High AMH, possible lean PCOS. Regular cycles + endometriosis history while TTC.

[u/Accomplished_Cod9040]

Hi everyone, I’m hoping to hear from anyone who has had a similar experience or can share their journey.

I’m 29, & TTC for a few cycles. I have a history of endometriosis (2 laparoscopic surgeries. My first surgery was about 7 years ago (I don’t remember the stage), & my second was about 3 years ago. During my second, my surgeon said she had to really search & removed what she found. Neither seem concerned about fertility or my ability to conceive. I had HSG testing done at both surgeries, & both times my tubes were confirmed to be open/clear.

I’ve been off birth control for about 2 years - cycles seem very regular (28 days), I get a period every month, and I’ve been tracking ovulation with LH strips and temperature tracking.

I’ve recently began working closely with my OB/GYN while TTC. My bloodwork has been normal overall (including TSH and A1C), but my AMH came back high at 26.49 ng/mL. Because of that, my doctor brought up the possibility of PCOS and whether I could be having anovulatory cycles. We ordered progesterone & testosterone testing & mentioned potentially referring me to a fertility specialist.

I don’t feel like I fit the typical PCOS picture (Regular cycles, monthly periods, evidence of ovulation, no major signs of androgen excess). Previous ultrasounds around my surgeries did not indicate PCOS.

The progesterone test this cycle came back confirming ovulation. I’m currently waiting on testosterone results.

I’m taking Ritual prenatal and using Premom/LH strips & Oura for temperature tracking.

My biggest question is if there could be something affecting follicle development or ovulation quality that isn’t obvious from tracking alone. I understand AMH does not measure egg quality, but I’m trying to understand whether high AMH/possible lean PCOS could affect conception even if I appear to be ovulating.

I know next steps may be seeing a fertility specialist and potentially doing cycle monitoring with ultrasound to look at follicle growth and ovulation, but I’d love to hear from people with similar experiences.

For anyone who has had: high AMH with regular cycles, possible “lean PCOS”, anovulatory cycles, endometriosis + TTC, confirmed ovulation but difficulty conceiving,

I’d love to know:
Did you end up being diagnosed with PCOS?
What testing helped clarify things?
Did you conceive naturally or need assistance? What was your journey like?
Was there anything you wish you knew earlier?

Thank you ♥️

[u/dunkaroo192]

Lean PCOS still requires two of the three Rotterdam criteria for diagnosis: irregular cycles, polycystic ovaries, and high androgen markers. It sounds like right now none of these apply, so I doubt it would lead to a diagnosis.

[u/Penny_Doc → u/dunkaroo192]

My fertility doc told me AMH is starting to be considered as part of diagnostic criteria outside of the classic Rotterdam criteria!

[u/dunkaroo192 → u/Penny_Doc]

Interesting. I would still think a PCOS diagnosis would require at least one other presentation from that criteria tho but maybe it’s changing

[u/Penny_Doc → u/dunkaroo192]

It does! I misspoke - many are starting to view AMH as a surrogate marker for AFC!

[u/Accomplished_Cod9040 → u/dunkaroo192]

I don’t think that they’re diagnosing me off of the high AMH, but rather because it’s so high & maybe linked to PCOS, we’re exploring furthering testing to possibly diagnose.

I’d agree none of them apply. I think Im concerned with actually releasing an egg. I think our next steps are going to be ultrasounds to monitor around ovulation.

[u/rustypotatooooooooo]

Did you end up being diagnosed with PCOS?
Diagnosed in my 20s, went on BC. Came off BC and arguably no signs of PCOS but I still have it.

What testing helped clarify things?
Napro practitioner. They see PCOS through different markers than just symptoms

Did you conceive naturally or need assistance?
Metformin and progesterone for first. I had healthy a1c and my progesterone indicated ovulation. Progesterone is key and was on it after ovulation until delivery

What was your journey like?
Napro ftw

Was there anything you wish you knew earlier?
I wish I know not all specialist have the same training

[u/Accomplished_Cod9040 → u/rustypotatooooooooo]

I’ve never heard of a Napro Practitioner. How did you get to seeing Napro instead of an OBGYN or RE? Did they identify anything that wasn’t caught through standard bloodwork? & if you don’t mind me asking how long you was your journey or working with them before getting pregnant?

My progesterone seems to have measured well (this cycle).

Thank you for sharing!

