FSH and AMH – Determining Ovarian Reserve PART II

Our patients who are trying to conceive question us – almost on a daily basis – about our ability to influence their FSH and AMH levels.  Many of our patients have been told that these numbers can’t be changed and, if your FHS is high or your AMH low, that your reproductive future has been determined.  At Reproductive Wellness we have seen and believe otherwise.

If you would like more information on what your FSH and AMH levels mean, you can visit our other blog post which explains this in greater detail.  In this post, I would like to explain our theory regarding these 2 fertility markers and what we do at Reproductive Wellness to improve high FSH and low AMH.

We have heard our patients tell us thousands of times that FSH and AMH can’t be improved.  And yet we have seen improvement of FSH and AMH levels in these patients, which is also typically when patients conceive.  While most Fertility Clinics will base your IVF protocol on your highest FSH reading and lowest AMH reading, these clinics also are aware that your FSH will fluctuate from cycle to cycle.  They also know your response during your IVF cycle will be better on those cycles where your FSH levels are on the lower side.

FSH is an indicator for egg quality in current or future cycles.  At Reproductive Wellness we believe there are so many factors which influence FSH levels, the most fundamental of which are stress management, having a balanced exercise program, cleaning up your diet and having a functional medicine supplement program.  We also find that acupuncture, reproductive massage, and Chinese herbs can speed up the progress we are aiming for.  That being said, each plan needs to be customized according to the individual because no two cases are identical.

Moving our discussion toward AMH, this is an area where I often find patients have more questions and concerns.  Current AMH testing is thought to be an indicator for a woman’s ovarian reserve.  If AMH testing was truly a reflection of ovarian reserve, this number would never improve with time or treatment.  The number of follicles/eggs a woman is born with is finite and never increases.  As we age this number decreases and at certain times in a woman’s life more dramatically so than at other times.  It would only make sense to see this number decrease and never go back up.

At Reproductive Wellness our clinicians have seen AMH levels improve with appropriate treatment.  In theory, if AMH was truly testing ovarian reserve, improvement should not occur – but it does.  Why is this? We paid closer attention to this and began, after a minimum of a 3 month treatment period, retesting this value and found an increase of levels in about 40% of patients. To give some background, imagine that there is a pool of eggs/follicles that the body pulls from each month.  And on any given cycle there is a conveyor belt that some of the follicles ride on until they are ready to be selected for ovulation.  This process is known as folliculargenesisI believe that what current AMH tests actually measure is how many follicles are on that conveyor belt rather than the core pool of finite follicles.  We are able to influence and enhance the process of folliculargenesis by restoring function and enabling the body to push more follicles on the belt towards ovulation.  It is when this happens that we see the AMH value increase!

If these tests are not measuring what they claim, than what value do they serve?  Ultimately, it is important to keep in mind that these tests are only reliable as indications.  I believe that these tests are still valuable in that they show the health of folliculargenesis and we can use these values as a way to gauge progress.  To keep some perspective, FSH was considered the main indicator of fertile health some years ago.  AMH has now come into the spotlight, and while it has not completely replaced FSH, most offices now use AMH as the main indicator of reproductive health.  Soon AMH will become obsolete and a new test will replace it claiming to be the superior test for ovarian reserve and quality.  At the end of the day while lab values are important in determining reproductive health, they should not be the only factors to focus on.

To improve and influence FSH and AMH the following areas should be addressed:

  • Stress management
  • Balanced exercise program
  • Cleaning up your diet
  • Creating a functional medicine supplement program
  • Acupuncture
  • Reproductive massage
  • Chinese herbs

Watch this video to learn more about FSH- AMH levels, what the numbers mean and what could be done to improve yours.

Do you have questions after reading this article? Please let us know! Leave a comment below, we would love to give you some answers!

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2018-08-23T08:52:40+00:00

22 Comments

  1. Rachna January 13, 2015 at 11:52 pm - Reply

    My fsh level is normal as per reports of my 2nd day of periods. But amh is 42.20ng/ml. Amh test was not done during periods. What are my chances of getting pregnant. I m pcos patient

    • admin January 21, 2015 at 2:28 pm - Reply

      Hi Rachna
      Your chance of getting pregnant is dependent on your ability to control your PCOS. If you can control this your AMH should come down and your chances of getting pregnant should increase.
      Are you doing anything to control your PCOS now? I can help you with this. If you are interested, I would love to talk more about it. I offer free consultations via skype.
      Take care!

