FSH and AMH Levels: What are they good for?
From Dr. Paul Gindoff of Chelsea Fertility NYC:
This week I facilitated the weekly journal club at my local hospital. The topic was FSH and AMH, and their relevance to predicting pregnancy. The journal club was attended primarily by resident physicians, but the topic is critical for both patients and practicing physicians alike.
I thought it was important to sound off about the facts and myths concerning FSH, which is a follicle stimulating hormone, and AMH, which is an anti-mullerian hormone. High FSH and low AMH blood levels are considered to be “bad”. These tests are biological markers that indirectly predict how well a woman “may” respond to fertility drugs – emphasis on “may”.
In the world of fertility, FSH and AMH levels predict response to fertility drugs – that is the conclusion based on evidence based review of the medical literature to date. There is just no evidence to conclude that “bad” lab tests mean that fertility is hopeless. Getting pregnant and delivering have many more variables for consideration some of which can mitigate against “bad” blood levels of FSH or AMH. Unfortunately, some women are misled and told that their individual case is hopeless and they cannot conceive if they present with the wrong combination of FSH and AMH blood levels.
Fortunately, this is simply not true. Yes, they can bode poorly when one stimulates the ovaries with industrial strength fertility drugs to allow recovery of multiple eggs (for example, a dozen or more) at egg retrieval, but even with the wrong combination of FSH and AMH, many women can generate good numbers of eggs and they can certainly generate eggs during IVF cycles. The real key to understanding all of this is a woman’s age.
Age simply trumps everything else. The wrong combination of FSH and AMH in a younger age female patient will probably work out just fine. Perhaps the cycle success rate is somewhat lower, but it is respectable and happens. This is where the difficulty lies.
When you embark on the fertility journey and select IVF as your treatment option, it makes sense to try to predict just how easy or hard things are going to be. Searching for this “holy grail” of prognosticators has eluded science for decades. What we have are simple blood tests (FSH and AMH) that are somewhat misleading if taken concretely.
We advise concluding that there is no dogma or accepted evidence on this that clearly links FSH and AMH to pregnancy rates in regularly cycling women. Older women will show changes in these levels and have lower pregnancy rates, but we know this de facto since they are older. Likewise, any younger woman with acceptable FSH and AMH in range will generate eggs for egg freezing or IVF cycles to lead to a pregnancy.
The simple way to think about FSH and AMH levels is as follows: our goal as fertility specialists is not egg numbers, but helping you get to the delivery of your child. Sometimes the fertility journey is more challenging, but we recommend using these blood tests simply to alert us and prepare us.