![\"Filomena](\"https:\/\/www.newsbeep.com\/ie\/wp-content\/uploads\/2026\/08\/UMYYAGZS4FHVHI45S56RGALA6A.jpg\")
Filomena Kaguako: ‘Being proactive about having children is not something I ever envisioned for myself.’<\/p>\n\u201cYour AMH level has come back at 2.72 pmol\/L, which would be considered in the lower range for your age.\u201d <\/p>\n
Those exact words taunted me from across the screen as I read over the findings of a blood test I had taken at Th\u00e9rapie Fertility Clinic in Dublin just two days before receiving that email.<\/p>\n
I fought the urge to release the tears building up behind my eyes, partly because I was sitting at a table in the middle of a coffee shop, coincidentally beside a woman and a child who appeared to be her daughter.<\/p>\n
It only took one glance in their direction for that future to start feeling more and more unlikely with each passing second.<\/p>\n
Fortunately, my angst around the situation was silenced after I spoke to Dr John Kennedy, the medical director at Th\u00e9rapie Fertility, who explained the role of Anti-M\u00fcllerian Hormone (AMH) and how it\u2019s used in fertility assessments. AMH is a protein produced in the ovaries. It is a marker of egg supply because it provides an estimate for the number of eggs remaining.<\/p>\n
Kennedy says a normal AMH range for a 36-year-old woman is somewhere between 10 and 20 pmol\/L. <\/p>\n
With mine being 2.72, an undeniably low figure, it means I likely have fewer eggs in my overall supply compared with someone with a higher AMH level.<\/p>\n
But it is only an estimate. AMH is more of a screening tool than a fertility test because it doesn\u2019t indicate how likely a person is to conceive spontaneously. It also doesn\u2019t shed any light on egg quality. <\/p>\n
As far as egg quality goes, age is the best indicator of egg quality, and egg quality is the best indicator of overall fertility. <\/p>\n
Another important note he made about AMH is that it relies heavily on the point it\u2019s taken in a woman\u2019s cycle. So it really is a result you take in context. A combination of AMH and a scan of the ovaries is what he\u2019d recommend for a clearer picture.<\/p>\n
Although Kennedy referred to it as an \u201cunreliable witness\u201d for fertility, he says it indicates what fertility options could work for them, and how proactive they should be about having children. <\/p>\n
Being proactive about having children is not something I ever envisioned for myself.<\/p>\n
As someone who has always lived a life of serendipity, the story I told myself over the course of my life is that it will happen if it\u2019s meant to happen. <\/p>\n
But when you\u2019re presented with information that can potentially exclude you from being the type of woman who blesses her friends and family with news of a \u201chappy accident\u201d, it forces you to confront the script you\u2019ve been telling yourself all these years. <\/p>\n
It forces you to challenge your ideology of what it means to be a mother and contemplate whether you believe you have the mental strength it takes to be one.<\/p>\n
Filomena Kaguako: ‘Being proactive about having children is not something I ever envisioned for myself.’<\/p>\n
But most of all, it forces you to reframe the question of whether you want a child to a question of whether you actually can have one, because the desire to have a child and the ability to create one are not always one and the same. <\/p>\n
The second screening tool for measuring ovarian reserve is a transvaginal scan. It\u2019s described by Dr Adeola Adewole, clinical director at Sims IVF in Swords, as an ultrasound performed through the vagina that can visualise the uterus and ovaries. It provides the measurement of the antral follicle count (AFC), which is the count of the small ovarian follicles in each ovary. <\/p>\n
A follicle is a tiny pouch containing one immature egg. During each monthly cycle, a group of follicles begin to develop from the eggs already stored in the ovaries, so this scan detects how many are growing at a particular time. <\/p>\n
According to Adewole, a normal antral follicle count for a woman my age is somewhere between 8 and 20.<\/p>\n
Since the results from an AMH blood test and a transvaginal scan are normally used in conjunction to provide an assessment of ovarian reserve, I knew I needed to get a second opinion.<\/p>\n
But I was reluctant. <\/p>\n
I could not see how any result could possibly brighten up this already bleak picture. I just didn\u2019t know if I could handle another blow.<\/p>\n
