Statistics and You
Through blood testing, these tests measure levels for FSH, Estradiol, LH, AMH and Inhibin B. This particular lab considers these results along with your age and they use their proprietary “Ovarian Assessment Report” formula to come up with an “Egg Retrieval Score.” Their formula is based on results from hundreds of women who had blood tests and egg retrieval reported through their lab.
The end result is a score from 1 to 20 indicating your likelihood of having 5 eggs or more retrieved through ovarian stimulation. So essentially the test is designed to give you an idea of how likely you are to get several eggs from an egg retrieval cycle. It does not give any indication of the quality of the eggs that might be retrieved.
The actual values of the blood tests are not shown on this report, but I had the office fax me a copy of the detailed report. (I included this as the last page in the report; the one in black and white.) You can see there that my FSH is VERY high (33.6) and my AMH is VERY low (0.19). Neither of those values would be considered good news for fertility.
Putting my numbers through their clever formula, they came up with an Egg Retrieval Score of 1 (the LOWEST possible score out of 20), which is means I had the worst possible chance of egg retrieval going well, based on their database of outcomes. You’ll see this represented bright and clear on the first horizontal bar on the first page.
They clarify that this test doesn’t give any indication of egg quality, but then they go on to explain that age is the best predictor of egg quality. And they show bright and clear in the second horizontal line that based on my age, I have a very poor chance of having good quality eggs.
At the bottom of the second page, they illustrate in another elegant visual that, even within my age group, I have the worst possible chance of retrieving eggs.
I didn’t trust the numbers because I had that blood test drawn on a day when I was very exhausted, having just returned from a cross country trip. In fact I was so mistrusting of the numbers that I had the tests done again by a different lab the very next month. In particular, I doubted that my AMH could be that low. The next labs came back with my FSH more normal (9.0) but my AMH was even lower, at 0.07! And it’s generally believed that FSH does fluctuate, but “you’re only as good as your highest FSH." So based on that notion, the fact that my FSH had come way down wasn’t relevant anyway.
I was disappointed, but it didn’t really have any bearing on what I was going to do, given that AMH predicted egg retrieval outcomes and I had no intentions of going that route. The acupuncturist who ordered the tests didn't seem particularly concerned. I also went back to another acupuncturist whom I really adored. When I told her my concerns about my low AMH, she practically yelled at me, “AMH MEANS NOTHING!”
You know the rest of story. I went on to get pregnant naturally three times in the next year. The first two miscarried and the last one was a good egg…conceived a full year after that Ovarian Assessment Report gave me those grim predictions.
So let’s look at what this tells us about how to use statistics to inform our expectations and our decisions.
Know what the statistics actually mean
First of all, it’s very important to look specifically at what a statistic means. I can’t tell you how many times I have heard someone say, “I have low AMH, and therefore I can’t get pregnant with my own eggs.” Many women claim their doctors have specifically told them that AMH means they have poor quality eggs or a low number of eggs, and therefore they might as well forget about conceiving with their own eggs. [Editing out my angry rant here!]
The ReproSource report that I’ve shared here does an excellent job of being VERY SPECIFIC about what their results mean and what they don’t mean.
“The Egg Retrieval Score reflects a woman’s chance of successfully having 5 eggs or more retrieved through ovarian stimulation.”
The score gives you and idea of how well you are likely to respond artificial stimulation of your ovaries for egg retrieval.
This is generally true for looking at AMH as an individual data point too. Lots of people are running around talking about AMH as if it’s some definitive egg viability measure.
The Advanced Fertility Center of Chicago website does a good job of explaining the biological basis for the interpretation of AMH. They explain that AMH is a substance produced by the ovarian of follicles at the early stage of development (probably around the time the eggs are moved from the “deeper freezer” stage to start maturing). The amount of AMH is thought to reflect the size of this pool of eggs. They conclude that “Therefore, AMH blood levels are thought to reflect the size of the remaining egg supply—or “ovarian reserve."
Here’s what else they say…
Women with higher AMH values will tend to have better response to ovarian stimulation for IVF and have more eggs retrieved. In general, having more eggs with IVF gives a higher success rate.
AMH levels probably do not tell us much about egg quality, but having more eggs at the IVF egg retrieval gives us more to work with - so we are more likely to have at least one high quality embryo available for transfer back to the uterus.
During IVF, they want to grab as many eggs as possible to increase the odds of getting some viable ones to fertilize and transfer back. Those with low AMH typically don’t produce lots of eggs during retrieval cycles. HOWEVER, doctors keep telling women that AMH tells you about your chances of conceiving with your own eggs period.
But what does AMH really mean if you're trying to conceive naturally, counting on your body to release a single egg each month?
In July 2020, I dug into recent research on AMH and fertility outcomes. I have not yet transferred that information into this course. But I did a livestream on the topic and linked to all the research articles I referenced in the description below the video. AMH & Getting Pregnant Naturally: What the research tells us
In a nutshell, what I found was strong indication that low AMH should not be used as a predictor of fertility potential when you are trying to conceive naturally.
