There’s been a lack of progress for the last few weeks, which I’ll have a whinge about later. First, a few words about AMH, which I didn’t really know much about until this month.
After the counselling session, I didn’t hear anything from the clinic until my nurse co-ordinator rang in August to say they were missing my sperm bank consent form. While we were on the phone, I happened to ask if there was any news about test results and she mentioned they had my AMH result back and it was 25. I had no reference point at all for this but she said it looked fine – the doctor would make the call but IUI looked on the cards.
The modern woman’s biological clock measure
So obviously, that sent me hurtling to the internet. Anti-Müllerian Hormone gives an indicator of a woman’s egg reserve. It’s apparently more reliable than measuring Follicle Stimulating Hormone (FSH), partly because it doesn’t fluctuate much during a woman’s cycle, whereas FSH needs to be measured on day 3. Having said that, the AMH test is relatively new, so information on the levels considered normal isn’t what it might be. Either way, the clinic didn’t seem to be that interested in day 3 and day 21 bloods – it was all about AMH for them.
I’ll admit to feeling slightly sick in the stomach while looking up what a level of 25 means. You spend many years of your single 30s worrying about the biological clock and this is a pretty definitive marker of how yours is ticking along.
A look at how you measure up is not helped by the fact that there are two units of measurement: pmol/L and ng/ml. You could be told you have a level of 2.2 and have a mini meltdown before realising that’s in ng/ml and actually translates as 15.7 in pmol/L. You multiply by 7.14 to convert from ng/ml to pmol/L – apparently. Stuff I never needed to know before.
There’s a decent overview of AMH here, where they explain that healthy women below 38 years of age with normal follicular status on day 3 have AMH levels of 14.28-48.55 pmol/L (2.0-6.8 ng/ml). Very high levels might indicate polycystic ovarian syndrome.
Breaking that down, AMH levels between 28.6 and 48.5 pmol/L (4.0 to 6.8 ng/ml) indicate optimal fertility and those between 15.7 and 28.6 pmol/L (2.2 to 4.0 ng/ml) indicate satisfactory fertility.
So it looks like I’m a “satisfactory”, which for a 39-year-old I’m pretty happy with.
I also found an information leaflet in my intro pack from the clinic containing a graph similar to this one on Fertility Associates New Zealand that maps your AMH level against your age:
The average for my age group is around 10 if I’m reading this properly. Note the big caveat on that website though: “Please remember that age is still a very important factor for fertility. The AMH tests can suggest when a woman might have lower fertility than expected for her age. However, there is no evidence that ‘good’ AMH results mean that women have a higher fertility than expected for their age. We strongly recommend all women start their family well before 40 years of age.”
That’s me told. All the same, it’s a relief to get the result. I resolve to tell a couple of friends in their later 30s who are thinking about having babies to get this test done. I’ve seen stories online of women finding out in their 20s or early 30s that their level is on the floor, which must be scary. Although they do say that for IVF all you need is one decent egg, and the test is there to see if women need that extra bit of help. Better to find out the level is low and take appropriate action than to waste those all-important years trying to conceive naturally.
Gritting my teeth again
So, happy with the AMH. Now to my whinging. The lack of communication from the clinic has surprised me quite a bit. I was pretty much ready to go in the second week of August, having had my initial consultation and done all the tests in mid-July, submitted my donor characteristics form at the counselling session at the end of July, and handed in full blood results on 8 August. No word from the clinic other than to request proof of my blood group and that missing sperm bank consent form in the first week of August, when I found out my AMH result only because I happened to ask.
So, as far as I knew, I was all checked out and ready for IUI barring the obvious sticking point of no sperm, no idea which donor I would get, or indeed when the stuff would arrive.
I called my co-ordinating nurse on 14 August to ask if there was any definitive news on the plan of action, was IUI a goer and what was happening with sperm.
“Yes, IUI is the plan and Dr Y will be looking at your files.” Me: “Is it not Dr O any more?” Her: “Oh yes, Dr O.” Hmmm.
“Okay, so great, I can do IUI, but what about the sperm?” “Oh, the embryologist is very busy; they’ve been undergoing a review [same explanation used when I didn’t hear from him back in July when I was looking for an initial chat about how things worked] but I’ll check again today that he has your form” [which I submitted 14 days ago].
