Episode 26: Two Fertility Docs Get Their Own Hormone and Egg Count Results Live

For educational purposes, Dr. Klimczak and Dr. Reed open up and do a live reveal of their own personal hormone and egg count lab test results. They share their interpretation of their results as well as their personal feelings (and disappointments) with their results.

Transcript

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Hi, I am Dr. Beverly Reed. And I'm Dr. Amber Klimczak. And we are Two Peaks in a Pod. Well, hi, welcome back everybody. We are really excited. We have a very special episode for you today. We've actually been planning this episode for a long time, right? Is excited the right word? I'm really nervous. Well, I guess first maybe we should give a trigger warning, um, for some of our patients because I will say we sort of teased this a while ago on our Instagram. So today's episode is about AMH testing and specifically Dr. K and I are wanting to spread awareness about checking an AMH, what different results can look like and kind of the implications about it. But when we teased it out, honestly, some people were upset and I totally understand. So if AMH is a sensitive topic for you, it might be a good time to just skip this episode and move on to another one. Um, and we'll make sure we put a trigger warning on our, um, social media posts too. But for those of you who are just curious to know more about, Um, fertility testing and specifically about AMH levels, this could be a good episode. And so the concept is, you want to tell them what we did? Yeah, so we will, some of you know that we have our blood machine here at Peak Fertility, and so we wanted to try it out on ourselves. And we decided to get our blood drawn and test. some common hormones that we use to sort of estimate how many eggs you have to work with and what your fertility looks like. Um, it's not quite that simple, but that's the most basic understanding. So we both got our blood drawn yesterday, which was not too enjoyable. Actually, the girls did really well. I know. Let's talk about a little bit about the blood draw too. Yes. Yeah. So tell us about how terrified of needles you are. I'm really scared of needles. If you know, if you've ever gotten that, prenatal blood work draw, where they draw about like eight tubes from you. I used to, you know, feel faint getting that done. Um, anytime the needle comes close to me, I really don't like it. I really feel like my blood should just stay in my body. Ha ha ha ha ha. And so I was very nervous about Kennedy drawing my blood, but she was really excited because she feels like she's really gentle and gives our patients a really nice experience. experience. And I have to say, I was pleasantly surprised. Yeah. It was really not too bad. Yes. Yes. Well, I was so glad when you opened up about your needle phobia because what's so odd is I also have a needle phobia. Now, I don't mind sticking needles in other people, but I don't like needles going in me. Yeah. And, um, honestly, like, it, it has been to the point where I've gone against medical advice sometimes. I was supposed to get blood tests done. I didn't go to get them done because I was so scared of, of the needles. Like, um, and I will say something that helped me is during my pregnancies, I did have to take progesterone shots and I just kind of had to get over it. And it was that desensitization therapy where every single time I would get So worked up and then I would get my shot and I'd be like, oh, that was fine. It was so bad. Yeah. Um, and, and so I think that was a good forced therapy for me. So it's definitely not as bad for me as it used to be. Um, but still even getting the blood drive, I cannot say I was excited about it but I had Nurse Amanda. She was so gentle and so wonderful. It was not actually that at all. Like, I actually don't even feel like I. felt it. It was just more Absolutely. Anticipation is how most medical things Yeah. And let's just kind of the special things we draws. So do you want to Yes. So we really like bu may have heard of this be little gadget and it vibr To it as well. Yeah, we don't do the cold pack, but maybe we should try it. I haven't done it yet with patients and buzzy basically vibrates. You can put it on for blood draws and it distracts the nerves so that you don't really feel the pain when you're getting your blood draw and it definitely works, I can tell you from personal experience, um, the other time that I had used it full disclosure was on my, when I had my Botox. Yes. My dermatologist used it. I was really nervous about getting stuck over and over again and she put Buzzy on my clavicle and I do feel like it really helped. Yes. Well, but I, since we're talking about them, can you tell me about the other circumstance you did Buzzy for too? Do you remember? Yes. Yes. I think it's such a good idea. This is, I don't think has been reported and I think it's a great idea. Yes, so I think the concept of sort of tricking the nerve with vibration is a really great idea and there's something else that we often