The AMH/FSH debacle

The glaring omission of IVF

AMH and FSH levels determine how well IVF drugs will grow good eggs. Women with high FSH and low AMH levels respond poorly to IVF drugs. They have the smallest chance of success with IVF. To date, no IVF hormone therapy has been able to lower FSH levels or raise AMH levels.

The success of IVF hinges on good quality eggs. Quality egg production hinges on good AMH levels.

The AMH/FSH Debacle
IVF is the number one treatment for infertility, yet it fails so often. What is missing?

The failure of IVF is clear. To date, Research and Development has not begun to address this problem.

The AMH/FSH Debacle
Good egg quality is the foundation of IVF success. AMH is the foundation of good quality eggs.

Fix the hormone levels, fix the problem! Right?

To date, science has nothing. The 40-year-old focus of IVF applies to all women. IVF philosophy can read, “Grow as many eggs as possible, fertilize what you can, hope they fall pregnant.”

IVF remains the number one treatment for women with low AMH and high FSH. The problem is that it works for so few.

The FSH trap

1981 heralded the importance of Follicular Stimulating Hormone (FSH) in fertility. FSH levels created markers for ovarian responses to IVF drugs. Women responding poorly to these drugs established the upper and lower limits of good FSH levels. These levels became the gold standard for predicting IVF outcomes. These values helped create dosage levels for the ovarian stimulating drugs of IVF.

Researchers knew the FSH test was far from perfect. It had to be done in the early follicular phase. Variations in Estrogen (E2) levels changed FSH interpretations. It also required the normal functioning of the hypothalamic-pituitary-gonadal system. FSH is a marker of low response to ovarian stimulation. However, only elevations above the norm carried significance. Moreover, FSH does not detect high ovarian reserve. This is a known risk factor for ovarian hyperstimulation.

Because of these limitations, researchers pursued a more ideal test.

Research showed that as women’s FSH levels exceeded 20 IU/L, egg pick up and fertilization rates declined. Levels over 25 IU/L were still able to create viable eggs for transfer in women over 40. Even today, IVF birth rates with FSH over 20 IU/L are around 2%.

High FSH levels are terrible for egg quality and the effectiveness of IVF drugs. We also know that FSH injections are the beginning of every IVF treatment. If women already have high levels, and can’t produce a good egg, how can adding more FSH help? Yet this treatment is applied to all IVF patients, regardless of existing FSH levels.

AMH enters the arena

In 2002, AMH became the new marker of ovarian reserve. AMH took over from the FSH test because of superior accuracy. AMH levels now predicted the effect of IVF drugs on ovarian stimulation. Like FSH, response rates to IVF drugs created the good and bad AMH reference ranges. FSH values remained as a guideline but now less significant.

AMH testing created two new terms. ‘Diminished ovarian reserve’ is for women whose ovaries show less than five eggs in each ovary on a pre-IVF CT scan. ‘Poor ovarian responder’ is for women who do not grow more than five eggs with IVF drugs. A recent study showed that low AMH levels are more indicative of IVF outcomes when FSH in normal. It also showed that abnormal FSH levels have less impact on fertility than low AMH levels.

The benefits of AMH testing over FSH

  • The AMH test can be done on any day.
  • FSH levels are best tested on day 3 of a menstrual cycle.
  • AMH levels tend to stay the same over subsequent tests.
  • FSH values can vary dramatically cycle to cycle.
  • The AMH test is a ‘stand-alone’ test.
  • FSH needs other reference points to interpret its significance.
  • AMH levels are predictable at different ages.
  • FSH levels are unpredictable regardless of age.

The AMH/FSH balance

Good AMH levels are the foundation of growing a fertilizable egg. AMH begins the life cycle of your eggs. FSH takes over halfway and matures the egg, as AMH passes the baton. If AMH levels are low, FSH levels increase to try and help the egg grow.

Without enough AMH, FSH cannot mature an egg for fertilization.

FSH is excellent at finishing eggs; it needs a good foundation to work from. Think of AMH as Primary school and FSH as a secondary school. You can’t put your five year old in secondary school and expect them to be like the others. Likewise, your body can’t use high FSH levels to grow good eggs if AMH hasn’t helped first. 

Sufficient AMH underpins the entire success of IVF treatment.

Current IVF methods do not address issues with low AMH levels. Adding FSH to a woman’s body with low AMH levels does not help eggs grow. Adding FSH to already high FSH levels doesn’t help either. The IVF drugs that have helped so many others, now falter and fail. In no way does any treatment in IVF address low AMH levels.

Improving low AMH levels will cause high FSH levels to reduce, but science has no treatment for it. It doesn’t even appear to be a field of research to broaden the effectiveness of IVF.

Not addressing AMH levels is a glaring omission. Medicine glosses over the problem, “nothing can really help anyway.” Women are still advised to rush into IVF with a ‘before it is too late’ warning. No gambler would put their money down on such a long shot, yet many people will.

In 40 years, IVF strategies have not changed. Improved discoveries in how fertility works has not prompted new treatments to address them. IVF remains the only recommended medical option for low AMH.

IVF strategies are unsuitable for women with low AMH and high FSH levels. Einstein said, “Repeating the same thing over and over again is the definition of insanity.” With high costs and meager success something, a change in strategy is needed.

Using Ovance & RPM to raise your AMH levels is an excellent way to solve this problem.

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