Meet The Doctor Who Is Empowering Patients And Bridging The Doctor-Patient Gap

http://www.thebetterindia.com/12671/meet-doctor-empowering-patients/

The Horrible 3WW and A New Beginning

Even the most difficult times of our life will be strewn with happiness. That was the case with my 3WW. I am thankful that I had the heart to enjoy those happiness amidst that horrible uncertainty. During 2WW, I was praying to God, "Please let it be a positive so that I can stay with my mom for some more time". I was away from her for 10 years. Every year, or sometimes once in two years, I got to spend only a couple of weeks with her. I feel guilty that she is alone with my very old grandfather. She herself is getting old. If the pregnancy test had been negative I wouldn't have been able to extend my stay in Madurai. I have to go with Rajender. I was away from him for more than a month and already every of his relatives were asking him when I would be back. My mother-in-law was too worried too that we were staying apart. So, when I got a positive, my joy knew no bounds. I had a valid reason to stay back.

The other reason for my happiness was our cats. We always had pets in our home. We had a peacock (actually a peahen), parrots, squirrels, rabbits, dog and even a wounded crow as pets. Actually, I was gifted to grow up with pets. Pets can teach young children many important life's lessons. They did teach me how to be caring towards the weak, to be compassionate, empathetic; they did teach me unconditional love and thus polished my nurturing skills. They not only taught me about life but about death too. Death of our pets did bring in lots of sadness and pain, but, those experiences were invaluable lessons which taught me how to grieve for the loss and get over it. It introduced me to the concept of death at a very young age and made me realize that death is an inevitable part of life. I think because of such valuable lesson I learned so early in life, I managed to get over many other losses in my life in a better way.

I must say I grew up with cats. There will be several cats running here and there in our home at any time of the year. When I left for Mumbai, for treatment, two of our pregnant cats have given birth. Oh, what a joy it was to see those tiny creatures! There were altogether 7 kittens. The most beautiful part about kittens was to observe them play when they grow a bit. When you watch those tiny bundles of joy you would forget all the adversities. Because of the 3WW I got the chance to be with them longer, to see them grow and to enjoy their playfulness and naughtiness to my heart’s content after a long, long time.

Rajender on the other hand was not used to pets as I was. He is afraid of them, or, the more apt expression would be, he is not comfortable with them. He thinks that they carry harmful germs. When he married me and came to our home, he was shocked to see cats roaming everywhere. And, he was more shocked by the way I play with them. He made sure that they don't come near him. If at all our cats wanted to be friendly with him and came near him, instead of shooing them away he would move away from that place quietly. This obviously increased our cats love and respect for him. The more he tried to be away from them, the more the cats grew fonder of him and wanted to get closer to him. They showed their love in so many ways. They used to cajole him by friendly brushing their body against his legs, (which made him keep his legs lifted away from the ground when he was sitting on the sofa :) or sometimes, when everyone of us were watching TV, the cats wanted to climb only to his lap and to no one else's :) When we were newlywed, one fine morning, I got up early and went to the kitchen to help my mom. I left the bedroom door open. I and my mom were chatting and suddenly we heard my dear husband's distress call, " Manju, Manju, where are you!" My mom was too worried. She said. "Go and see Manju, he sounds very disturbed". I ran to the room. On the cot, at one end, my dear husband was sitting with lots of sleep still in his eyes and I could see some fear too. On the other end of the cot one of our sweet little cats was sitting and watching Rajender interestingly and naughtily. I would never forget that scene. On seeing that, I broke into laughter. Rajender said, “I was sleeping and it came and laid between my legs"  He said, "It is not going away, I had to get up, please take this away". Our cat wanted some warmth during that December month's early morning. It usually finds some comfy place in between my mom's legs when she was sleeping. With the same expectation it went to Rajender. I removed the cat and came out. From then on until now, Rajender reminds me when I come out of the room in the morning, " Manju, please close the door" :)

