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Maria72

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Friday, August 31st 2012, 6:54am

FSH/AMH/hormones/POF/menopause FAQs

What is the menopause?

The menopause, also known as the 'change of life' is the end of menstruation. This means a woman's ovaries stop producing an egg every four weeks. She will no longer have a monthly period or be able to have children.
In the UK, the average age for a woman to reach the menopause is 52, although women can experience the menopause in their 30s or 40s.
If a woman experiences the menopause when she is under 45 years of age, it is known as a premature menopause.
Menstruation (monthly periods) can sometimes stop suddenly when you reach the menopause. However, it is more likely that your periods will become less frequent, with longer intervals in between each one before they stop altogether.

You will get a diagnose of ‘menopause’ if you have had NO PERIOD at all for 12 consecutive months. Once you have had a diagnosis of menopause the only way of conceiving is through donor eggs or donated embryos. There is virtually no chance of conceiving naturally or with fertility treatment after a woman has missed her period for 12 months

What is POF (Premature Ovarian Failure?)

The term premature ovarian failure describes a stop in the normal functioning of the ovaries in a woman younger than age 40. Some people also use the term primary ovarian insufficiency to describe this condition. It is also known as hypergonadotropic hypogonadism.
Health care providers used to call this condition premature menopause, but premature ovarian failure is actually much different than menopause.
In menopause, a woman will likely never have another menstrual period again; women with premature ovarian failure are much more likely to get periods, even if they come irregularly.

How is POF diagnosed?

Because one of the most common signs of premature ovarian failure is irregular periods, women should pay close attention to their menstrual cycles and tell their health care provider about any changes.
If your health care provider thinks you may have premature ovarian failure, he or she may do a blood test to measure the level of a hormone called follicle stimulating hormone (FSH) that is normally present in the body. The level of this hormone between day 1-3 of the cycle (at the start), combined with others like LH, Estradiol and progesterone (day 21) will help with the diagnosis.
You can also be asked to take the AMH blood test and to check your ovaries with an ultrasound scan to perform an antral follicle count. These last two tests will give your doctor an idea of your ovarian reserve.
Be aware that there are at least 2 scales to measure AMH and various ones for the other hormones. You will need to check your levels against the scale your hospital, clinic or lab uses NOT on Google or other websites.

Can I still conceive?

A woman in menopause has virtually no chance of getting pregnant, naturally or with IVF, while a woman with premature ovarian failure has a greatly reduced chance of getting pregnant, but pregnancy is still possible.
Most clinics will not treat ladies with a confirmed diagnosis of POF as they have a much reduced chance of conceiving and will respond poorly or not at all to the drugs used in assisted conception. Clinics will treat patients who choose the donor egg route.
Between 5 percent and 10 percent of women with POF do become pregnant, even though they have not had fertility treatment. Scientists don’t know why this is.

I have high FSH, do I have the menopause or POF?

You cannot self diagnose POF or the menopause on your own based on one FSH test on its own or on one missed period. If you are worried you need to see your healthcare provider.
If you have constantly high FSH levels, low estradiol levels and low AMH levels then your chances of conceiving using assisted reproductive methods are reduced as you would not respond well. Also your chances of conceiving naturally are reduced, but you can still fall pregnant. As long as you have your period you have a chance, even if greatly reduced.

I have high FSH and I have been told I have the PERIMENOPAUSE.

Perimenopause, or menopause transition, is the stage of a woman's reproductive life when the ovaries gradually begin to produce less estrogen. It usually starts in a woman's 40s, but can start in a woman's 30s or even earlier.
Sometimes the doctor will say you have the perimenopasue if you have (consistently) high fsh (but not very high) levels, low estrogen (estradiol) levels and a lower ovarian reserve but you still have your periods and ovulate (even if only occasionally).
Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last one to two years of perimenopause, this decline in estrogen accelerates. The average length of perimenopause is from a few months up to 10 years. Perimenopause ends the first year after menopause (when a woman has gone 12 months without having her period).

Can I still conceive if I have been told I have the perimenopause?

Yes. Despite a decline in fertility during the perimenopause stage, you can still become pregnant. If you do not want to become pregnant, you should continue to use some form of birth control until you reach menopause (you have gone 12 months without having your period).
A woman with perimenopasue has a reduced chance of getting pregnant, but pregnancy is still possible. Basically her reproductive life is coming to an end, fertility is declining, but it hasn't ended yet.
Clinics will look at hormonal levels before deciding to treat a woman in the perimenopausal stage as she has a much reduced chance of conceiving and will respond poorly or not at all to the drugs used in assisted conception. You may be advised to go for natural IVF or un-medicated IUI.
Clinics will treat patient who choose the donor egg route as it has a higher success rate.


