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Premature Ovarian Aging (POA)
While the term premature ovarian failure refers to a woman whose ovaries have stopped functioning before she is 40 years old, there is another term that refers to a woman who has elevated FSH levels: premature ovarian aging, also known as diminished ovarian reserve.
"Premature ovarian failure [as a term] should be used only for women who are already in menopause, meaning they have an FSH above 40," says Norbert Gleicher, M.D., a fertility doctor and medical director of the Center for Human Reproduction (CHR), a New York fertility clinic that specializes in treating POA. " But it is, unfortunately, [a term that is] very widely used for women who have mildly elevated FSH levels, and in that context it should not be used. We call women who have that, premature ovarian aging."
A woman has premature ovarian aging when her follicle stimulating hormone (FSH) levels are above where they should be at her age, or her anti-mullerian hormone (AMH) levels are below where they should be for her age, according to Dr. Gleicher.
A woman with diminished ovarian reserve may experience no symptoms other than difficulty conceiving, but her blood test will reveal elevated FSH levels. While some fertility doctors may use a universal level for diagnosis, Dr. Gleicher recommends an age-specific approach. "We use age-specific cut-offs both for FSH and AMH, which we feel is very important for a timely diagnosis," he says.
Dr. Gleicher says the normal cut-offs for FSH levels are:
- Under 7.0 mIU/ml up to age 33
- Under 7.9 mIU/ml between 33 and 37
- Under 8.4 mIU/ml between 38 and 40
- Under 8.5 mIU/ml between age 41 and 44,
"The diagnosis of diminished ovarian reserve is, unfortunately, very often overlooked or late, especially in younger women," Dr. Gleicher says. "And the reason is that many still don't use age specific levels for FSH and AMH. They still use universal cut off levels. It does not make sense to consider the diagnostic cut off for a normal ovarian reserve in a 21 year old to be the same as in a 45 year old."