One other thing I learned from our cats is the joy of motherhood. I have been seeing our cats get pregnant and giving birth from a very tender age. I have seen and felt a pregnant cat’s tummy so many times. It is a joy to feel the little ones from outside. When I keep my hand on a very pregnant cat’s tummy, I could feel the head of the little ones rolling inside. When they move, you get a tickling sensation in the palm, I used to enjoy it and would count how many heads are there inside. After giving birth the mother cat turns into a bundle of love. It purrs gently (the purring actually sounds like a little motor running inside its body) and feeds its young ones dutifully. I have even helped our cat birth its little one - worked as a midwife for it! It was such an experience to see it give birth. I have not only shared their happy motherhood times but also have seen them grieve the loss of their little ones. The greatest enemy for new born cats is a male cat, even its own father. If the male cat finds the place where the little ones are, it just bites and kills them. It is of course horrible! The reason why it behaves so is, if the little ones are no more, the female cat reaches its estrous cycle soon due to the lack of feeding period and gets ready for the next copulation! The plight of the female cat that lost its children is not any less than that of human. It cries and cries for days. It will keep on roaming around the place where the little ones were kept. Whenever it hears a mewing kitten somewhere it gets paranoid and runs around to see whether it is her children. Like every living being, it gets over its grief gradually, comes to an acceptance, and moves on!

I spent my 3WW with my mom and our cats. I ate very well, enjoyed all the native delicasies and my mom's cooking. I vomited very rarely. When compared to my pregnancy with twins it was a cake walk. I didn't have smell sensitivity, no constipation, there was no constant nausea, foods and its smell didn't turn me off. The more I felt better, more I was getting depressed. The only consistent symptom I had was gagging when brushing teeth.  When I get very paranoid I would take my brush and attempt to brush my teeth any time of the day :) My mom would look at me very surprisingly and with worry!

I literally tortured Rajender. I would call him and ask where he is. Whatever he says was enough to trigger my self-pity and anger. If he says he was with his friends or with his niece watching a movie, I got so irritated. I would cry, tell him all nasty things. I would say, "Here I am struggling every moment with uncertainty and fear, you left me to deal with all this alone and you are enjoying there", this was my constant accusation.  He would say, "I asked you several times whether I must stay back and you said I can leave. I will come back now". My mom on watching this got very angry one day. She said, “This is very unfair. You only asked him to go, I heard it myself, why are you now torturing him?” She would murmur, “It is not your fault, it is his fault. He has pampered you so much". I got so furious and told her, “When I have the heart to think about his happiness, his comfort, won't he think about me? It is his child too and how can he even come and ask me whether he could go? If he wanted to go, should I plead him to stay back?  I will never do that. That's why I asked him to leave". My mom had nothing more to say. She understood I was very disturbed and let me be the way I was. Not only with Rajender, to many of my loved ones I showed my anger and frustration. They understood me, forgave me. This is the reason why it is important to be with your mom during IVF times and not with your in-laws. If I have behaved the same with my in-laws our relationship would have definitely got strained. I also realized something after this incident between us, in any relationship compromise and sacrifice will not do any good. Make sure that you remain happy first. Only a happy person can keep others happy too!

At last, the day of ultrasound came. As the time got nearer I became surprisingly calmer. I prepared myself for the worst. I told Rajender that he must be strong. He said, "We have done our best, nothing more is in our hands, whatever is the outcome, please don’t worry". I told Dr that I will not mail him if there is no heart beat. He replied, “I will be praying and awaiting your mail". Before I entered the ultrasound room I looked at my mom. I was breaking down inside. I thought, “Whatelse and all she has to endure because of me!" I told her, "Amma, you must be brave. Even if there is no heart beat you must not worry too much, I will not worry too". I entered the room when my turn came. I felt I was carrying so many people's expectations, my heart was heavy. That was the first time in our 7 years of infertility history I was going to have a scan without Rajender. He was always with me for hundreds of scan I had before.

In the scanning room there stood the same lady doctor who measured my antral follicles. I gave her the necessary information. They first did an abdominal scan. Then they asked me to move to the other part of the room where they will do the vaginal scan. I looked at her and asked eagerly, "Is there a heart beat?" She said, “I have to look vaginally". There was a big screen in front of me and I could see the live scan picture on it lying down. I closed my eyes. My heart was beating so fast. The picture got clearer on the screen as the doctor focused on my little one and......

"THERE ARE TWO HEARTS BEATING INSIDE ME" :)

My follicles were growing but my eyes were wet!