Me: “So when will I know whether any of my extended profile donors are available? If they’re not, does he just go ahead and order other sperm based on my general characteristics?” Her: “Mmmm, errrrr.” Me: “Cos I would like to know at least whether the sperm is going to cost me €1,800 for an extended non-anonymous donor or €1,500 for a standard non-anonymous donor.” Her: “Mumble, mumble.” Me: “Eh?” Her: “He would just order. Sperm can take about eight weeks to arrive.”
Oh-KAY… “And what’s the procedure for the IUI? Will you be contacting me to let me know what to do [like, would you have contacted me at all if I hadn’t rung]?” Her: “Oh, just call me on day 1 in mid-September and we’ll give you the prescriptions for the meds and get going.”
Kind of pointless if the sperm hasn’t arrived, I’m thinking.
She’s a very nice girl and I’m not sure if she’s stressed or unsure about how things work or just trying to get me off the phone. So I email the embryologist the same day to see if he can shed any light. I get a response in the evening to say he’ll look at my characteristics form and get back to me.
By 20 August, I haven’t heard anything and I am getting pretty stressed. And narked. I decide to give it one last shot before raising a stink and email him again that day. At last, I get a response at nearly 8pm. Two of my donors are available and he names them. (I quell a nasty thought that it’s a coincidence these two have names at the top of the alphabet – did he check the others?) So I email back to say please go ahead and order Donor A and say I assume I’ll be contacted when the order arrives. No answer obviously.
It’s brilliant news that one of the extended profile donors is available, don’t get me wrong. But I’ve no idea whether the sperm has been ordered, if not when it will be, and most crucially when it will arrive. When I talked to the embryologist that first time on 25 July, after chasing him for a week, he said he wouldn’t be ordering for another three or four weeks. I don’t know if I’ve missed that boat (a sperm boat, how lovely). If so, he may not be ordering until mid-September, who knows. And I don’t know how long an order actually takes to arrive.
You wouldn’t buy a used car from people who gave you so little information, honestly.
My instinct is that the embryologist is completely overworked and possibly also irritated at the lack of support and misinformation from other staff. Surely someone else can look up availability and order the stuff and let him get on with what he does best (what that is I don’t know but I imagine it involves a lot of thawing). And the fact that the co-ordinators don’t always seem to know what’s going on probably doesn’t help – you shouldn’t have to hassle the embryologist for info that could come from your co-ordinator.
So the positives are that I appear to be fertile and ready for IUI action. I didn’t know this six weeks ago, so obviously it’s great news. I know of many women who have to spend a year or so sorting out medical issues before they are even ready to get going and who have terrible fertility problems. I’m very lucky. Plus one of my extended profile donors was available, fab.
I’m just frustrated that the hold-up is because I haven’t been able to contact people to order the bloody sperm. In an ideal world, we would have ordered back in July ready to go when all the tests were completed. Instead, it took me a month just to be in a position to tell them which little guys I wanted – and who knows if they’ve even been ordered yet.
I contacted another girl from the same clinic to see if I was getting my knickers in a twist for no reason. Like me she had no contact from the clinic other than to chase a missing form and had to wring info out of them. She had spoken to another girl who had the same experience. She also said she spent a weekend crying after her nurse told her none of her donors were available, only to find out from the embryologist that they all were. On the sperm, her advice was to get email addresses and phone numbers for the nurse, doctor and embryologist and hassle them all for definitive answers about what was being ordered and exactly when it would arrive.
So at least I’m not alone and there are obviously communication problems at the clinic. Unnecessary stress and time-wasting, two things most women can do without when trying to conceive.
In summary, all basically good but I’m in limbo now not knowing when things will kick off. I think we’re looking at October, not September, at this rate. I will go with the flow and see when the stuff arrives (assuming they bother to tell me). I’m busy for the next month with a very intense work project, so I’m rationalising that it’s not the end of the world if I can’t have my first try in September. Stress not being conducive to getting preggers, an’ all.
Extra time to bone up on the whole donor insemination thing. More of which later.
Another long post, sorry. It was the narkiness that made me this time, honest guv…