deal with in our patient population called vaginismus and vaginismus can be where someone basically has an involuntary reaction where their vaginal muscles just clench any time anything gets close to them. Speculum, pelvic exam, intercourse, and it's extremely painful for the patients, and it's an anticipatory thing that happens to them, they cannot control it, and it's something that's really difficult to overcome and treat as a gynecologist, and so what we tried was trying Buzzy on her like back pelvis right here, one of my patients that has pretty severe vaginismus, and we put it on there and it was Vibrating and it relaxed her and I really feel like it helped. Yeah. We were able to do insemination for her. Mm-Hmm. I was able to do her transvaginal ultrasounds and it was amazing. I mean, it was like, it was. Novel. Yeah. I couldn't, I couldn't believe that. It was like not something needs to be created. Maybe specific for this, but we use fuzzy Yes. Well, I love you just that you came up with that idea on your own. I think it's such a good idea and I need to try it on some of my patients too. Maybe we should just come up with one specifically for Yeah, it, I will say fuzzy doesn't really. fit very well behind your on your hip. That was the I need something flat. Ye on different parts of her gotta work on them. And t about our blood draws tha difference. Um, is that f you go to lab for probabl to get your blood drawn. they are going to probably use a pretty big needle. Okay. Um, and one of the nice things that I think we do for our patients is we ordered order the fancy expensive needles. They're called butterfly needles, which even the name sounds so friendly. But butterfly needles are just really tiny little needles that we use in order to do the blood draw. And that's what they used on both of us yesterday. And again, I mean, um, I didn't even feel anything. So I, I think that's great. So if you guys end up needing to have blood drawn with us, um, we can assure you that you should have a great experience. Um, for buzzy, you probably just have to ask for it.'cause not everybody wants to do it necessarily. Mm-Hmm. So you can just ask us for it and we're happy to, um, add it on. And then one extra thing that I wanna start doing actually, is I've been using some, um, compounded numbing cream. Mm-Hmm. from our pharmacy that we use. Mm-Hmm. And, um, so I was thinking maybe we could have patients start putting it on maybe like an hour before their appointment just to kind of add some additional comfort to it. That's a great idea. We have the numbing spray that they sometimes will use for the IVs. Yes, yes. IVs are another experience that I don't enjoy. Yeah, that's right. Right, right. Exactly. Yeah. Um, and then I do want to just touch on our blood analyzer a little bit too. So we've had our blood analyzer for a while and we just now are kind of. able to use it freely. And the reason for that is when you get a blood analyzer like that, you have to do validation testing. So that means you've got to make sure this machine is giving you correct results. And to do that, we actually, um, did sample testing on 50 different people where we, um, did our lab results here and at LabCorp, we compared to make sure that we got similar results and we did. And so now that that validation is complete, that's why we were finally able to, um, to run our test. I am so happy about it. Yes, I know. It's been a long time coming. We really, we fertility doctors really liked. to see what your labs are right then and there. I don't have any patients to wait till the next day. And so that's why we like to run our hormone levels in house. Yeah, really helps us with clinical decision making. So I'm so happy that I don't, you know, patients, it's not my virtue. Oh, especially pregnancy test, I'm so glad that we had. And so what we were having to do before, or even at my last clinic, is patients would have to go to LabCorp. We send it out to LabCorp and you get results back the next day, which is fine. It's appropriate. so long to wait when you're waiting for the results. And so now that we have our analyzer, it was so fun. I had a patient that came in. Um, this morning for her pregnancy test and I already know the results. She's pregnant. That's so exciting and I just love that we didn't have to wait for it Um, okay. So what we decided to do, because we just wanted to kind of teach and educate how unpredictable A MH can be, but also how we might be able to make some guesses as well, is we have two separate envelopes. One has my results, one has Dr. K's results, but we don't know which is which. So we're going to each open one and we're going to figure it out. And I guess later we'll just have to make sure we're right about it, but I think it'll be pretty obvious. Yeah, I hope so. The information that you should know is that Dr. K is much younger than I am. And so. We kind of have expectations on what our level is going to be, but there might be some things that can throw a kicker into it like you're taking. Yes, I'm on birth control