On the day of my first ultrasound, I entered the clinic. I am no more a stranger there (but it is not so amusing to visit an infertility clinic often); people were greeting me with a smile. I sat there waiting for my turn to be scanned. I could hear Dr’s voice in his consulting room. I was looking at the baby pictures on the walls as usual. I started to think of my children. I dreamed of bringing them both to the clinic, to meet everyone who took part in creating them. I always imagined how happy those moments would be, but, now, I am sitting in that same place with empty arms and an aching soul! Suddenly all my happiness vanished, I felt gloomy; an unknown fear gripped me strongly. I felt miserable. I wondered what I am doing there! Like in snake and ladder game, I was back to square one when I was thinking that my destination is at arm’s reach. I realized the cruel joke life played on me much more intensely at that moment! I had tried 6 long years to achieve my dream and suddenly it was taken away from me in the most unfair manner. What is the guarantee that such a thing will not happen again? How long will I be able to play this IVF roulette? Why I am not provided with the ease and security of normal conception? What is the guarantee that I will produce enough eggs and embryos, what is the guarantee that I will become pregnant again?  Even if pregnancy happens, will I have a healthy child in hand? What gave me the courage to try this stupid stuff all over again? My eyes started to tear. I tried hard to concentrate on my smart phone. Dr came out of his room, and I tried even hard not to look at him. I was sure that, if I do so, I will cry. I expected that he will greet me, say hi and ask how I am. But he just carried on with his work. That was even more hurting. He didn’t even say hi! It brought more tears.

Dr. Anjali came. She was as cheerful as always. She gave me a warm smile as she entered her room. Sister Mary called me in. The moment I entered in, I broke down. I started to cry. I felt embarrassed but I had no control over my crying spell. Dr. Anjali did the scan; she said that everything looks fine and showed me the growing follicles. There were many. There was one follicle which was well ahead of the others. I was a bit worried whether this lead follicle will suppress the other small ones. But, there is nothing more I can do than to just wait and watch. Dr. Anjali called Rajender inside and explained him the scan picture. I was asked to continue the same dose of menogon (300 IU) Dr. Anjali said, ‘we are sorry, it was really an unlucky happening. We were shocked when we heard about your loss’. She asked me, ‘is it still painful?’ I replied, ‘this place is painful for me, I have gotten over it (really!) and sometimes the pain is unavoidable’. She said, ‘try to forget it and move on’. I smiled and came out of the room. We went to the reception to buy some medicines. 

Rajender was looking at me. He understood that I cried. He asked me what happened. That was enough to trigger my crying episode again. He was so used to this. I just went on shedding tears. He said, ‘Manju, there are people around you, stop crying’. I told, 'Dr didn’t even talk to me’. He said , ‘didn’t you see, he is busy’. I replied, ‘but how much of his time will be wasted if he asks me how I am!’ Rajender said, 'when you went out of the room, Dr came outside, he did greet me'. My sobbing got even more uncontrollable, ‘see, he did talk to you but he didn’t talk to me’. He looked at me as if I was mad and he realized too it was a waste of time talking to me, consoling me. Sister Lizzy gave me that day’s injection. I haven’t stopped crying yet. She was curious to know what is going on. She asked me, ‘aren’t you responding well to medicines, aren’t your follicles growing?’ She said, ‘don’t worry; you have taken medicines just for four days’. I told her that my follicles were growing nicely. She looked at Rajender. He was forced to respond and he said, 'she is crying because Dr didn’t talk to her'. For the first time I came to my senses, felt ashamed. I stopped him in between and said, 'nothing sister, I am a bit depressed'. She told that it is very normal to feel so because of all the medicines I was taking, might be she was right! She consoled me by saying, do not worry, all will be well. I said to myself, 'yes, all will be well!'

We came out of the clinic. I wanted to go to marine drive, so we went and sat there. I was getting back to normal. My fears eased a lot. The vast, roaring sea always brings calmness within me. I was watching the huge crowd in that area. There were so many different people and everyone must be having their own world filled with struggles and happiness. I was thinking, what for should I worry. I am following my dream and that makes my life interesting. Life is more beautiful when there is a challenge to face. I must be proud of myself; I am strong even after going through so much. Living in the present moment is the best thing I can do. I don’t know what tomorrow holds for me. I do have problems in life like everyone else and I have learned a great deal out of it. Those lessons have helped me to enjoy life even better. Hard times in life have taught me many things than any of my good times. Struggles are what that gives definition to my life.

