I’ve got high FSH/low AMH … what does it mean?

Ohhhh boy, I know this topic better than just about any other, as you may have seen from my story. I remember finally plucking up the courage to see a fertility specialist, being sent for blood tests, immediately getting online and googling what all the tests were and how to interpret the results … and fast coming to the conclusion that the absolute worst case scenario was an FSH over 10. “The cruelest number of all” was how one site described it.

If you’ve clocked in with elevated FSH (usually defined as any reading >10) or OK FSH but elevated E2 (>150 in NZ units, or >40 in U.S. units) or low AMH (<14 pmol/l in NZ units, or 2ng/ml in US units), then you have probably been visiting Dr. Google and have come up with a very depressing view of your chances. Your specialist may also have told you this is not good news. And no, it’s not, but here are a few snippets of information I’ve been able to glean in my travels.

First, let’s blow a few myths out of the water …

  • Your age is far more important than your FSH – if you are 33 years old with an FSH of 20, then you do NOT have the eggs of a 43-year-old. You have the eggs of a 33-year-old, just fewer of them than your average 33-year-old.
  • If your FSH fluctuates and is sometimes high and sometimes normal (with normal E2 as well), then your prognosis is about the same as if your FSH was consistently slightly elevated (say, low teens).
  • Even if your FSH reading is quite high (say, 30 or 40 or more), this alone does NOT mean you are in menopause. Menopause is defined as not ovulating and no periods for 12 months. If you still get AF – and particularly if you are still ovulating! – you are definitely NOT in menopause!
  • If you do get pregnant, your chances of miscarriage are just the same as anyone else your age – high FSH does not increase the chances of aneuploidy or miscarriage (yes, this has been studied!).

What does high FSH/low AMH mean?

  • You have diminished ovarian reserve (DOR). This means you are running low on eggs and are likely to hit menopause sooner than average (the average is age 51). How much sooner is very hard to say – it could be 10 years away or more; it could be much sooner.
  • You are likely to be a “poor responder” to IVF stimulation drugs. In other words, if you try IVF, you are likely to produce fewer eggs than most women and your chances of pregnancy will be lower because of the smaller numbers.

How can I reduce my FSH?

The short answer to this is that it’s a wild goose chase. Nothing much works to get the number down consistently, but the more important point is that even if you did, it doesn’t change the fact that you are low on eggs. Don’t waste your energy chasing a lower number because that isn’t going to get you pregnant. What you do know for sure is that you are short on time, so put your energies into finding the golden egg(s) from those that are left.

Having said that, it is possible to artificially suppress FSH using either Buserelin (an agonist), birth control pills or some form of estrogen (such as estradiol valerate). This is usually done prior to starting an IVF cycle and is known as ‘pre-cycle suppression’. More on that in another post …

Should I believe just one reading?

It’s never a good idea to make major decisions based on one blood test result, or even on two or three tests that confirm a similar result. There are some other tests of ovarian reserve, and it’s a good idea to ask for them:

  • FSH – Follicle Stimulating Hormone – should always be done with a test for estrogen as well (otherwise it’s uninterpretable); should be done on CD2-3 of cycle, although some drs will do it CD1-4.
  • AMH – Anti-Mullarian Hormone – may be done at any time during the cycle
  • AFC – antral follicle count – this is a vaginal ultrasound,  usually done early in your cycle, where the dr counts the number of ‘resting’ or ‘antral’ follicles that are candidates for selection at the beginning of a cycle. This gives you a  very rough ballpark of the maximum number of eggs you might get on the right IVF stimulation protocol.

Is there any hope for women with high FSH not using donor eggs?

High FSH does present some difficult challenges. However, there have been success cases, lots of them, especially among those with just mildly elevated FSH (in the teens). At higher levels (FSH in the 20s, 30s and 40s), we still see successes, but just in lower numbers, and the success cases show a definite drop-off in older women. There have been some rare cases of success in extremely high FSH cases – two I know of personally were a 28-year-old with FSH 164 (yes, that’s a hundred and sixty-four) and another with FSH clocking up to 110 who had three children over several years (including the last one at 41).

Those interested in poring over some unscientifically documented success cases should check out the following links:

I’ll follow this up soon with some more information on treatment options for high FSHers, including natural approaches and alternative medicine as well as different IVF protocols that seem to work best for high FSHers.

In the meantime, a great resource to check out is my friend PJ’s site: http://highfshinfo.com

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14 Responses to “I’ve got high FSH/low AMH … what does it mean?”

  1. Susie says:

    Hi, I’m just wondering if you know the answer to this question, I am just about to start IVF #2 and got an FSH and E2 blood test on day 2 through my GP. But stupidly I started the pill for IVF at 7am and then went and had blood test at 9.00am – do you know if that would have supressed my FSH and E2 results. I was happy cause they had dropped but now realise they may be false. So stupid when I could have just started after the test! many thanks

  2. Nirjosh says:

    My AMH value is 9.98.
    FSH is 8.71, LH 10.71, Estradiol is 38.89 and Progestrone is .038.

    With above mentioned hormone levels i started for IVF treatment (3rd) but after 10th day my doctor said she can not do IVF with less follicle. So i had my IUI done but still couldnt get pregnant.
    Pls suggest.