pills, um, and like I said, this is making me really nervous because I'm not necessarily done having children, so I'm really hoping, and you guys know I struggle with fertility, so I'm really hoping this isn't too bad because sometimes birth control pills can sort of artificially will say lower your AMH level. Does it mean that you're running on eggs quicker? It just kind of shuts everything down. Yeah, but I mean, I think it brings up a couple of points too. So one is just because we're fertility doctors doesn't mean we don't have those same thoughts and feelings and fears and worries and, and all of those things that anybody else may, um, also have when they go through this, it doesn't change that I've seen. You know, uh, fertility doctors go through those same emotions, even though we may know all the scientific facts behind it. But I think the other point it brings up is, remember, this is not gonna tell you anything about your actual fertility, right? yes. A MH level, although it's. It's kind of sold to us as a fertility test, does not predict whether you're going to give birth. So, all right. Who's going to go first? Should we just do one at a time? Sure. Okay. I'm going to open first. I literally can't wait. I told you. My hands are sweating. I'm nervous. I was like, is it anonymized? Okay, so I definitely know who's the sickest. Okay, so we'll go ahead and read all the results. You want to read them? Okay, so estrogen level is low, between 0 and 5. Progesterone level is pretty much nothing, very, very low, 0. 3. LH, very, very low. HCG, this is the pregnancy hormone, definitely very, very low. And the AMH level was 1. 73. So, okay, before we say whose we think this is, I'm just, as an audience member, you try to think whose this might be. So all of those hormones are very low. And the AMH level is 1. 73. So you can kind of think, is it Dr. K or is it Dr. Reed? And then, do you want to guess whose this is? I think it's definitely mine. I think so too! I think so too! And I think you have a nice AMH level. You think? It could be better. Oh my gosh, I should know. Y'all need to know about Dr. Pei. She's always number one on everything. She's so smart. No, I'm greedy. That's what I tell my patients. I'm always like, I'm greedy. I go after every egg. I'm like, you know, I just want more. There's probably no level that you would be happy with. But that, but that's okay. I think it's a good level, especially because we know that that level is probably lower than what your real level is. You're probably a little bit suppressed from the birth control pill. So I would guess your actual level is probably like a 2. 5 and 2. 5 would be normal. So yeah. Okay. So let's open this other one, which now we know is going to be mine. Oh gosh. I'm sweating. HCG positive. I would die. Okay. So, estradiol level 67. 7, progesterone level 5. 75, LH 1, HCG 0, AMH 0. 716. That is very good. I still have some AMH, I'm surprised. You still have it. Oh my goodness. Okay, so I wanted you. to look at my hormones and tell me what part of my cycle. Dr. Reed looks like she just ovulated and she's in the second part of her menstrual cycle. Yes. So I'm in my luteal phase and the way we can tell that is the estrogen level is elevated and my progesterone level is higher than three. And so that's how she's able to know that, um, that I'm in that cycle. second half of the cycle. What's it like to have progesterone around? Do you feel good? No. I don't know what that feels like. It was actually, it was really funny. Shout out to nurse Julie. She and I were both on the phone talking about this today because I've just been having a bit of a grumpy day and everything's been driving me crazy. I have PMS, um, and it was just funny because when I called her, she was telling me about her PMS and I'm like, Oh my gosh, why is it like this? Like every little thing, she called it being like overstimulated and just like overly anxious and just like overly irritated. And then like when your period comes, you're like, Oh. Oh, I feel so much better. So, but I have heard, I don't know because I don't experience this. Um, so if you have PCOS like me and you don't ovulate, you actually never really have a rise in your progesterone. And so you don't get to have those effects of progesterone. So that's why I'm asking Dr. Reed what it's like to have progesterone around. Um, but I've heard that people feel like really good in their luteal phase or their second part of their menstrual cycle because your progesterone level is up. So you don't feel good? fat. I feel tired and gross and irritated. So my favorite time is kind of right before ovulation when the estrogen levels are high. I'm feeling skinny, energetic. Things are going good. I'm in love with the world. Like things are great. So maybe you should start tracking my cycle. I know I present to you topics around that. Yeah. You know how they say things are so like coordinated with technology. So I need to like Bluetooth you my menstrual cycle so that you're aware. Um, but, but it's true. I guess that's what's always