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It May Not Just Be About FSH

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by Rachel Lehmann-Haupt, Nov. 30, 2009

When it comes to measuring ovarian reserve, many of us live and die by our Antral follicle counts and Follicle Stimulating Hormone (FSH) levels. Every month, the pituitary gland in your brain sends out FSH to tell your ovaries to get to work growing the follicles that will hold and eventually release an egg. Your number of Antral follicles (determined via vaginal ultrasound) and the amount of FSH you produce (measured on day three of your period) will be a clue to your ovarian reserve, the quality of your eggs, and your ability to get pregnant each month. These days, however, many REs are also starting to rely on another hormone as a marker: Anti-Mullerian Hormone (AMH), which also strongly correlates with the size of your ovarian follicles to predict your ovarian reserve.

A new study published in the October, 2009 edition of Human Reproduction concludes that “AMH demonstrated less individual cycle variation than Antral follicle counts and may therefore be considered a more reliable and robust means of assessing ovarian reserve in sub-fertile women.”

“The size of the remaining ovarian follicles decreases and the level of AMH becomes lower to signal a change in fertility," says Dr. Edward Marut, an RE at Fertility Centers of Illinois. "Some believe AMH better reflects the overall size and volume of the ovary. A menopausal woman would have a very small ovary, while a normally ovulating young woman's ovaries would be larger."

But REs differ on whether or not AMH is the best the predictor of ovarian reserve. “Because FSH can fluctuate from cycle to cycle, a lot of doctors are looking for a marker that is not going to vary as much,” says Dr. Marut. “AMH is another piece of the puzzle, but I think a low AMH is not enough to say that you shouldn’t be stimulated or that you can’t get pregnant.”

Dr. Bill Meyers, an RE with Carolina Conception in Raleigh, North Carolina would argue otherwise. “We’ve become very comfortable with using AMH as a marker of ovarian reserve,” he says. “The great advantage is that you can get it at any time in the cycle and the test is generally more accurate than an FSH test."

"Considering the differing opinions, it seems a woman's best medical decision would be to consider AMH but also to continue to pay attention to all the markers," adds Dr. Marut. "It can't hurt."


Rachel Lehmann-Haupt ( is a journalist and the author of In Her Own Sweet Time: Unexpected Adventures in Finding Love, Commitment and Motherhood (Basic Books, 2009).