  2. Diva July 9, 2015 at 1:39 am - Reply

    I am a 37 year old woman. My FSH level was 3.7 last September. I am ready for a pregnancy now. I am a healthy female with no bad habits. No smoking or alcohol or caffeine. Last week I approached a doctor and got myself tested for AMH. It came to 0.91*. I am very tensed as according to the doc, it’s low fertility. In the sonography she could see fibroids n small cysts too. She is suggesting hormonal injection during the next cycle to improve the quality of eggs and then freezing the eggs for later pregnancy. I just want to know if I am normal. I just want to have normal and healthy babies. Does the count look so bad? Pls help.

    • Marc Sklar July 27, 2015 at 1:16 pm - Reply

      Diva
      The first thing to recognize is that all fertility clinics will recommend IVF as that is what they do and it is their business. Normally at your age we would like to see your AMH be over 1 and yours is .91; this is not far off from the desired goal. There are many factors that come into play when we evaluate AMH and fertility options, and this is just one. Part of my concern has more to do with the fibroids and cysts. These need to be addressed to allow for implantation and have a healthy pregnancy. I hope this information is helpful. If you would like to set up a time to talk more about your case then you can schedule a time at consult.marcsklar.com

  3. Gayle July 23, 2015 at 12:21 pm - Reply

    I am being seen by a Reproductive Encronologist. I am currently in my 1st cycle with Gonal-F & Ganirelix. I am 38 with a BMI of 40 (very obese). My Day 3 blood work showed
    Estradiol 26 LH 8.1 FSH 9.6 AMH 0.51 Prolactin 7.5 Testosterone 4 DHEA-Sulfate 83.4 AFC 5
    TSH 4.01 on Day 3. TSH was repeated 2.99
    FT4 0.98
    Cholestreol and Trglycerides are normal. I do not have diabetes. A1c is 4 & Fasting glucose is 100.
    Low Calcidol 24 Low Ferritin. Recently increased Iron levels to a borderline low (Ive been taking supplements for about a year. ). RBCs/MCV are normal.

    I am discouraged by my AMH levels. I started Gonal F 150 IU from CD4 to CD6. At CD7 morning U/S I only had 2 larger follicles at 6mm. They rest were very small. My RE raised my Gonal F to 225 IU on CD7-CD8. I am starting to think my past life style and health issues is the main obstacle versus my low AMH and advanced reproductive age of 38.
    I had anorexia with complusive over excerising and heavily drank until I was about 22. I stayed sober from age 22 to 32. My weight was stable for those 10 years although my nutrition was still poor. Ex. My hair and nails didn’t grow. I gained weight at age 33 to slightly overweight and my hair and nails started growing. I actually started complaining because now I had to shave my legs. I had low folic acid levels due to drinking from age 33 to 36. Folic Acid is now normal. I again started drinking heavily again from age 33 to 36. I have gained 80 pounds in the last 4 and half years My drinking is now moderate at twice a month 4 drinks per occurence. My stress levels have been high my entire life. My above medical history points that out being they are both coping mechanisms.
    So in your opinion do you think my past history of self abuse/poor coping is the main cause of my infertility?

    • Marc Sklar July 27, 2015 at 1:19 pm - Reply

      Gayle
      I certainly think this is a major contributing factor and needs time with proper lifestyle changes to see this corrected. I think that there is a lot that I can discuss and go over with you that I feel can be improved, which I can’t go into on this post. I would be happy to discuss this over the phone. The one thing I will mention about the information you provided is that I do not believe your thyroid is functioning optimally. I feel that it requires a closer look and proper treatment. I would love to help you, if you would like to schedule a free fertility assessment, you can do so here. http://consult.marcsklar.com/

  4. Anayansi July 27, 2015 at 12:41 pm - Reply

    Hello, How can I contact you?

