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What if My FSH Level Is Normal but My AMH Level Is Low?

My project-1 (78)A cycle day-3 follicle stimulating hormone (FSH) level and anti-mullerian hormone (AMH) level are commonly used to evaluate ovarian reserve. FSH level generally predicts pregnancy rates with in vitro fertilization (IVF) and a level < 10 mIU/mL is considered “reassuring”.

On the other hand, AMH levels predict the number of follicles (eggs) that the patient will produce during IVF and a level > 0.8 ng/mL is considered “reassuring”. (It is important to note that these cut-off levels can vary based on the assay used and can vary from lab to lab.)

A combination of reassuring FSH and AMH levels is generally considered “good” and a combination of concerning FSH (> 10 mIU/mL) and concerning AMH level (< 0.8 ng/mL) is generally considered “bad”.

But, what if there is discordance between FSH and AMH levels?

Sometimes, your tests may show a concerning FSH level with an AMH level that is reassuring, or vice versa: a reassuring FSH level with a concerning AMH level. How common is this discordance?

Discordant Hormone Levels are Common

In a recent paper by Leader et al. (Fertil Steril 2012;98:1037-42) this very issue was addressed. They found that of the 5,354 women tested, 1 in 5 had discordant AMH and FSH values. Of the women with reassuring FSH values (n = 4,469), the concerning AMH values were found in 1 in 5 women in a highly age-dependent fashion, ranging from 1 in 11 women under 35 years of age to 1 in 3 women above 40 years of age. On the other hand, of the women with reassuring AMH values (n = 3,742), 1 in 18 had concerning FSH values, a frequency that did not vary in a statistically significant fashion by age.

Clinical discordance in serum AMH and FSH values thus was frequent and was age dependent. This paper, however, did not address the clinical outcomes in these patients.

What Mixed Hormone Messages Mean for IVF Success

So, what does this discordance mean to a patient’s chances of success? The current belief is that the number of eggs retrieved decreases in the following order: reassuring FSH and AMH, concerning FSH but reassuring AMH, concerning AMH but reassuring FSH, and both concerning FSH and AMH.

In another publication, Buyuk et al. (Fertil Steril 2011;95:2369-72) studied 73 women with elevated cycle day-3 FSH levels (> 10 mIU/mL). Women with elevated FSH who had a AMH level > 0.6 ng/mL, had twice the number of eggs retrieved, a greater number of day-3 embryos, a third of the cancellation rate, and a trend toward higher clinical pregnancy rates when compared with women with a AMH level <0.6 ng/mL.

Thus, the literature currently suggests that the combination of the two hormones together provides more information, although more studies with clinical outcomes are needed to confirm this concept.

So a patient with a normal FSH level but low AMH level will probably do better than someone whose FSH level is high. Age, antral follicle count, body mass index and previous ovarian response to fertility drugs are other factors that need to be taken into consideration for complete assessment of ovarian reserve.

To see a fertility specialist who is a board-certified physician with excellent success rates, make an appointment at one of InVia’s four Chicago area fertility clinics.

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Dr. Vishvanath Karande

Dr. Vishvanath Karande

Dr. Karande is Board Certified in the specialty of Obstetrics and Gynecology as well as the subspecialty of Reproductive Endocrinology and Infertility. He is a Fellow of the American College of Obstetricians and Gynecologists and Member of the American Society for Reproductive Medicine.


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