When you “barely pass” AMH testing, this over-40 mom has encouraging words to offer: “A low AMH score doesn’t mean it’s the end of the world. There is hope.”
Shannon and Noah Rippner were married after she turned 39. The couple planned to have children of their own, but first Shannon would need treatment for a previously undiagnosed under-active thyroid. She remembers her physician cautioning her about the link between thyroid problems and infertility, asking: What’s your plan? Do you have a reproductive endocrinologist?
That started the journey, says Shannon. Her advice was to get AMH testing for a baseline number. AMH stands for anti-mullerian hormone, and it is produced by very immature ovarian follicles (eggs) and detected by a blood test. Scores range from over 4.0 to less than 0.5.
Shannon, age 41, had an AMH score of 0.23.
The plan that most OBGYNs recommend for women over 35 is to try on their own for six months, and then seek out a specialist. Yet, due to her age and her physician’s advice, Shannon decided to start her search immediately for a board certified reproductive endocrinologist.
The first fertility specialist that Shannon saw gave her a very negative prognosis, mainly due to her AMH score. He suggested she had a less than 4% chance of getting pregnant with IVF. He also detected a uterine polyp which would need to be removed. He recommended IUI without ordering testing for Noah. Shannon, concerned about what her low AMH score meant after receiving this poor prognosis, began to do her own research, searching for low AMH success stories online while she looked for another specialist who helped others with similar challenges.
Dr. Burger, Shannon’s second stop, didn’t agree with the initial assessment. The South Austin fertility specialist stressed that AMH reflects egg quantity and not quality and recommended that the couple begin a fertility workup that would include male factor testing and a hysteroscopy. Noah tested positive for sperm antibodies, which would hinder success with IUI. Dr. Burger also confirmed Shannon’s uterine polyp with a hysteroscopy and quickly removed it.
“Now at least we can start with a full picture and design the most optimal approach to overcome all of our obstacles,” Shannon remembers thinking. Because of her age and low AMH, and the sperm antibodies, Dr. Burger recommended IVF with PGS to identify chromosomally normal embryos. She recommended they do so sooner rather than later, due to Shannon’s age and test results.
They had no [chromosomally] normal embryos on the first and second IVF attempts. However, they had one normal embryo on the third, which led to a successful pregnancy; and multiple normal embryos on the fourth, which the couple cryopreserved for the option to try to expand their family later.
“Not only did PGS help speed up the process, it helped us avoid the pain of going through multiple miscarriages because we only transferred the one embryo that we knew, through PGS, had tested normal.”
Dr. Burger, Shannon and Alejandra Carrasco, M.D., a board certified physician in both family medicine and integrative and holistic medicine, came up with an integrative regimen through research of successful treatments for advanced maternal age. Shannon whole-heartedly believes that ubiquinol (CoQ10), micronized DHEA, and D3 vitamins and dietary changes that Dr. Carrasco recommended, contributed to her successful outcome and improved her overall health.
“I think it’s important to note that Dr. Burger thought my fertility potentially might decline [over the course of treatment], due to my age and test results, but it actually improved over time. As my overall health improved with thyroid treatment, nutrition and supplements to support my condition, my fertility was improving,” Shannon said.
Dr. Burger reinforced to this couple that you can have a low AMH score and still have pregnancy success. Shannon and Noah only had a few embryos, but it just took one. Today, baby Genevieve, “Evie,” is six months old.
“She is super happy, incredibly sweet and smiles all the time,” says her mom. “She is the light of our lives.”
Shannon’s advice to women still trying to conceive? Don’t wait, and don’t be afraid to get tested. Make sure your doctor tests both partners because the causes of infertility are divided equally among men and women. A full picture and an optimal plan based on your unique circumstances is critical to your success. She also found support in online communities, like Inspire, that allowed her to read about the experiences of other women going through infertility treatment and what approaches worked for them.
“When I found out my AMH score was low, I looked for success stories online, but wasn’t able to find many at the time. The news I initially received, of a less than 4% success rate, was heartbreaking. I was looking everywhere for hope. That provided me with motivation to share my story. I want others who might be in a similar situation to know that there is hope.”
Shannon highly recommends finding the most qualified group of specialists – for your overall health as well as your fertility – to be your advocates on the journey.
“We are so grateful to Dr. Burger, the Texas Fertility team, and Dr. Carrasco. Not only did they offer us hope, they helped us to create a miracle, and she is truly the greatest gift of our lives. There are truly no words to express our appreciation.”