AMH, Vitamin D and my ovaries!

An AMH value of 0.6 ng /ml is bad, really bad. In the report I got in hand, it was written that, an AMH value of less than 1.6 ng/ml might indicate a poor response to ovarian stimulation. I was heartbroken and angry; my reproductive life is nearing its end! I expected it, but I didn’t expect such a drastic fall in my AMH. After I returned home with the results, I called Rajender. He was cool as a cucumber. He said, I read about women who produce eggs even with much lesser values. I was irritated by his positivity; I thought, why won’t he leave me in peace, take an alternate solution (donor eggs) and move on. I had no energy to argue with him or break his enthusiasm. Dr. Malpani gave me one more suggestion. He asked me, from which lab did you measure AMH. I told him that I got it measured from Thyrocare. He replied, Thyrocare is not so reliable, please measure your AMH again from SRL (Ranbaxy)! I was not hopeful, but I was badly in need of a miracle. I gave blood to SRL for AMH and Vitamin D measurement and waited for a couple more days.

From now on, this post will turn a bit more scientific.  Many of you might wonder why I measured Vitamin D along with AMH. Is it necessary? What is the rationale behind that? There is a connection between Vitamin D and AMH. AMH gene (the sequence of our DNA which codes for AMH protein) has a Vitamin D-response element (a region which is responsive to the presence of Vitamin D in a positive manner). To put it in a more simple way, Vitamin D can bind to the AMH gene and increase its expression.  If this is so, can low Vitamin D level lead to low AMH levels in blood? When they initially found the presence of Vitamin D-response element in the AMH gene of prostate cancer cell line, frenzied researchers, as usual, hyped out of proportion the importance of Vitamin D in reproductive biology.  Their understanding was and still is, if high AMH levels in blood indicate good ovarian reserve, increasing AMH levels by increasing Vitamin D intake, especially when one is deficient,  (since Vitamin D could increase AMH level) will lead to good ovarian reserve too. What a simple way to solve the problem of poor ovarian reserve! Just pop in Vitamin D, and the problem will be solved! But, this kind of (il)logical reasoning without understanding the basics of the science of AMH is half-witted! To read more about the science of AMH please refer to:  http://myselfishgenes.blogspot.de/2012/08/amh-paradox.html

It is true that Vitamin D could increase AMH levels. But increasing the expression of AMH from the already existing follicles (antral follicles) cannot increase ovarian reserve. More antral follicles lead to more AMH production, but increasing your AMH levels artificially (either by taking substances which increase AMH production, like Vitamin D, or by injecting AMH into your body) cannot increase your ovarian reserve. Actually, increasing your AMH level artificially, could lead to opposite effect - high AMH can decrease the amount of antral follicles available for FSH stimulation. So, if you are having poor ovarian reserve, taking Vitamin D is unlikely to help and in worst cases it can bring down your antral follicle count (AFC) too.  In case, if your Vitamin D levels are low, or if you are Vitamin D deficient, your AMH levels might be artificially lowered even though your ovarian reserve is good (there is no solid proof for this statement!). And, this is the reason I measured my Vitamin D levels too when measuring AMH. 

After two days, I got my blood test reports from SRL. My AMH level was 1.6 ng/ml and my Vitamin D levels was 17ng/ml, while the minimum recommended Vitamin D level in blood is 20ng/ml. Need not to say that I was happy and hopeful again.  A value of 1.6 appeared very great when compared to 0.6.  My thoughts used to wander, and I would wonder, which lab result is correct! But, as per natural human tendency, my mind decided to stick with the more promising value.  I had only 12 more days for starting the stimulation. I was waiting for my periods so that I can measure my antral follicle count (AFC). I knew well that, AMH value could only be interpreted sensibly with antral follicle count (AFC). I was afraid, yet eager to know my AFC! I was wondering, what if there were only few antral follicles left!

You might ask whether I took Vitamin D to correct my deficiency. Again, I have a very different view of the whole Vitamin D story. I was in India, I was getting ample sunshine. I had no signs of Vitamin D deficiency. I read somewhere that 99% of Indian population is Vitamin D deficient. This kept me wondering! If 99% of Indians contain a particular range of Vitamin D in blood, then, which is the normal range for that population ( whether the value which occurs in 99% or the one in the remaining 1%) ?  There are not enough studies to show the normal range of Vitamin D for a healthy, Indian population. No one still knows how Vitamin D is processed by our body. People who live in places where sun light is meager, must have or must need mechanisms to store Vitamin D in body, so that they can utilize it during days where sunlight is not available. But, do people who live in tropical regions like India have such mechanism? If not, then what should be their normal blood levels? Nobody has the answer for these questions. After, all the initial hype about Vitamin D, and connecting its deficiency to almost all the diseases in the world, researchers have recently started to understand that, measuring Vitamin D or supplementing Vitamin D to a healthy person is not advisable. As more randomized clinical trials are performed, the results of such studies shows that there is no benefit of Vitamin D supplementation whatsoever, and some studies even showed a negative effect (17% increase in kidney stones!).  For further reading: To [Vitamin] D or Not to D? That Is the Question. After considering everything, I decided to not take Vitamin D. Since I had only 12 more days to start the stimulation, I was too chicken to change anything in my body drastically! Vitamin D has the ability to change the expression of 3000 different genes (not only AMH!) in our body and I didn’t want to take any invincible risks.

My periods arrived after making me to panic a little! Have you ever noticed this - when you don’t need it, it comes on time and when you are waiting for it there will be no sign of it? I went to a nearby scan center to have my antral follicles counted on day 3 of my menstrual cycle.  I was too nervous. I entered the scanning room and there stood a lady doctor and her assistant. I told them that they must measure my antral follicle count, ovarian volume and make sure my uterine lining is thin and the cavity is free from any abnormality. She asked me where the doctor’s prescription was. I said, I don’t have one, I do my IVF in Mumbai and my Dr emailed me that I should measure all this. She looked at me uninterestingly and said, we do only follicle tracking studies. I had no energy to argue with her or teach her about IVF and the importance of measuring AFC! She was not ready to hear any of my lectures too; there were so many people waiting outside. She was still looking at me as an unwanted intrusion. The assistant was smirking. I felt so helpless and then I literally pleaded them, please do what I say. Since I have to do IVF, I need all these details. I must say that the scanning machine they had was excellent. The lady doctor counted my antral follicles. Unable to control my curiosity, I asked her, do I have antral follicles. She said 8 on one side and 10 on the other. I was so happy; I forgot how they behaved with me. With a broad smile I thanked them and came out, ignoring their strange looks. I waited for some time to get the results in hand. From the beautiful picture of my ovary they gave me, I counted my AFC once again. The result read: one of the ovaries is bulky – possible PCOD! I was too happy to have PCOD or anything that could give me more follicles and more eggs. I thanked my ovaries. Immediately after reaching home, I conveyed the results to my hubby and Dr. Malpani. I started to eagerly look forward to go to Mumbai- our happy vacation after staying away from each other for so long !