fascinating to me as everybody always feels so differently with different hormones. Some people love progesterone, some people hate it. Um, so I have to just say I'm, I'm not a fan. Um, okay. So the AMH level. So let's kind of talk more about what is the AMH test? Um, what is it looking for? What can it tell us? Um, one of the things that drives me crazy is there are lots of companies out there which are offering AMH testing, which I understand like the concept here is we want to make this test available to people, but I feel that they are marketing it in an incorrect way, a way of fear mongering or scaring. patients. And, um, one company in particular, I even commented on their social media and I, I get a lot of likes from that comment too. They marketed and said, um, you know, you should have this testing so that, you know, if you're fertile and you know, the quality of your eggs or something to that effect. And I commented, this is not true, you know, are you trolled? Instagram troll. I actually, well, I have to tell you too, maybe because we've written this up. Most liked comment I've ever had on Instagram is actually, um, a comment I left for a plastic surgeon. Okay. So this is from Beverly Hills Plastic Surgeon, I guess. She held up two sandwiches and one sandwich, um, had like floppy deli meat coming out and the other sandwich was like a nice meat sandwich with the deli meat tucked in. And she was like, which labia would you rather have? And I was like, this is shaming women's bodies, like, oh my God. So I like this is a comment of like, women are all shapes and sizes. You shouldn't make a woman feel like she's abnormal or like a sloppy sandwich. If she has longer lady or something. So many people have, like, liked that comment, like, almost every day still, and it's been a while, it'll be, like, somebody else liked that comment, somebody else liked that comment, so. No, I love that. No, I think you should comment, I'm just messing with you. I do think you should comment because you're one of the people out there that actually can correct these comments. craziness, the things that are being posted, my gosh. Yeah, so I guess I do have to troll some people, but, um, but anyway, so what, so what do you think, what would be the right way to market an AMH test, what would be the headline you would use for it? Ooh, that's a really good one. I know, yeah. That is a really good question. Because I can definitely criticize other people for how they're doing it, but it is kind of a hard test I think probably what most people are kind of interested in and what it would be reasonable for is, say, Um, you know, come get this test done to see how you would, how many eggs you could freeze, how you would respond to IVF treatment like egg freezing. Because a lot of times it's women who aren't ready to get pregnant yet that are curious about their fertility. Yeah. And it really is a pretty good test for telling us how likely are you to respond. To the IVF medications that we use when we do egg freezing. Mm-Hmm. and probably gives us a pretty good idea of how many eggs we could get, you know? Yeah. Um, and so something like that might be more reasonable. Yeah. Like be advertising for egg freezing, I guess. Right, right, right. Absolutely. Okay, so let's talk a little bit more about A MH. So an A MH stands for Anti Marian Hormone, and interestingly, this has not been available for me as a physician to order my whole career. So when I was in residency, this. we didn't have this to order. And so it didn't come out until later. And when it did come out later, we did sometimes order it on people and not even fully understand ourselves the implications of what this test meant. But, um, AMH is a substance that is actually released by the very small follicles on the ovaries. and follicles are where eggs come. But with follicles, they're always coming and going, coming and going in waves, kind of all throughout the cycle. And so this just gives us a rough idea at any given point in your cycle, how many of those little follicles you likely have for that month. Absolutely. Yeah. Um, and what happens is for women as their ovarian reserves Starts to go down. Instead of your body giving you lots of follicles to work with in that month, your body starts to conserve the eggs that are left, and so your body starts to get a little stingy and say, okay, maybe in a normal month I might have given you six to 10 follicles per ovary. But now that we're starting to run low, I may only give you two or three follicles in any given month to work with. But ultimately, out of all those follicles in a woman who's having a monthly period and ovulating every month, out of all those follicles, only one is going to ovulate anyway. So if you're starting with six or 10, or you're starting with two, either way, It doesn't really matter how many you start with. And so I think that's an important factor, right? Yes, this is what I really always explain to my patients. If you've seen me before, you know I do this little drawing for you, and I show you, okay, this