During the days which followed, I had two more scans. My follicles grew luxuriously and there were many too. My only concern was that of the fast growing follicle. Dr. Anjali said that, it might be just a cyst and we might not get an egg out of it. I was thankful that it didn’t hinder the growth of other follicles. The second time when I went for scan, Dr was not there in the clinic. So there were less patients around. I and Rajender had time to have a hearty chat with Dr. Anjali. I told Dr. Anjali how difficult it was for me when Rajender tries to control what I eat too during IVF times. He doesn’t even want me to eat papaya when stimming, and I love that fruit. Even worse, for breakfast, in the hotel we stayed, they always have that colorful fruit. Whenever I pick a bowl of it, Rajender gets restless. He believes that it enhances body heat and it might interfere with the cycle. I have tried to make him see the truth, I told him how nutritious it was, I even fought with him but I could never get back the joy of eating my bowl of papaya. Dr. Anjali was kind enough to explain him why he must allow me to do what I like. She said, ‘the more stress you put on her, it is not good for her during this time. I believe that stress do play an important role in hindering IVF success, but, Dr. Malpani might not agree with this’. This is enough to put my dear hubby at ease. The next day I took an extra large bowl of papaya and sat in front of him. I ate to my heart’s content and he was not bothered too, atleast he tried hard to act as if he was not bothered :) Not only that, he allowed me to eat whatever I wanted thereafter. He was also extra nice to me the entire cycle and I must thank Dr. Anjali for that :)

The day of egg retrieval approached very fast. I took menogon only for nine days. For the last two days I took 450 IU of menogon. This cycle was somehow much easier. I never obsessed about the number and size of follicles. I never asked Dr.Anjali how many eggs I might get. I just took each day as it was; neither did I expect anything miraculous, nor was I fearful. I had copious amount of EWCM and my estrogen rose very nicely. This put my mind at ease.If I remember correctly my estrogen was 2000 plus (pg/ml) before I took the trigger shot (hCG). On the day of egg retrieval I was eagerly waiting to go under anesthesia and I just love it!

I started injections for ovarian hyperstimulatimon

I started to take birth control pill 12 days before my expected menstrual period. I do it to make sure that I get my periods on time. There were times when I wait and wait for my periods to start and it never happened. The reason was, either I failed to ovulate that cycle or I ended up with a cyst which prevented my periods. So, to be on the safer side, I took birth control pills. After 7 days on birth control pills, I started taking lupron too (overlapping BCP and lupron). I stopped BCP after 10 days and continued only lupron. When my period arrived, I started FSH injections on day 3 of my menstrual cycle (lupron continued until egg retrieval). Don’t ask me the name of this protocol. This is what has helped me previous time to get more eggs and so we followed the same. 

I ordered medicines in Madurai. In the beginning, I was scared. Medicines necessary for IVF will not be available in nearby medical shop (definitely not in our village). In a small city like Madurai, I was wondering, where will I go in search for it? But to my surprise, I found that, I could order all the medicines from home. I just have to call the pharmacy and order the medicines and they delivered the medicines to my home safely in a cool pack. I never expected this in Madurai and I was relieved. If any of you staying in Madurai was wondering how to order the necessary medicines, please contact Vasan medicals. They are very sincere, and prompt. They do their best to get the medicines you ask for in time.

I called Vasan medicals and the first question I asked them was which FSH preparation is the cheapest in the market. FSH is available in 3 different forms – Gonal F, Menopur and Menogon. Gonal F is the purest form of FSH. It is a recombinant preparation (genetically engineered) and hence very costly too. Menopur and menogon are prepared from the urine of post-menopausal nuns and hence called as hMG (human menopausal gonodotrophins). They are of course purified (not as pure as Gonal F) and contain equal amounts of LH and FSH. Menopur is a much purer version than Menogon. Menogon is the cheapest. I ordered Menogon. I used Gonal F for my first five IVFs in Germany. My ovarian response to Gonal F is very, very poor. But when I came to Dr. Malpani for my 6^th IVF, I was given menogon and I responded so well to stimulation and produced many, many eggs. Might be I needed LH too for getting my follicles to grow. So, when you are given an option to select between gonal F and menogon, chose the cheaper one. Scientific studies have failed to show that one form of FSH preparation is superior to the other.