Again, I\u2019ve never actively tried for children, but the idea that a second test could possibly confirm that pregnancy would be a long road for me, genuinely made me uneasy. Not to mention the feeling of lying on my back with my legs in the stirrups of an examination room at ReproMed Dundrum two weeks later.<\/p>\n
Staring at a screen of what is being described as a healthy and normal uterus in real time sends your mind wandering. I couldn\u2019t help but imagine what it would be like to have a nurse pointing at a similar screen to identify a growing foetus \u2013 my growing foetus.<\/p>\n
But like earlier stages of this journey, with every fleeting fantasy comes the painful truth of my reality, which I was confronted with in the days that followed. <\/p>\n
At my consultation with Dr Ernesto V\u00e1zquez Hidalgo, a senior consultant with ReproMed Galway, I was informed about the female reproductive system at length. <\/p>\n
He explained how no such test exists for egg quality and how it is not the only consideration when it comes to natural conception. We also need to have other systems in balance, such as thyroid function and prolactin levels.<\/p>\n
He discussed how women are born with a fixed number of eggs, somewhere in the millions. But we lose about 80 per cent of them during childhood, and by the time we have our first menstrual bleed, we can have about 350,000 to 500,000 eggs for the rest of our reproductive years. <\/p>\n
He also spoke about the fascinating process of natural selection, and that it can take anywhere from 500 to 800 eggs to create one single mature egg, as well as the importance of optimal sperm. <\/p>\n
Then, he shared the results of my transvaginal scan.<\/p>\n
They were less than optimal. <\/p>\n
The nurse identified four antral follicles in my right ovary, and three on my left. With an overall antral follicle count of seven, it is certainly below the expected count of at least eight for my age.<\/p>\n
Having seven follicles does not mean I only have seven eggs left, though. It means seven follicles were visible at the time of my scan. <\/p>\n
This number provides (another) estimate for the size of my remaining egg supply, or medically speaking, my ovarian reserve. <\/p>\n
Generally, women with a higher follicle count tend to have a larger ovarian reserve and those with a lower count tend to have a smaller reserve.<\/p>\n
So where does that leave me? <\/p>\n
I know egg freezing has become increasingly popular among women who are not yet ready to start a family. But with my numbers, embryo freezing could be more appropriate. It involves freezing an egg that has been fertilised by a sperm for future pregnancy attempts and is generally more effective. <\/p>\n
While egg freezing is roughly half an IVF cycle, embryo freezing is more or less a full one, and they both require about 14 days of fertility medication, attending multiple appointments, an egg retrieval procedure, and, in my case, most likely stopping and switching some of my current medication.<\/p>\n
A recent study found that egg retrieval cycles with a lower proportion of mature eggs tend to be associated with lower AMH levels and fewer follicles.<\/p>\n
I now know I tick both of those boxes, so I don\u2019t think it would be unreasonable to assume getting pregnant might not be the easiest road for me.<\/p>\n
Either way, it all seems like a lot of time, effort and energy to put into a life I\u2019m not entirely sold on.<\/p>\n","protected":false},"excerpt":{"rendered":"\u201cYour AMH level has come back at 2.72 pmol\/L, which would be considered in the lower range for…\n","protected":false},"author":2,"featured_media":603944,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[2121,72,12875,61,60,9386],"class_list":["post-603943","post","type-post","status-publish","format-standard","has-post-thumbnail","category-business","tag-womens-health","tag-business","tag-health-wellness","tag-ie","tag-ireland","tag-pregnancy"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/603943","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/comments?post=603943"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/603943\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media\/603944"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media?parent=603943"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/categories?post=603943"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/tags?post=603943"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}