Circus School, Traditional IVF & AMH

There has been a lot of talk in my world lately about AMH and what it does and doesn’t mean.  Assume when I say “my world” what I mean is in my head. It’s involved reading a lot of white papers, and understanding who the players are and what they are trying to determine with this piece of information that can be so devastating to so many women. You may or may not recall that 5 days ago I was told that my AMH was .16, which puts me in the bottom 1% in my age bracket.

Prior to 2008, the “gold standard” for treating infertility was FSH and E2. As IVF became more popular and sought out by infertile couples, IVF clinics began to try to protect themselves by only taking on the cases most likely to have a positive outcome. The reason for this? Largely couples chose clinics on their success rates. If a clinic had 1000 patients, and only 20% of them were getting and staying pregnant, then you can see that those odds are really quite poor. Consequently you can expect that the profit margins can and will suffer. But if a clinic was able to “cherry pick” their patients by only taking on the ones who had the best chance of a successful outcome, then the clinic can control their percentages, stack the proverbial deck in their favor, and potentially make larger profit margins. Thus enticing new patients to cycle there.

For those of you who have been to more than one clinic, you know that some are hard sell used car sales man types, some downright refuse to treat you depending on your age, or your issues, and some promise the moon, knowing full well that they are taking your money without giving you the chance at a positive outcome. Trust me when I tell you, that the profit margin in these clinics is huge, primarily because most people pay at least partly, out-of-pocket. Overwhelmingly IVF is not covered by insurance. Yes there are exceptions but most people have to pay at least some amount out-of-pocket.

Is it ruthless of me to boil it all down to money? Maybe, but these clinics are business’ and every business is in business to make a profit. Some just go about it with more integrity than others. I’m not saying all traditional IVF clincs are bad either. What I am saying is “your mileage may vary.”

The best I can research is that the AMH test was conceived of,  and propagated by Dr. Schoolcraft at CCRM for evaluating the reserve for his patients who are mostly undergoing traditional IVF. If you had a low AMH, you would be shown the door right away so that he could keep his 40+ success rate in the 30-40% range, which didn’t last when he ceased cherry picking, because economic conditions are making it hard for him to be so choosy. AMH, just like FSH, is only indicative of quantity, it provides no indication of quality. It also provides no information about whether or not you can sustain a pregnancy assuming you should become pregnant.

Traditional IVF clinics now treat AMH as their “gold standard” but its only one piece in a larger puzzle. And to see the larger puzzle you need to understand the motivation behind this test, and at least grasp how the other pieces fit.

I am not doing traditional IVF. Because of my age, there are very few IVF clinics that will treat me without trying to shove the idea of donor eggs down my throat as an immediate cure-all. Not that there is anything wrong with donor eggs or people who use them. I’m just not there yet, and my RE doesn’t think so either. Donor eggs are seen as the single “condition” under which traditional IVF clinics would in fact be willing to treat older patients, or patients with secondary issues.

The treatment I am pursuing is based in the idea that fewer eggs produced =’s higher quality. So far I have found it to be so, but it’s still basically the same process as regular IVF, it’s just less drugs, and it’s significantly less expensive. Depending on where you do it, the outcomes are still very high considering nearly everyone getting treated there is of AMA, and lots of times, have secondary fertility issues. What I’m talking about here is still somewhere between 30 and 40% success rates even though this particular Dr, takes on the hardest cases. Women that are post hysterectomy, have cancer, polyps, PCOS and varying degrees of additional secondary issues.

AMH is rarely tested for at the kind of clinic I go to, because it’s just not that important to the goal or the outcomes, and my RE sees it as 1 factor out of a myriad of other factors.

Its harder to find information about the larger picture, because well, it just doesn’t serve most IVF clinics, so fewer are willing to write about it. But the information is there, from reliable sources if you look.

Its taken me nearly a week of researching, and mulling it all over to be able to articulate this, and I hope its helpful to someone. I think what it says about me is that I am an enormous nerd who has the ability to completely geek out with numbers, percentages and algorithms. Who also has the desire to truly understand this new language I am learning.

School is dismissed.

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2 comments on “Circus School, Traditional IVF & AMH

  1. This is very interesting to me. I started my ‘official’ infertility exploration while living in New York. Because I was a student, I had access to an endcrinologist who did more than what duty called for in treating me, basically everything short of IVF. At a certain point, we realized I needed surgery and she referred to someone. But the office said I would have to pay 500$ just to talk to him because we was an fertility specialist.

    I’m from Canada, although I haven’t lived there in a while. But I just couldn’t believe the amounts of money people were talking about. In the end, I saw the man, he signed me off as a normal OBGYN patient and my surgery was covered. Now, I’m in Belgium where IVF is covered by healthcare. Our total bill will be less than 3k. I am grateful to have the means to do this process without thinking about money and I’m grateful the system can do this process without thinking about the profit margin. Yes, there are differences (way less hand holding, way less client service), but it’s a trade off I happily make.

    Incidentally, I’ve looked at AMH too. Still confused. And I reasoned at the end of the day it didn’t matter because it wasn’t going to stop what I needed to do. Good for you for doing the same.

  2. Jeanette says:

    If it helps anything, my RE read the AMH entry, and said that I had gotten it completely correct, right down to the money and the donor eggs. He said its correct in that it identifies quantity remaining and nothing else, not quality, nor does it identify if a woman can or can’t sustain a pregnancy. He said if you follow the assumption that a woman requiring IVF needs help getting and staying pregnant, that its basically useless, that there is absolutely no reason it should be anyone’s “gold standard”. He said, “it just means they are lazy.” Which I laughed at.

    Expense wise: What I am doing is still 8400, for 3 retrievals and 3 transfers, there is a monthly cycling fee of 650, and then meds which can run anywhere from 200, to 2000 per month depending on your protocol.

    The first IVF clinic I went to asked for 36k for 3 attempts, meds not included, anesthesia not included, and a cycling fee. They couldn’t even give my blood test results correctly, and had a high pressure kind of sales pitch so I never moved forward with them.

    Hand holding: Even still, with all that out of pocket, the patient still has to advocate on their own behalf lest they get lost in the shuffle. In my case the Dr is so busy, and his time is so subdivided, his staff has had so many growing pains you (as the patient) still need to remain on top of what you’re doing, to ensure mistakes are not made.

    Separately I really excited you posted, and I really like your writing. So thank you! I hope we can get to know one another and become a good source of support!

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