Is really AMH deciding factor for pregnancy?

Question

Hello doctor,

I am 35 years old and my wife's age is 28 years. We got married three years before. I have been experiencing erectile dysfunction for the past two years. Consulted with a couple of doctors and took medicines. But in vain. Hence we decided to go for fertility center. After consulting in a center, they advised taking few blood tests for my wife and a semen analysis for me. Reports seem fine for us. But the doctor informed that AMH level is low. Hence, she has been advised to go for IVF. But we request to consider her for IUI for few times and then we go for IVF. She agreed to go for IUI for two times. She has the regular period of 28 to 30 days and HSG report is also normal. We have also done follicle study. Please go through the reports and clarify us whether we both fit for pregnancy. Is really AMH is deciding factor for pregnancy? Kindly scrutinize the semen analysis report too. Currently, I am taking medicines for prolactin and Vitamin D.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through the elaborate investigations performed (attachment removed to protect patient identity). In your case, I feel you must be suffering from premature ejaculation, rather than erectile dysfunction. You are not able to hold back semen for long, sometimes your erection goes even before ejaculation, maybe also some irritation or burning sensation at end of the penis after ejaculation, while passing urine after sex. Your only problem in semen is the lack of rapidly motile sperms. Usually, this is seen in males with low water intake, frequent urinary infections, renal stones, who hold back urine for long. IUI (intrauterine insemination) is not the first step. Better to have a course of antibiotics, improve the weak sperms and then go for IUI. Have:

Tablet Azithromycin or Azilide or Azithral 1 gm stat (single dose before food) also for your wife.
Tablet Fluconazole or Flucostat or FZ Win 150 mg stat after food.
Tablet Cynomycin 50 mg or Doxycycline 100 mg twice a day for two weeks.
After two weeks, have tablet Levoflox 500 mg once a day for two weeks.
Apply Candiderma (Beclometasone and Clotrimazole) cream locally over the penis, moving back the foreskin twice a day for seven days.

During this one month, do not have sex, so your infection does not go to her. Use a condom if sex. After one month masturbate 2 to 3 times then have sex. This will clear the semen and sex issue. Medicines for prolactin really not needed. For your wife, the only problem is AMH (anti-mullerian hormone) in the results. Hope the test was done within first 10 to 12 days of periods. As per scans, her follicles are growing on time, so there is something wrong with results. Better have a day three or four FSH (follicular stimulating hormone) and serum AMH from a different or better center. I think the result will come normally.

For IUI,ideally, more follicles are induced. She can be given small doses of hormones and around 4 to 5 follicles are grown, they are better in health and can be triggered and ruptured using hormone injection. Then IUI can be done, of course after correcting semen only. In that case, more eggs will have a better chance with more sperms. Maybe we can discuss the corrections I have advised. I hope and feel the results will be different. You will not need IVF in that case.

For more information consult an infertility specialist online.