Interpreting Your Levels
A few years ago, CHR's research established age-specific levels of FSHFSH and AMHAMH . Any FSH level means different things if found at different ages. For example, a normal FSH level for a woman at 42 suggests premature ovarian aging (POA)premature ovarian aging (POA) if found in a 30-year old. To really assess a woman's ovarian reserve, and her IVF pregnancy chances, one really needs to look at age-specific AMH and FSH levels. The table below demonstrates age-specific AMH and FSH levels for CHR's patients.
Age Specific Baseline FSH and AMH Levels
|< 33 Years||< 7.0 mlU/mL||= 2.1 ng/mL|
|33-37 Years||< 7.9 mIU/mL||= 1.7 ng/mL|
|38-40 Years||< 8.4 mIU/mL||= 1.1 ng/mL|
|= 41+ Years||< 8.5 mIU/mL||= 0.5 ng/mL|
"CHR developed and uses an age-based AMH and FSH scale, which is more accurate at predicting pregnancy chances."Dr. Norbert Gleicher
Many fertility centers, unfortunately, still use universal cut-off values for FSH (and AMH). When a patient has high FSH, some of these centers simply refuse to provide treatment, irrespective of patient age and other factors, or push women to egg donation (prematurely, in our opinion). This approach may ensure higher pregnancy rates at such centers (because they reject women with lower chances of pregnancy), but it leaves women with elevated FSH (and/or low AMH) abandoned. CHR, therefore, does not have such arbitrary cut-off values. The figure below shows the age-specific normal level of FSH and AMH levels, as they change over a woman’s reproductive lifetime.
What makes the “universal FSH cut-off” approach even more problematic is that fact that the most up-to-date medical literature suggests that FSH is not as specific as it was once thought. A number of papers published by CHR's physicians suggest that AMH is actually more specific than FSH in assessing ovarian reserve and pregnancy chances with IVF. Better AMH specificity makes sense because AMH reflects the smaller follicles,follicles, which represent a majority of a woman's ovarian reserve. (The figure above demonstrates that ranges are narrower for AMH than FSH, suggesting that AMH is more precise in reflecting ovarian reserve.) Given the superiority of AMH, IVF treatment decisions, based on high FSH levels alone, appears outdated.
While FSH levels and AMH levels are important in assessing ovarian reserve, both have limitations. Neither FSH nor AMH can, indeed, categorically determine whether a woman can or cannot conceive, unless she has very high FSH levels. Women can get pregnant with IVF even when AMH is completely undetectable, as over 50 pregnancies established so far at CHR in women with undetectable AMH levels clearly demonstrate. Therefore, placing too much emphasis on high FSH and low AMH can be misleading.
Last Updated: November 15, 2014