is the group that's put forward every month, and then just one is selected. And all the rest of them are destined for cell death, and it's inevitable, and we can't do anything about it. And I think it's really important to understand that regardless, you're still gonna have the chance at pregnancy because you're ovulating at least one egg. Even if you're choosing from a smaller number of which to actually release, you still have a shot at pregnancy. Exactly. And there was a really large study that looked at women who did not have a history of infertility, who just wanted to conceive. And they checked their AMH because their theory was the higher the AMH, the faster they'll get pregnant. And they were totally wrong. Um, your AMH level did not predict how long it took you to get pregnant. And so we get so many consults where patients come in and they're panicked and they're so upset because they found out through, for example, one of the social media companies or something that they had a low AMH level. And I think what feels so good is we're the first ones that get to reassure them, Hey, like, even though this was sold to you as a fertility test, this does not mean you're pregnant. So the data that Dr. Reid is talking about is. um, Dr. Ann Steiner's data. She's in Duke and she, one of my favorite things is that when she came to my fellowship to present, um, some of the spinoff studies that she's done with the data is that she said that she still would get calls from women like seven years down the line from when they got their AMH level drawn when they released it to them. And the women are like really worried, right? Oh my gosh, my AMH level was 0. 3. I'm so worried. What should I do? It's really low. And Dr. Steiner would be like, okay, well, do you have any children? Oh yes, I had five children. You know, so it was just so clear that they didn't have any trouble getting pregnant, but their level was so low back then and now they're like, you know. Really concerned that it's something to do with her health or, you know, all of this. And so she, the way she presented that, I'm like, that is such a funny concept. Like, you know. Right. And I think it shows like how big of an impact numbers have on us, right? When we see a number, then you're, what does this mean? What about, what does this mean about me? And even if everything's okay, you still feel worried. Why am I different than somebody else? I think one of the nice things is, and you guys, any of y'all could Google it too, is oftentimes when I have a patient who's had an AMH done, I'll look up the AMH age chart. And so I'll just look at the age and then look at the percentiles so I can tell them, okay, for your age, your AMH 50th percentile or the 80th percentile or the 5th percentile. And that way they really get a sense of. How they're doing, um, in compared to other people their age because it really wouldn't be fair to compare, for example, my AMH to your AMH, right? We know that for my age that is an appropriate AMH level But if I were your age that AMH level would be way too low and so it's really a customized Interpretation. It really, it's the same question I get from a lot of patients. They say well is my AMH normal? You know, and the way I trained is like, there's not, typically with blood level values, we have a normal range, right? And AMH isn't really a level that we say, okay, from this value to this value is normal. It's very much so tailored to how old are you? What sort of medications are you taking? What have you had done in the past? You know, all of these things affect this value. So it's not something so simple as, Well, I got my AMH tested and they told me it wasn't normal. Or they told me it was normal. If there's just, whenever I hear that response, I'm like, we've got to dive more into this. Absolutely. Yeah. I think the other hard part about it too, is we don't know how fast the AMH can change over time. In most women, you don't really ever see it go up. I'm not to say I've never seen that, but most of the time you don't see it go up. But sometimes it can stay very stable for a long time, sometimes it can drop drastically, sometimes it'll just drop slowly over time. That's something I would be really interested in just studying, um, over time too, to see, you know, how that drop looks. Um, the last time I had my AMH level checked, it was, I was in my 30s. I want to say like late 30s, it was about 2. 5. So definitely it's gone down. Ragging. No, that was actually, actually, you know what, now that you say that, I do remember feeling disappointed because my friends have higher, but I think my friend had PCOS or something. Um, but, but the point of it is that I don't know how I got from 2. 5 to 0. 7. did this happen last year? Has it happened little bits at a time? Did I go from 2. 5 to 0. 