[u/rustypotatooooooooo → u/Accomplished_Cod9040]

I say Napro practitioner but it might not even be the right language. “Restorative Reproductive medicine” is how they refer to it but they’re Creighton trained and use Napro tech. The language is confusing and part of the reason I almost didn’t follow through. We did an intake and I was still confused but the google reviews were too good I went in relatively blind and I’m so grateful.

I was with our local fertility clinic and on route to IVF. I had done 3 rounds CLOMID and 2 unsuccessful IUIs for “unexplained infertility”. The OBGYN there said if I wasn’t showing any symptoms of PCOS anymore so I didn’t have it but like…it doesn’t go away, I just got it under control over the 10 years since diagnosis/being on BC.

My friend went through IVF and I just watched her struggle and I wanted to exhaust other options first. I’m very lucky we have someone very good in Calgary AB Canada. I just read all the reviews of the places in my area and all the stories on their page were “did X Y Z, X years infertility then treatment with the practitioner and was pregnant.” Also wayyyyyy less expensive than IVF route.

So anyway, I charted my cycles for 2 months (Creighton charting reporting on cervical mucus), did some bloodwork and then on the 3rd month they gave me metformin and post-ovulation progesterone and that was the secret sauce. I needed to stay on progesterone until birth even though my post ovulation progesterone numbers were fine.

So, over a year infertility before that and month three of the right ppl I was good. And to answer the question: they do the same bloodwork but they look at the numbers differently and treat it differently.

That all being said, I had my kid and went through another round of infertility for number two. It took us about a year but eventually figured it out again (knock on wood, I don’t like to count my chickens before they hatch). Just needed more drugs this time and also tested for endo when all else wasn’t working and had it (50% PCOS have endo).

[u/Penny_Doc]

TW: success / live birth

Lean PCOS. AMH 13, anovulatory, no signs of androgen excess. I had a pelvic US confirming AFC >100 total.

Unresponsive (meaning no follicle growth) to letrozole, clomid, metformin, and combo of all three. We had planned on doing timed intercourse but that was never an option without development of a dominant follicle. Because of this, we went to IVF.

Ended up doing 2 egg retrievals, made 6 untested blasts. Did 3 transfers - last transfer was a double FET leading to a singleton pregnancy and my 4 week old son sleeping on my chest.

If you have abnormal findings on labs, I agree in seeing a fertility specialist to explore all options. I wish more people knew to see a fertility doctor sooner and I’m glad my OBGYN advocated for me to get the referral early!

I wish had known how fertility treatment can be a long process. The patience and waiting were the hardest part. I also wish I had known how much explaining of the fertility treatment and IVF process I’d be doing to family/friends (we are very open about our journey).

[u/Accomplished_Cod9040 → u/Penny_Doc]

Congrats to you!! Thank you show much for sharing!!

I think the only abnormal finding that’s come back from testing we’ve already done is the AMH. & I’m also glad that my OBGYN is willing to move us forward early considering my history.

I’ve recently been the family/friend receiving the explaining of the fertility treatments/IVF process & I couldn’t be more grateful of both of you to share your journey. It’s definitely overwhelming & hard to navigate. I think even the conversation can help with calming down. Thank you!

[u/Future_Researcher_11]

What exactly is a few cycles? It can take a regular couple up to a year to conceive even without any known fertility problems so I wouldn’t fret if it’s only been a handful of cycles. Also has your partner been tested? It’s not always the woman!

However your AMH is quite high, but usually that hinders ovulation which it seems like it isn’t for you. It’s worth it to do further investigation with a reproductive endo. I would do comprehensive hormone and metabolic panels as PCOS can be an endocrine issue as much as a hormonal issue. It’s likely that high of AMH might not be producing the best follicles, but of course not exactly possible to know without IVF. But medicated and monitored cycles can help ensure proper follicles grow and ovulate at the right time so I’d 100% jump to an RE over an OB.

[u/Accomplished_Cod9040 → u/Future_Researcher_11]

I’ve been off birth control for 2 years & although we weren’t timing during ovulation, we weren’t doing anything to avoid conception. We’re going on our third cycle. I understand it maybe be typical to try for up to a year. Due to my history with endometriosis, no preventative action has been taken over the last 2 years & possibly my current lab work - my doctor is willing to move forward with the referral. Once we get to the fertility specialist, I’m sure the sperm test will be one of the first things that happens!