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The Case for AMH Not FSH
FSH is no longer the standard by which to gauge a woman’s ovarian reserve or predict successful outcome with fertility treatment. This, according to Dr. David Seifer, Co-director of Genesis Fertility and Reproductive Medicine in Brooklyn, NY. In an article published in Fertility and Sterility, he and Dr. James Toner makes the case that AMH, Antimullerian Hormone, is a more informative and better test than FSH, Follicle Stimulating Hormone. “Antimullerian hormone is the most informative serum marker of ovarian reserve currently available… It is both more convenient and informative than basal FSH and can be assessed at any point in the cycle. It is the most useful serum method of determining ovarian reserve…”
FSH testing to assess ovarian reserve has been used since 1988, but clinicians have since realized its limitations. It can only be accurately tested at a specific time during the menstrual cycle (day 3), there are fluctuations within a cycle and from cycle-to-cycle, and FSH is often looked at in the context of other tests, Seifer explains.
AMH, on the other hand, has a number of benefits, Seifer says:
- AMH can be obtained at any point in the menstrual cycle
- It has age age-specific values and ranges
- AMH detects high ovarian reserve, which is a risk factor of hyperstimulation. (An AMH of 5 or higher is consistent with predisposition to hyperstimulation and polycystic ovaries.)
- AMH is an earlier marker of diminished ovarian reserve – a woman’s AMH levels will change before FSH goes up.
- AMH provides more information to the patient and the doctor regarding the current egg supply, and if you test it over time you get a better sense of rate of decline.
Each patient will respond differently to ovarian stimulation. Being able to predict her response will make stimulation safer and more effective, and allow for better counseling of the patient, he says. “So depending on a woman’s chronological age, we can get sense of what treatment is appropriate for her age: if she should try on her own, take an oral medication like Clomid or Letrozole, or use injectables with insemination or IVF,” Seifer adds.
Seifer recommends AMH testing if you want the full benefit of the most amount of information regarding your response to ovarian stimulation. Unlike the FSH test, not all insurance companies pay for AMH testing. The good news? The cost is less than $100. “Why use an instrument that is 20 years old with limited precision when there is something more informative with greater precision and more information?,” Seifer asks. Ask your fertility doctor for an AMH test if it’s not being offered, he advises.