7 the next year? We don't really know. Right. We don't know how that transition happened. Two things that you made me think of. One of, I've definitely seen people's AMHs go up. Um, and one comment's It's kind of what we were talking about with me is I've had some patients who had been on birth control pills for a long time and we've tested it and because they were thinking about doing treatment and you know, I'm like, I think you might be suppressed. Let's go off of birth control pills for a little bit and see if we can get your AMH up higher. And I've definitely seen that come up and that's really exciting. I like that when that happens. It's nice to see that number go up. True. And. Sometimes after getting a Mirena IUD taking the same thing. Yeah. So that's definitely a good point. Um, and since you brought up the birth control pills, let's look at your labs again too. Let's kind of comment on this. I think this is really good, not only for patients, but maybe providers that are listening too. So what I've seen sometimes happen is a patient on birth control pills gets her hormones checked. Okay. So birth control pills typically have. Some form of estrogen and some form of progesterone, okay? But if you check your estrogen and your progesterone level, what are they going to come back as? Very, very low. Very low. And the reason why is your blood, when we're checking these, these are for estradiol and progesterone. But for example, birth control pills, it's not estradiol. It's ethanol estradiol, which is a synthetic form of estrogen that is not picked up with this lab assay. So I've actually had this happen many times where I've even been consulted by other doctors who say do I need to increase this dose of birth control pill on a patient because she's on it and her estrogen level is still low despite that or do I need to be worried because her hormones are low when she's on the pills but I think importantly there's not really any utility to checking hormones when somebody's on birth control pills in general, you know, right, exactly. So that's kind of, I think our biggest hint as how we knew this was you because all those hormones were low, um, from being on birth control pills because they were doing what they were supposed to be doing. So, um, okay. So, um, what, so what does AMH tell us and what's it good for? It's really, um, helpful to tell us how somebody might respond if we did our biggest treatment idea for egg freezing. Because imagine that person with an ovary that has six to 10 follicles on it. If I give somebody like that injections, we might get six to 10 eggs out of that ovary. Whereas if we're starting off with somebody who maybe only has two follicles, we just have less potential. We might only get. UX. And so that is what AMH is usually really good at helping us predict. But it's not always about numbers. What we do know is quality is most important. So let's just take a hypothetical scenario. Let's say we switched them and you had a 0. 7 AMH and I had a 1. 73 AMH. Okay. If that were the case, who would have more normal embryos if we did IVF? Let's say we both did IVF cycles. Okay. It would be Dr. Penny. Even if she had a much lower AMH in that circumstance, we know her egg quality would be so much better. How do we know that? Well, we don't have a test for egg quality, but our best surrogate marker for egg quality is age. Since I'm 44, we know the vast majority of the eggs that I would make out of my body would be abnormal eggs. which means they would have trouble fertilizing or even if they did fertilize, they would produce abnormal embryos. And that's why women like myself in their forties can struggle so much with trying to get pregnant. That's why I have a lot of miscarriages and things like that. So I, you know, will sometimes tell patients, look, I Much rather have somebody that is younger with a low AMH than somebody who's older with an amazing AMH. Definitely. Definitely. The other thing that really AMH has demonstrated utility in is it really tells us how to dose our patients when they're going through IVF. So that's the two things that I tell my patient. It really helps me to tailor your cycle to you, know exactly how much medication your body's going to need to respond. Fund. If you have a higher A MH, you probably don't need a lot of medication. If you're gonna go through IVF or egg freezing. If you have a lower A MH, then we may need to dose you higher. Mm-Hmm. So that's helpful. Absolutely. Absolutely. Okay. Well, how do you think it went? Do you feel like you got some good information about yourself? I don't know. I'm probably gonna go home and cry. Oh. Oh my gosh. that's the thing. I think don't think objectively s You know, we have our dif I don't think you should. an amazing image. You're doing great. Um, for me, because just my periods have become like more regular. I get hot flashes. So I'm definitely approaching, um, or maybe I'm even in perimenopause. So it might be interesting for us to recheck in a year and, you know, see what happens. Track how it's going down. Definitely. All right. Well, we hope this was really helpful for you guys and, and educational. And um, if you need anything, reach out and let us know. And if you would be kind enough, please leave us a good review. All right, have a good week. Bye.