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FSH vs. AMH vs. AFC
Testing ovarian reserve - the quality and quantity of a woman’s eggs - can help you decide whether you should consider pregnancy sooner rather than later, if you should freeze your eggs, or whether fertility treatment may be successful. There are three tests that doctors use to predict ovarian reserve: FSH, AMH, and AFC.
FSH (follicle stimulating hormone) is a hormone that is secreted in the cells of the ovaries and at one time was the gold standard for predicting ovarian reserve. While it can be a predictor of conception, it fluctuates during the cycle and therefore is tested on day 3 of the menstrual cycle.
A day 3 FSH level of 10 is generally considered normal
A day 3 FSH level above 15 is considered “high FSH” or low ovarian reserve.
AMH (anti mullerian hormone) is a more reliable predictor of ovarian reserve if done properly, says Dr. Glenn Schattman, a fertility doctor with The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at Weill Cornell Medical College in NYC. Because there are eight different assays – tests that are done to determine AMH levels – Schattman explains that his practice manages this in-house, standardizes and normalizing results to correctly interpret AMH levels.
AMH levels continue to drop as a woman ages, and are essentially non-existent at menopause.
AFC (antral follicle count), a measurement of follicles on the ovaries, viewed with a vaginal ultrasound, is just as good as indicator of ovarian reserve as AMH Schattman says.
One caveat with testing AMH and AFC, he adds, is that you cannot be on birth control pills when your levels are measured; they decrease when you are on the pill. Levels can be measured at least 30 days after you stop taking the pill and after you’ve had one normal menstrual cycle.