Hormone levels guide (please note the units, as your lab/hospital/clinic might use different ones).

THIS IS ONLY A GUIDE and may differ from your clinic’s levels. You cannot compare it to your own levels if you don’t know the units or if they are different.

A comprehensive blood test for women would include:
Estrogens (usually only the estradiol (E2) form is tested) on day 1-3 of the cycle
Progesterone on day 21 of the cycle
Follicular stimulating hormone (FSH) on day 1-3 of the cycle
Lutinizing hormone (LH) on day 1-3 of the cycle

EXAMPLES OF LEVELS (may differ from your clinic’s levels)



For each test you will need the following information:
Hormone name (units names) Stage (stage in the cycle, as most hormones vary depending on the time of the month) Range (units abbreviations)
You cannot compare these figures to your own levels if you don’t know the units of your own blood test or if the units and cut offs levels are different.

Progesterone (nanograms per milliliter or nano-moles per liter)
Follicular phase < 1.5 ng/ml (< 3.18 nmol/L)
Mid luteal phase 3 – 20 ng/ml (9.54 – 63.6 nmol/L)
Postmenopausal 0 – 15 ng/ml
Estradiol (picograms per milliliter or pico-moles per liter)
Follicular phase 50 – 145 pg/ml (184 – 532 pmol/L)
Midcycle peak 112 – 443 pg/ml (411 – 1626 pmol/L)
Luteal phase 50 – 241 pg/ml (184 – 885 pmol/L)
Postmenopausal < 59 pg/ml (< 217 pmol/L)
FSH (units per liter)
Follicular phase 3.0 – 20.0 U/L
Ovulatory phase 9.0 – 26.0 U/L
Luteal phase 1.0 – 12.0 U/L
Postmenopausal 18.0 – 153.0 U/L
LH (units per liter)
Follicular phase 2.0 –15.0 U/L
Ovulatory phase 22.0 – 105.0 U/L
Luteal phase 0.6 – 19.0 U/L
Postmenopausal 16.0 – 64.0 U/L

Using this scale you can see that a postmenopausal FSH level is 18 or over. Using my own clinic’s scale the cut off value is 26, so again make sure you are looking at your own blood tests AND the cut off levels from your own clinic/hospital/lab. They are normally found next to your own levels. Also note that FSH should be high during ovulation, so the day you have your blood test is very important. If you are not able to have a copy of your blood test, ask your clinic to tell you both the level and the units, which are those letter found next to the numbers.

Check this for more help: http://www.nichd.nih.gov/publications/pu…ave_POF_rev.pdf
(link external to FZ)

Maria72

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Friday, August 31st 2012, 12:31pm

This post has been edited 1 times, last edit by "Maria72" (Aug 31st 2012, 12:32pm)


Maria72

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Friday, August 31st 2012, 1:44pm

AMH and antral follicle count

What are they?

AMH (Anti-Mullerian Hormone), also called MIS (Mullerian Inhibiting Substance) is produced directly by the ovarian follicles. Follicles are fluid filled sacs in your ovaries where the eggs or oocytes are located. Your healthcare provider will ask you to do an AMH test (blood test) to check your ovarian reserve. They may also check your antral follicle count. This is counting your follicles at the start of your cycle with an ultrasound scan.

Women with lower AMH have lower antral follicular counts (lower number of follicles) and produce a lower number of eggs when stimulated by drugs.

The number of antral follicles visible on ultrasound is used to estimate the number of microscopic (and sound asleep) primordial follicles remaining in the ovary. Each primordial follicle contains an immature egg that can potentially develop in the future.
When there are only a few antral follicles visible, there are far fewer eggs remaining as compared to when there are more antrals. As women age, they have less eggs (primordial follicles) remaining and they have fewer antral follicles.

How is AMH used?

Since AMH is produced only in small ovarian follicles, blood levels of this substance have been used to attempt to measure the size of the pool of growing follicles in women.
Research shows that the size of the pool of growing follicles is heavily influenced by the size of the pool of remaining primordial follicles (microscopic follicles in "deep sleep").
Therefore, AMH blood levels are thought to reflect the size of the remaining egg supply - or "ovarian reserve".
With increasing female age, the size of their pool of remaining microscopic follicles decreases. Likewise, their blood AMH levels and the number of ovarian antral follicles visible on ultrasound also decreases. This is because women are born with a certain, fixed number of eggs which goes down in time as the woman ages.

Women with many small follicles, such as those with polycystic ovaries have high AMH hormone values and women that have few remaining follicles and those that are close to menopause have low anti-mullerian hormone levels.

