24 January 2019

AMH and FSH: How They Impact Your Fertility

If you’re trying to get pregnant with the help of a fertility doctor in Orlando, you’ve probably had some blood work done. This blood work, done on day three of a woman’s menstrual cycle, is necessary to check a woman’s hormone levels, specifically AMH and FSH, which can help doctors better understand her chances of conceiving.

While there are many hormones that affect fertility, two in particular reveal the most about a woman’s egg reserve: Anti-Mullerian hormone, or AMH, and Follicle-stimulating hormone, or FSH. If you’ve already had your blood drawn, you’ve been given these two results, and you might be wondering exactly what they mean.

Reproductive Medicine Associates of Florida (RMA-FL) founder Dr. George Patounakis explains below.

AMH and FSH tell us about a woman’s egg reserve. Why is that important?

Dr. Patounakis:  A woman’s egg reserve is one of the more important factors when it comes to infertility treatment. You may be surprised to know that a woman is born with all the eggs she will ever have. Over time, however, the number of eggs declines. During a natural cycle, a woman’s ovary releases one egg. If that egg is healthy, it may form an embryo and hopefully result in a baby. The loss of the eggs happens whether or not she is having periods and even if she is on birth control pills. If everything is functioning normally, a woman will mature and release one egg every month until menopause, which usually happens around 50 years old. The goal of most fertility treatments, unlike natural cycles, is to mature more than one egg at a time to try to overcome the factors that are keeping the woman from becoming pregnant, so number of eggs matters more in this case. Additionally, age is just as important as egg reserve because a younger woman will generally have healthier eggs than an older woman. Both quality (health) and quantity (number) of eggs matter when it comes to infertility treatment.

What is premature ovarian aging?

Dr. Patounakis: Sometimes, a woman’s ovaries contain fewer eggs than she should, given her age. This may be because she was born with fewer eggs to begin with or she is losing eggs faster than most women. The end result is a young woman that experiences early menopause. This is known as premature ovarian failure or insufficiency, but it does not mean that the woman herself is aging prematurely, it just means her ovaries appear older than her age. Diminished ovarian reserve is the stepping stone between normal ovarian reserve and premature ovarian failure. Both diminished ovarian reserve and premature ovarian failure place her ability to have children at risk. FSH and AMH levels help doctors gauge a woman’s egg reserve and how close it is to ovarian failure.

What is FSH?

Dr. Patounakis: FSH is a hormone produced by the pituitary gland that tells the follicles in a woman’s ovaries to grow. Each follicle contains an egg, and as the follicle matures, so does the egg within it. If there are not many eggs left in the ovaries, the pituitary will release more FSH to try and stimulate the ovaries. This leads to a woman’s FSH level being high. For example, an FSH of above 10 or 12 can be a sign of diminished ovarian reserve. It is important to note that the FSH level must be drawn at the proper time in the menstrual cycle (around cycle day 3) and should be measured along with an estrogen level to interpret the results properly. Otherwise, the FSH level measured may be falsely reassuring.

What is AMH?

Dr. Patounakis: AMH is a hormone made by granulosa cells that support the eggs as they mature. Particularly, the more immature eggs there are, the more granulosa cells there are, so the AMH will be higher. An AMH greater than 1.2 is reassuring whereas an AMH less than 1.0 becomes more concerning. Too high an AMH is also an issue, as it could signal Polycystic Ovary Syndrome (PCOS).

What are some fertility options for women with AMH and FSH levels outside the normal range?

Dr. Patounakis: For women with PCOS, treatment options include lifestyle changes, medication to stimulate ovulation (with or without Intrauterine Insemination (IUI)), and In Vitro Fertilization (IVF) to conceive. IVF is also an option for some women with diminished ovarian reserve. For women who don’t find success with IVF, using an egg donor is another option.

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