Confused - 29 & healthy with AMH of 25 ng/mL - please help

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spartin
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Joined: Thu Sep 08, 2016 4:37 pm

Confused - 29 & healthy with AMH of 25 ng/mL - please help

Post by spartin »

29 yr old female.

I am healthy overall with a BMI of 22.1, no weight around the middle, no excess hair growth, no male pattern baldness, no high androgens, no insulin resistance, no high glucose, fairly large natural breasts, and no ovarian cysts visible in a ultrasound.

I do have acne that worsens when I go off birth control and dramatically improves when I'm on it. I have amenorrhea (and have gone as long as 2 years without a natural bleed, prior to being on BC). And, I just got test results showing my AMH is 25 ng/mL....25!!!

I was diagnosed with PCOS (due to acne and no menstrual cycle). Then my doctors told me no, I just have extremely low progesterone, instead. Now, I'm being told with 99% that I have PCOS (because my AMH is so high).

I am thoroughly confused.

What do you think is really going on? And, what are my possibilities for conceiving? Husband is 31 with excellent sperm count/morphology/motility. We would like to conceive as naturally as possible and are willing to try 2-5 years of treatment before we go to IVF.

FSH (Day 3) 4.1 miU/mL
Prolactin (Day 3) 35.3 ng/mL
Estradiol (Day 3) 74 pg/mL
AMH 24.7 ng/mL
Thyroxine, Free (FT4) 1.18 ng/dL
Ferritin 24 ng/mL
Testosterone, TOT., S. 61.1 ng/dL
Sex Hor. Bind. Glob. *NJ1 83 nmol/L
Free Testosterone 5.86 pg/mL
FSH (phase UNK) 4.7 mIU/mL
Progesterone (phase UNK) 0.41 ng/mL
Estradiol (phase UNK) 57.8 pg/mL
Insulin, Total/Random 6.8 uIU/mL
Hemoglobin A1c 5.3
e-AG 105 mg/dL
T3, Free (FT3) 3.2 pg/mL
25OH, Vitamin D 39.7 ng/mL
DHEA Sulfate 98 ug/dL
DHT (7) 116.0 pg/mL
Estrone (E1), Serum *NJ1 55.7 pg/mL

I am a Ph.D candidate with an excellent background in statistics and a strong understanding of the body. I am capable of learning and looking up anything, so please feel free to respond with straight medical terminology and reference me to medical studies that you think may be helpful. I have read EVERYTHING available on the internet, 6 books on PCOS, and 2 books on menstrual cycles. Nothing that is publicly available has been helpful, yet. I'm going on 4 years of trying to figure this out.

Any insight or direction for further research that you could provide would be much appreciated. Thank you!
Dr. Amin
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Joined: Wed Mar 30, 2016 10:49 am

Re: Confused - 29 & healthy with AMH of 25 ng/mL - please he

Post by Dr. Amin »

Hello. While I can't give you an exact diagnosis without knowing more about you, I can tell you more about PCOS.

The diagnosis of PCOS, which stands for polycystic ovarian syndrome, is generally made when a patient meets at least 2 of the following 3 criteria:

1. Polycystic appearing ovaries on ultrasound. This means that there are more than 12 follicles seen on at least one if not both ovaries.
2. Infrequent or irregular periods.
3. Some evidence of high androgen levels. The patient either has blood tests showing high testosterone or DHEAS levels or shows some clinical signs of high androgen levels (hirsutism, abnormal hair growth).

The diagnosis of PCOS can sometimes be confused with other conditions, such as hypothalamic amenorrhea. Hypothalamic amenorrhea occurs when the pituitary gland does not secrete enough hormones to cause ovulation. This condition often occurs when the body is under stress, such as in the case of women who exercise heavily.

Since you are not having periods on your own, you will likely need to use some fertility medications to help you ovulate in order to conceive. My suggestion would be to see a reproductive endocrinologist to help you sort out your diagnosis and guide you with fertility treatment.
Marli Amin, MD
Reproductive Partners Medical Group
Orange County, CA
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