me around. I have had a hystoroscopy and D&C in April which was 7 months after my miscarriage along with results being lost and wrong information given. I have been told that my husband and I need to have IVF treatment. Yet, nobody has sat us down to fully explain our situation.
We have an appointment at our local hospital In December this year.

Can I ask you about my FSH and AMH level and is it that I have ovarian failure due to irregularities of my period?

My husband and I are in our mid thirties and at this point in time feel very lost with information that has been given to us.

Kind regards

I.

Dear I.,

I am very sorry but what I have to tell you is probably not brilliant news. What do you appear to describe is indeed the onset of ovarian failure. You are very young for this but some of the pointers that you mentioned in your email are discouraging. Firstly, your FSH level is high – any reading above 10 international units at your age is a fairly strong indication that your ovaries are not responding to the stimulatory hormones which are being produced in your brain by your pituitary gland. The AMH level also suggests that the ovaries are not able to respond to increasing levels of FSH. This plus the story of your miscarriage and the irregular periods really does seem to fit the diagnosis of a loss of ovarian reserve. This must mean that even if you go through IVF, your ovaries are quite likely not to respond to the high levels of FSH-like drugs which will be given to try to stimulate your ovaries to produce more eggs for the treatment cycle.

I think that what I would do in your situation is to get your FSH levels repeated a few more times, preferably at the beginning of a cycle. However with irregular periods it probably doesn’t matter too much when you have these blood tests but I would space them a few weeks apart. AMH is generally done at the beginning of cycle paragraph

Unfortunately, FSH is released from your pituitary gland in a pulsatile fashion, so sometimes it will be lower than expected and possibly the other times, higher. What experience has shown is that whenever you have readings much above 10 this is generally a strong indication of a problem due to loss of eggs in the ovary. Under these circumstances the chances of the ovaries producing follicles and enough good eggs are undoubtedly reduced.

Believe me I fully understand how depressing this answer to your enquiry is but really you do need independent and unbiased advice before making a decision. My own experience after more than 40 years treating many patients like yourself, is that statistically people like you are a bit more likely to get pregnant naturally and to hold onto the pregnancy successfully than if they do in vitro fertilisation.

I am sorry that this is news you certainly do not want to hear but I think you do need to think about this before your appointment of the IVF clinic at the end of December. The process in your ovaries you are undergoing is slow. That does mean that delaying a final decision two or three months will certainly not make the slightest difference and it might help you to do more tests which will help you feel more comfortable about what you finally decide.

My best wishes,

Robert Winston