When I got all the medicines and when my mom saw it, her eyes became so wide for a moment and then watery too. She asked with fear, do you have to inject them. I said, amma I am so used to it. I don’t even feel any pain. If at all I feel something, it is just like an ant bite. From that day onwards I made sure my mom doesn’t see me injecting the medicines. Many women who are about to start IVF ask me with fear, "I am so sacred of injections, will they hurt?” Believe me, they don’t. I think, when compared to all the emotional turmoil we undergo during IVF, pain caused by these injections are nothing, absolutely nothing. If you are afraid of these injections, how will you face the pain of child birth? They say childbirth is the worst pain you could ever feel. I actually like those injections (FSH) for another reason. They are like costly anti-aging drugs (who wouldn’t love to look younger!). This is what my RE in Germany says. I truly, truly believe so. When you take those injections and when your estrogen level starts rising, it is a wonderful feeling, at least for me (I know women who suffer from nausea and other side-effects because of it). I feel like a teen ager. My thoughts change. I become so optimistic, I sleep too well and my skin becomes beautiful. Do you remember the first time you fell in love as a teenager (your first crush), it feels exactly like that! As a scientist, I am amazed to see and feel by myself how hormones could control our brain, our thoughts, perhaps our actions too. Is there anyone out there who could relate to what I say (very curious to know)? So, please do not panic about your injections. They are not as evil as you might think. One another fear most women have about IVF drugs is, “will I put on much weight when I take them?" I have heard women complain – “only after I started using them I became fat”. Please be assured that it is not true! What makes you gain weight is the depression that you go through during your infertility treatment. Because of the stress and depression, you unknowingly increase your food intake. Eating food, especially which are rich in carbohydrates, creates a feel good sensation due to the release of a hormone called serotonin. In order to beat depression, many women get addicted to the effect of serotonin and overeat unknowingly. The best way to prevent weight gain during fertility treatment is to develop creative strategies for beating depression. In my case, infertility actually helped me to maintain a healthy BMI. I understand the impact of body weight on fertility and I don’t want to put myself through another problem, I think I already have enough problems to tackle!

Rajender came to Madurai. I was eagerly waiting for him. How happy I was to see him! The first question I asked him was, “did you miss me?” He replied with a naughty smile, “no, never!” But his happy face said otherwise. I took my medicines for the first four days in Madurai, and on the fifth day we were in Mumbai for my first ultrasound. I asked Dr whether I could come to Mumbai much later, after 8 days of taking stimulation drugs (I thought I will reduce the hotel expenditure there, Mumbai is of course costly!). He was not happy. He said, “If you want to do so, I need a very good digital picture of your ovaries after 4 days of starting stimulation”. I was so sure I wouldn’t be able to get a digital picture (I remembered the not so cooperative doctor in that scan center).  He said, “Manju, don’t be penny wise and pound foolish. It is better we monitor you closely so that we can adjust your stimulation drugs as and when needed, this will provide you with a high chance for having an optimal outcome”. So, we were in Mumbai a lot earlier this time and I love Mumbai.

Mumbai is very beautiful and lively. People are friendly. Shopping areas are amazing. But the most important attraction for me in Mumbai is the Marine Drive area. I just love to sit and watch the sea. I feel so happy and relaxed when I do so. One thing that makes me sad about Mumabi is the wide-gap I see between the rich and poor people. There are overwhelmingly rich people who drive BMW and dine in Taj, and on the other hand I could see poor people, especially poor children who are just left on streets. I really, really feel guilty at such times for pursuing a costly way to have a baby, after all a baby, which are present in abundance in India, even on roadsides (babies, babies everywhere but not even one for me !) Once I was walking near the Taj hotel. The beauty and richness of it always amazes me! There were so many Benz, BMW and Jaguars parked there. Rajender was telling how much those cars would cost. I was hearing it open-mouthed. I thought what a life it is! I wanted to be that rich too. I want to drive a costly car, enjoy my evenings in a five star hotel like Taj and want to live like a queen (who wouldn’t want to!) Caught up so much in those thoughts I forgot to see the foot path. I was about to stamp on something and Rajender pulled me aside and looked at me angrily (It happens many a time when we go out, most of the time I will be too attracted by what I see or will go into dream mode). I looked down and realized that I was about to place my leg on the hands of a 12 year old girl. All my excitement drained in a second. There lay a poor girl, near that richest hotel, clothed in rags and with a small torn bag under her head (I hope it is her only possession). She was fast asleep in that busy roadside (serenity amidst chaos!). I was ashamed of my inability to do anything for such unfortunate children, yet, desiring after things which could make my life even more comfortable. I felt guilty. I was angry and bitter, I cried. People like me, easily blame Karma for such inequality and unfairness, and move on with their life. I realized that there are so many things in my life I must be grateful for. I had a safe childhood, I couldn’t imagine the life that little girl was leading. How unsafe it is for a girl to live on streets! I have a shelter above my head, I have good clothes to wear, I have food not only to satisfy my hunger but I could have food for my enjoyment too. If I start writing the things I must be grateful for I need several, several pages. If that is so, do I have any right to complain about infertility, not being able to have a child?

