When facing infertility, women are told that FSH and AMH testing is necessary to reveal the health of their egg reserve.
Simple enough, but what exactly is FSH and AMH, and how do they impact fertility?
Dr. Marcy Maguire, lead physician at RMANJ’s West Orange office, recently explained their meaning on an episode of This is Infertility, a new podcast examining what it’s like to be infertile in the U.S.
Here’s what Dr. Maguire shared.
What is premature ovarian aging, premature ovarian insufficiency or diminished ovarian reserve?
Dr. Maguire: All of the above mean essentially the same thing: the ovaries have less eggs in them than they should, given the woman’s age. Diminished ovarian reserve is not synonymous with whole body aging – it doesn’t mean that the woman herself is somehow aging prematurely, it just means her egg count overall is lower than it should be given her age.
What are the symptoms of premature ovarian aging?
Dr. Maguire: The two most common symptoms are infertility and irregular or skipped menstrual cycles.
How can premature ovarian aging be diagnosed?
Dr. Maguire: The best diagnosis will come from FSH and AMH levels, and then an ultrasound – all three can be markers of a lower egg count.
What is FSH?
Dr. Maguire: FSH, or follicle-stimulating hormone, is a hormone produced by the pituitary, an organ in the brain that encourages follicles and eggs to grow and mature each month. If the FSH level starts to go up, typically above the number of ten, that means that the brain is trying hard to stimulate the ovaries to produce eggs but having a hard time getting the ovaries to listen. So the FSH goes up and up, getting louder and louder and louder, trying to get the ovaries to listen – but there just aren’t many eggs left, so the ovaries are having a harder time producing.
What is AMH?
Dr. Maguire: AMH, or Anti-Mullerian hormone, is a hormone that is made by granulosa cells that take care of the eggs, so the more eggs a woman has, the more granulosa cells she has, and the higher her AMH. We like to use AMH as a marker of a woman’s overall egg count. If the AMH is above 1.2, we feel relatively reassured, and if it’s less than 1.2, that is more concerning. Of course this will also correlate with a woman’s age, so a woman in her early 30s with a low AMH less than 1.2 is very worrisome, whereas it’s more common for women in their early 40s to have a low AMH.
How do you test for FSH and AMH?
Dr. Maguire: A blood test will identify a woman’s FSH and AMH levels.
What are fertility options for women with high FSH and low AMH?
Dr. Maguire: If a woman has diminished ovarian reserve, meaning an overall lower egg count, she still may have the opportunity to have children using her own eggs – it just depends on her relative level of eggs. If there are some there that we can access, typically we would do in vitro fertilization (IVF) to get to them and potentially even bank some so that the woman could use them in the future when her egg count would be expected to be even lower.
What if a woman cannot use her own eggs at all?
Dr. Maguire: When a woman’s egg reserve is so low that she is in the early stages of menopause, fertility treatments typically can’t help a woman use her own eggs – but donor eggs are available and the woman can carry the pregnancy herself. This can be done with a known or anonymous egg donor.
For women considering using an egg donor, it’s important to make peace with that decision — to take time to process it, talk with counselors to consider all implications and then go forward. For all the patients I’ve had, once they get over that hump and say ‘yes, this is an option for me,’ they are very happy with the decision.