    • Marc Sklar July 27, 2015 at 12:42 pm - Reply

      To schedule an online consultation, please go to consult.marcsklar.com

  5. Katie October 4, 2016 at 4:06 pm - Reply

    Hi Mark,

    I’m encouraged by your article on AMH/FSH and its meaning regarding ovarian reserve. I am 30 and my husband is 34. We are both active and physically fit and eat clean diets with a lot of whole foods, organic, etc. in our diets. We have been TTC for 2 years and have done the gammet of tests, all of which have come back great except my AMH/FSH. My AMH was .61 and my FSH was 15.9. My doc told me I need to see an RE and that I only have a “few months” to get pregnant before my fertility is basically gone. Everything I read is very doom and gloom about diminished ovarian reserve. Considering that everything else has come back normal (no endometriosis/PCOS/clear tubes/ovulating/regular cycles/perfect semen analysis, etc.), should I still be concerned about this? I have started COQ10, DHEA and maca as well as take a fertility tea blend which includes vitex. We are trying to help my eggs be as healthy as they can. Is there really a chance I can greatly improve my labs to become normal? Thanks for any input!

    • Marc Sklar December 28, 2016 at 3:33 am - Reply

      With your age there is certainly a chance but I am not sure I would be taking all of these supplements without someone to guide you and monitor you. I’d be hapoy to review your case. The best way would be scheduling a 1 on 1 with me, you can find all the information about my programs here
      http://marcsklar.com/online-programs/

  6. Lucy B October 29, 2016 at 8:53 am - Reply

    Hi,

    I am a 34 year old female in same sex relationship. I have had 3 x natural IUI and 3 x stimulated IUI and the clinic have now recommended IVF. My AMH is 9 and FSH is 10.5. I am very healthy in terms of eating and exercise and maintain a healthy weight. I do not smoke,take caffeine but do drink alcohol 1 – 2 times a week but very modestly. What are my changes if falling pregnant with IVF?

  7. Courtney June 26, 2017 at 9:31 pm - Reply

    I am struggling with the decision whether or not to try IVF. I am 43 years old (12-01-73). I had 1 m/c in August, 2014. I had 1 pregnancy in April 2015 resulting in a healthy baby boy born 12-21-15.
    My husband and I would love to have another baby. We have been trying for about 9 months now. I drink Chinese herbal teas and receive fertility acupuncture weekly.
    Last month I had my blood work done on CD 3 with the following reults:

    AMH: 0.999
    FSH: 11.5
    Estradiol: 35.2

    Based on all this information, do you think I am a good candidate for IVF?

    Courtney

    • Marc Sklar July 26, 2017 at 7:47 am - Reply

      Courtney

      You are a good candidate for IVF with these numbers, but I also think you are a good candidate to get pregnant naturally. It all depends on time for you. I’m happy to talk, here is a link to my virtual consultations http://marcsklar.com/talk-with-marc/

  8. Robyn November 17, 2017 at 5:07 pm - Reply

    Im 42 and my fsh is 15.9. Do i have a chance at all? Naturally?

  9. Neetika November 18, 2017 at 4:04 am - Reply

    Hey Marc,

    Hi, I am based out of India. Reading your articles feels like there is some hope to get my fertility back but really not sure as to where do I need to start from.
    I am 29 years of age and was diagnosed with endometriosis 3 years ago.
    I and got my laproscopy done in April 2017 and they said it was grade 4 endometriosis.
    I was prepared that I will have to go for an IvF however after laproscopy, doing an IvF cycle with my own eggs seems like distant thought altogether as my blood tests are have no positive indications.

    My AMH level before lapro was 3.4
    My current AMH declined drastically and stands at 0.33 after lapro. ( This was done randomly)
    FSH 11.87 (day 2 results)
    LH 3.89
    E2 92

    My doctor suggested that I should go for a donor egg as the I will have a very low response to the hormonal medications on me and specially with such low AMH and high FSH, the probability is really low.

    Can you help and guide as to what can I do now ? What is the path that I need to follow to conceive ?

  10. Samantha February 27, 2018 at 7:45 am - Reply

    I am 38 years old, my SO is 30. I was just referred to an RE for workup to find out what our next options are as we have been TTC for over 6 months (I already have 2 children from a previous relationship, 10 and 8 years old). His semen analysis came back good, with some minor abnormal sperm, but nothing alarming, and my levels came back as:

    AMH: 2.28
    FSH: 11.7
    Estradiol: 37

    The FSH level is what concerned my doctor. I don’t have any coverage for IVF… is our ability to conceive naturally completely out of the question with these numbers?