I went to the clinic for my first scan after four days of taking 300 IU Menogon. I was very happy when I went in. I was eager to meet everyone, especially my Dr. I was very eager to know how I am responding to stimulation. But when I came out of the clinic I was too tired, tired of crying my eyes out!

Beginning of our 7th fresh IVF cycle

Every IVF cycle is like a roller-coaster ride – they are scary as well as exciting! As you get used to it, you will learn to enjoy the fun and suspense. Beware, it can be addictive too! I wonder whether women (including me) who go through IVF get addicted to the thrill of it.  I find no other sane explanation for going through it again and again. Of course, the urge to reproduce, to propagate one’s own genes, does play a major role in going through this insane IVF journey. Few months ago, I was so sure that, I will never go through a fresh cycle again. I was in so much pain and everything appeared scary. But, spending some time in India, in the warmth of loved ones was enough to get back the Manju I lost. Thinking of crossing the bridge was fearful, but when I came near it, I got the courage to do my best.

I wondered and wondered why I wanted to use donor eggs in the first place. There were several reasons. This IVF journey is eating up our normal life. All we are doing for several years is to wage war against infertility. I think, we forgot, how a normal life would be! On the other hand, I would rate our life as very interesting when compared to most other people. It is painful at times, but extremely challenging too. We learn a lot about life because of our infertility struggle. I thought, we have learned too much already (which is not too good too :), and I just want this struggle to end as quickly as possible in a pleasant manner, so that we can move on to the next stage of life. I am already 36, and one of my biggest fears is, the possibility of high risk of miscarriage and begetting a child with genetic defect when using my own eggs (although still the possibility of such happening is not extremely high!) I thought, if using donor eggs could reduce miscarriage rate and give us a higher change of having a healthy baby, why not go for it? Afterall, I and Rajender want a baby to make our life more interesting, we badly want to nurture our parenting instinct before it vanishes with age. You might ask why not adopt then, we tried. We did go to an adoption agency in Madurai (Grace Kennet foundation) to collect details. When we asked about international adoption, the response was, it will take many years. For domestic adoption, we have to live in India for a year and then we are eligible to apply for adoption. If we apply, it might take another couple of years to actually finalize the entire process! Rajender went with so much expectation and when we came out of the adoption agency I could see his forlorn expression. After we lost our twins, the longing to have a little one in our life as early as possible is very high for Rajender too.  He was able to quench his paternal instinct by the company of little ones in our family and immediate neighborhood.  

I started preparing for another ovarian stimulation. Dr. Malpani asked me to measure my AMH and AFC. Two and a half years before my AMH was 1.8 ng/ml. I was wondering what will it be now! When I started my IVF journey it was in between 4.5-3.5 ng/ml. One fine morning, I went with my mom to a nearby lab (Thyrocare) to give my blood for measuring AMH. I also asked them to measure my Vit D and TSH. I waited for the results anxiously.

I called Rajender and told him not to expect much out of this IVF cycle. I said, I am much older now and I have no idea how I will respond to stimulation. Perhaps, I might produce only a few eggs. Might be, we will not have enough embryos to grow to blastocyst stage. Who knows, I might not respond at all! I told him, be prepared for everything. He knows about me and how negative I could get. He thinks I am pessimistic, but I think I am cautiously optimistic and it helps me a lot to accept whatever comes my way.

Two days later my AMH results came. As I expected it was such a poor value. When I sent the results to Dr.Malpani, he sent me a sad smiley in return! My Vit D was 12 ng/ml and the normal range was 20 ng/ml (and this is after my skin enjoying lots of Indian sun!)

MY AMH WAS A MERE 0.6ng /ml :(