  3. sailaja says:

    Hi, I am with High FSH and low AMH, i am 34 yrs old..pls confirm is there any chance of conceiving with out going for IVF…Pls help i am very stressed out thinking about it

  4. Eve says:

    Hi Nirjosh and Sailaja,

    This isn’t a place to get medical advice, but the short answer is that yes, there is a chance to get pregnant with high FSH; I know many women who have. However it isn’t easy, depending on your age. The main thing is to make sure you don’t stop investigating causes of infertility as soon as you find the high FSH. In my case I had two other things going on that were fixable, and if I hadn’t addressed them we never would have succeeded.

    Hugs and good luck!

  5. elle says:

    Hi ,

    Could you please tell me if you used birth control and lupron/buserelin for suppression during IVF cycle? If so what doses did you use? Thank you

  6. Elizabeth says:

    Hi Elle,

    I used just a low dose of E2 as precycle suppression. Lupron/buserelin had oversuppressed me in the past, and birth control also seemed a bit heavy duty, so we took a minimalist approach.

    You can see full details of my cycles (and especially about the one that worked) on the “Elizabeth’s Story” page.

    Good luck!

  7. Jo says:

    Hi Elizabeth

    I am 42 yrs old and recently had tests done which came back not so good. FSH was 18 and AMH 0.0. The specialist at the clinic called me while I was work to tell me the news that IVF or Clomid would not work for me and that I should look at donor eggs. Naturally I was devastated with the news but felt her approach was a bit blunt.

    Are there any clinics out there (preferably in Auckland) that specialise in working with ladies who have low AMH readings? I feel like I want to explore every possible option before I go down the donor egg route, if at all. And I am not feeling compelled to go back to the specialist I saw.


  8. Elizabeth says:

    Jo, the trick in NZ is that it’s not clinics that specialise, but individual doctors. Last I looked the guy to go and see if you had low AMH was definitely Simon Kelly at Fertility Associates in Auckland. He’ll generally have some ideas and options, will be realistic about your odds, but won’t unilaterally decide on your behalf whether those odds are too slim, because surely that is up to each couple, right? Obviously DE would be a higher odds option – no denying that – but many women (me included) want to explore or at least clearly understand own eggs options first before making the call to go the DE route.

    Good luck, and drop me a note if you need to …

  9. Jo says:

    Thank you Elizabeth.

    I went to see Simon Kelly this morning. What a wonderful man. Whilst he was realistic he is also prepared to give clomiphene a go and he totally gets where I am coming from in terms of trying EVERYTHING before going down the DE path. He has a great bedside manner and I would highly recommend him to others in the same boat. So thank you very much for the advice.

  10. Jo says:

    Hi Elizabeth,

    I just wanted to give you an update also in the hope that others might read this and not give up. My initial results came back with a 0.0 AMH and the doctor advised me to go down the DE route. I was not completely happy with this so saw Simon Kelly at FA. He agreed that the initial advice I had received was a big call to make. He put me on some testosterone patches, and low dose Clomiphene and I ended up producing a few follicles, so we proceeded with IVF. I am now pregnant and have my 7 week scan in a couple of weeks! Unbelievable after being told I had no chance of conceiving. We are so over the moon as are the nurses at FA! Whilst I know I am probably one of the lucky ones, I strongly urge others going through something similar to not give up and if you are not happy with the advice you have received, go and see someone else. You just never know!!

    Thank you for recommending Simon, he has obviously made a huge difference to us!


  11. Elizabeth says:

    Jo, that is such fantastic news – congratulations! 🙂

    You know, even if luck hadn’t kicked in for you, I think many specialists don’t get how important it is to just be allowed to try with your own eggs, give them a chance. It’s the psychological and emotional process of finding closure.

    The blood tests like FSH are good but imperfect predictors. I was told at 38 I was in perimenopause, which meant menopause would be here within 9 years max and probably sooner. Well, I’m 48 and still waiting!

    Thank you again for sharing your story. So happy for you!!

  12. Hope says:

    I am 41 .. Last year I went to an Ivf dr and had 4 inseminations with follistim, no success. I decided to start taking maca root and royal jelly along with acupuncture . I got pregnant in january, and had a misscarriage 5 weeks later due to chromosome abnormalities. We had to wait 2 mos to try again after my d/c . I got pregnant immediately again also with the herbs I took and acupuncture , I full blown morning sickness , 8 week heartbeat and two weeks later a misscarriage. Had another d/c and found out it was a viable pregnancy . I just went to my gyno last week to check my levels , they came back fsh 17 / he said my amh was really low. Going to see another fertility dr. Next week for a consult due to my gynos request .I’m so stressed!! I got pregnant without dr’s … Any advice ???

  13. kat says:

    I have just turned 40 and was referred to fertility clinic for further investigation and testing due to my age. I have received a letter saying my amh is low reserve 3.1. When I saw the doctor he thought prior to these results my internal exam showed about 8 egg folicles and looked OK. Help! Im lost confused and beside myself. How many people have got pregnant at my age with low amh as mine! What can u do

  14. Karen says:

    Dear Elizabeth, I know this is an old post, but i just wanted to thank you for putting this information together -particularly dispelling the myths. Approaching 40, I have a very poor prognosis (the triple whammy – FSH, AMH, AFC) and these are all the negative thoughts that have been going through my head. Thank you so much for putting this information together.

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