  11. Cass March 8, 2018 at 5:49 am - Reply

    Hi. I am 45 and I’m considering a tubal ligation reversal so that I can try to get pregnant. My FSH on the 3rd day of my cycle was 10.4. My AMH is 0.19. I am having regular periods and no health issues. In your honest, professional opinion, would a reversal be a waste of time and money? Is there any chance of conceiving naturally?

  12. Julia Troyer April 10, 2018 at 1:55 pm - Reply

    My husband and I have been ttc for 3 years. He has morphology issues and I have an amh of .44 and an fsh of 10. My RE stated that IVF would be our best option of getting pregnant but the chances of it happening in 3 cycles were pretty slim. I am 27 and my husband is 26. Do you think we should go right to donor eggs?

  13. Guadalupe May 21, 2018 at 12:06 pm - Reply

    I am 28 years old and my AMH is 4.94 and FSH is 3.2 my email miss.lupita.510@gmail.com

  14. Jennifer Wes July 8, 2018 at 5:14 pm - Reply

    Hi Marc,
    Thank you for all of the great info on this topic. It gives me some hope :). I’m
    32yrs old, live healthy lifestyle, eat organic Whole Foods, exercise 4-5x/week easy to moderate. I’ve been type 1 diabetic for 14yrs, uncontrolled for 12yrs. Then I switched to low carb and brought down my A1C to 5.1 . I started tracking my cycles about 7 months ago (just charting cervical mucus, mood, other physical symptoms) and noticed they became very short, sometimes only 18 days long, with short bleeding of about 2 days. Sometimes have days of very light brown spotting after period is over for 3-9 days. So I had my typical well women’s exam w OBGYN and told her this info and she ordered some lab work.
    I just got my day 3 labs back:
    FSH 31.1
    AMH 0.13
    Estradiol 35
    LH 7.0

    Other relevant history:
    -From age 26-31yrs old I had the Mirena IUD and didn’t have a period for about that long.
    – From age 26-29yrs old I worked out very hard every single day to compete in bikini body building competitions
    – Not sure if my lack of period for that long was because of the IUD or from working out too much. Low progesterone I’m assuming
    – At around age 30 I started not feeling great w lack of energy and becoming really irritable/moody, felt like I was losing who I was, and like something was going on internally with my body. Also had a few night sweats. I started doing research and came across the DUTCH test. DUTCH test came back I was in menopause. This was a little over a year ago and I honestly just think I was in denial or thought the lab work was incorrect… so I didn’t do anything about it until now we want to start a family!
    – I had the IUD taken out at age 31 (13months ago)
    – Cycle was abnormal at first, then became “my normal” which was about 18-23 day cycles and assuming I wasn’t ovulating every time

    After finding out all this info now, I have started doing acupuncture and will start Chinese Herbs soon, I’ve only seen the acupuncturist once so far. I’ve also starting charting my cycle the correct way using BBT charting using fertilityFriend App .

    I’ve seen RE and was basically told I need donor egg. However, I feel like there could be more I can do and I believe in a more natural approach to things in general. Even though I found out these labs a couple weeks ago, my husband and I still officially wanted to start trying naturally since we haven’t yet. So now I sit at 10 days past my predicted ovulation and am at CD26 and this is the longest cycle I’ve had in months! Maybe this first try could have been a miracle..

    I was told to return to the IVF clinic on day 3 of my next cycle to do a Antral Follicle Count ultrasound so now I’m just waiting to start my period..
    I wanted to get that done first before I contacted you for help and start one of your programs.
    That’s where I’m at, do you think it’s possible to conceive naturally with an FSH of 31.1, AMH 0.13 age 32? Thank you so much!

    • Marc Sklar September 12, 2018 at 5:18 am - Reply

      Hi Jennifer, You need to get these numbers lower but I do think its possible Jennifer. Get on a good plan that you can follow. I’m happy to help you create a personalized fertility plan, if you’d like to chat here is the link to schedule an online fertility assessment http://marcsklar.com/hope/

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