My guess is that if you ovulate every month, you’ve got one egg coming each cycle, and that’s all that’s needed for a natural pregnancy. So perhaps, for natural conception, it’s irrelevant whether your ovaries can super-perform in response to various ovary-stimulating interventions, or whether you have a large pool of eggs maturing toward ovulation in a given cycle. This could explain why I was able to get pregnant THREE times naturally in the year after I was found to have extremely low AMH.
So this low-AMH discussion is just one example of how statistical data can be misrepresented in a way that leads people to see their situation inaccurately.
What does this statistic mean about YOU?
I encourage everyone to distinguish between an individual and a group. Start with asking yourself how the group represented in this statistic is representative of you as an individual. Perhaps you're actually different from that group in important ways. And if you still see your odds as slim, you can consider if that's going to be a demotivator or a super-motivator for you.
Let’s look at another piece of data in my lab report: age. The lab report explains, “Currently, age is the best predictor of egg quality.” And the graphs show that, based on my age, I had a greatly reduced chance of good egg quality. Unlike AMH, which is complex and harder to interpret, there’s not a lot of room for misinterpretation there. Higher age predicts lower egg quality. That’s a pretty well-supported statistic.
Specifically, some data show that by the mid-40s, only 10% of a woman’s eggs are likely to be genetically normal. Let’s pair that with another dismal statistic that says that, in her 40s, a woman’s chances of getting pregnant are less than 5% per cycle. Combine the chances of getting pregnant with the chances of catching a healthy egg. That would give me, at age 44-45, a 5 in 1000 chance of conceiving a healthy pregnancy naturally on a given cycle. Five in one thousand? Why bother trying at all?
I’m going to offer two perspectives on facing ridiculously dismal statistics.
#1 Is that group truly representative of YOU?
Those statistics are representative of the women who were included in that study, whichever one it was. So probably hundreds, maybe thousands of women of a given age were tested for pregnancy outcomes.
Were these women very knowledgeable about their cycle and timing intercourse effectively? Were these women taking exquisite care of their health for three months before TTC? Were these women exercising regularly for three months? Were these women eating right for their bodies? Were these women practicing regular calming techniques to keep their nervous systems balanced? Were these women sleeping well and getting ample rest from week to week prior to TTC?
Were these women doing all the things you are about to do for three months to nurture their eggs prior to trying to conceive? Without knowing any of the specifics of these studies, I think it's pretty safe to assume that, NO THEY WERE NOT! This study has not been done. There is NO data to tell us what the odds are of conception with a healthy egg when one does the fine-tuned self care that you are about to embark upon.
Well, ok, there is one data point, and that is me. But one data point does not create a database that you can base statistical predictions upon. (Since the original writing of this course, many women who have followed my guidance have gone on to have healthy pregnancies despite dismal statistics. We aren't at the stage of having good controlled data to report, but eventually I hope we will get there!)
So the truth is, we don't have truly useful data on your personal odds, given the conditions you are creating for your eggs and your fertility.
Examine the data you find, put it in an appropriate context, and feel free to flush it down the toilet if it's not relevant to you.
#2 What do YOU do in the face of slim odds?
But let’s say you feel the data might actually have something useful to say about you, given that you share some commonalities with the group in the statistic….maybe you’re looking at women of a similar age, or women with similar lab test results. For example, looking at my “Egg Retrieval Score” giving me a score of 1 out of 20 (1 being the dismal end of the scale). Maybe I don’t have everything in common with that group, but we do share some similarities.
We have some mindset choices here.
Let’s look at other situations where people face extremely slim odds of success. You’ve certainly heard stories of people who miraculously recovered from illness and injuries despite all the medical expectations. Rather than giving up, they put every ounce of energy into their recovery and they chose to believe something different was possible that what the stats told them.
And then there are the Olympic athletes, all of them. It’s not a contest where everyone gets a participant ribbon at the end. There are no guarantees and the odds of getting there are so tiny. Not one person standing on an Olympic podium started out with greater than a 5 in 1000 chance of getting there.
There were times in my life when I let the odds take me off the field. I was a top hurdler in high school, making it all the way to the California State Championships. But my coach told me I wasn’t tall enough to be competitive in college and based on that alone, I hung up my shoes after high school, and watched longingly through the fence at college track practices.
Later in life I decided not to back down in the face of low odds or lack of encouragement. I took the common belief of “it’s too hard to get into clinical psychology grad school” and turned it into my pie-in-the-sky challenge. I ended up one of three students accepted into the USC doctoral program out of probably over a thousand applicants. And toward the end of grad school, when I was applying to pre-doctoral internships, I was rejected by 19 programs but accepted by the most coveted program I applied to at Yale University where there were hundreds of applicants competing for, again, just three slots.
So when I looked at the odds stacked against me for a healthy natural pregnancy as I approached age 45, I just decided that I was going to do everything I could to be the exception to the rule, to defy the statistics.
Don’t let the data define you
If there’s one takeaway message that I want you to internalize from this lesson, it’s this…
Don’t let the data define you and your future.
Be discerning in how you use the data, and decide for yourself what part of it is useful to you. Recognize that you are unique, and there is no data that can reliably tell you what your outcome will be.
Here are some more Low AMH Success Stories. These are from women who persevered despite a diagnosis of "Diminished Ovarian Reserve," usually based on AMH level.
In closing I'd like to share this is coloring page. I haven’t completed yet, but you get the idea…
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