AMH can be used by fertility clinics for:
Evaluating Fertility Potential and ovarian response in IVF - Serum AMH levels correlate with the number of early antral follicles. This makes is useful for prediciting your ovarian response in an IVF cycle. Women with low AMH levels are more likely to be poor ovarian responders.
Measuring Ovarian Aging - Diminished ovarian reserve, is signaled by reduced baseline serum AMH concentrations. Women with poor ovarian reserve have low levels of AMH.

AMH versus FSH

The FSH level varies according to the cycle dates, AMH doesn't.
FSH depends upon the estradiol level (a high estradiol level will artificially suppress a high abnormal FSH level into the normal range) and it varies from cycle to cycle, so is not always reliable or dependable. AMH does not change significantly in the cycle. That is why many clinics prefer AMH or will use both tests to decide if you can have fertility treatments.

I have low AMH does it mean I have the menopause or POF?

A low AMH means your ovarian reserve is low. It does not mean you have the menopause or that you cannot get pregnant. Just that you have less eggs than you did before, when you were younger. POF and the menopause will need other tests to be diagnosed (see above) as well as AMH.

I have low AMH will my clinic let me have fertility treatments?

A low AMH is a sign that you may respond poorly when stimulated during fertility treatments.
This means you will produce fewer eggs, reducing your chances of success. Some clinics prefer to treat women with a normal AMH because they have more chances of success. Some clinics will treat you all the same, but will warn you of your reduced chances of success.
AMH will not affect your chances of success if you choose the donor egg route.
Each clinic is different, so check yours to see if they will treat you.
A low AMH doesn't mean you cannot get pregnant naturally, just that it will be more difficult as you have a reduced ovarian reserve. As long as there are no other problems like blocked tubes you can still try naturally.


AMH levels guide

One confusing thing about AMH is that there are at least 2 scales out there and innumerable clinic definitions of what is "normal" - it depends on which assay they use and which study! One scale is ng/ml and one is pmol/l. The pmol/l scale runs from 0 to about 48; the ng/ml runs from about 0-10. On the ng/ml scale , less than 2 ng/ml is considered to be low.

Please check the units and scales that your clinic uses as it may differ from these ones.

AMH Reference ranges.

PLEASE USE THIS ONLY AS A GUIDE. These levels may differ from your clinic's and are only to be used as a general guide not to self diagnose.

AMH levels do not change significantly throughout the menstrual cycle and decrease with age. It is a simple blood test that can be done at any time.

Ovarian Fertility Potential pmol/L
Optimal Fertility 28.6 - 48.5
Satisfactory Fertility 15.7 - 28.6
Low Fertility 2.2 - 15.7
Very Low / undetectable 0.0 - 2.2
High Level > 48.5

Ovarian Fertility Potential ng/mL
Optimal Fertility 4.0 - 6.8
Satisfactory Fertility 2.2 - 4.0
Low Fertility 0.3 - 2.2
Very Low / undetectable 0.0 - 0.3
High Level > 6.8


Antral follicle count guide.

PLEASE NOTE THIS IS ONLY A ROUGH GUIDE. Refer to your clinic for accurate information about your own case.

How many antral follicles is "good"?
Each clinics will have their levels, depending on their staff and machines, so please ask them about your count.
Bear in mind that it is not always possible to see both ovaries fully during a scan. Antral follicle counts are also "observer-dependent". This means that if we had several different trained sonographers do an antral count on a woman, they would not all get exactly the same result. Therefore, what looks like 6 antral follicles, at another clinic might have been read as 4 or 8, etc. The count will also depend on how accurate the machinery is.

Here are rough general guidelines. Please remember to talk to your clinic for your own results. This is just a ROUGH GUIDE.

Total number of antral follicles: 4 or less
Extremely low count, very poor (or no) response to stimulation.
Cycle cancellation is likely.

Total number of antral follicles: 4-6
Low count, possible/probable poor response to the stimulation drugs.
Likely to need high doses of FSH product to stimulate ovaries adequately.
Higher than average rate of IVF cycle cancellation.

Total number of antral follicles: 7-10
Reduced count
Higher than average rate of IVF cycle cancellation.

Total number of antral follicles:11-15
Intermediate count
Response to drug stimulation is sometimes low, but usually adequate.
Slightly increased risk for IVF cycle cancellation.

Total number of antral follicles: 16-30
Normal (good) antral count, should have an excellent response to ovarian stimulation.
Likely to respond well to low doses of FSH drugs.
Very low risk for IVF cycle cancellation. Some risk for ovarian overstimulation.

Total number of antral follicles: Over 30
High count
Likely to have a high response to low doses of FSH product.
Higher risk for overstimulation and ovarian hyperstimulation syndrome.

This post has been edited 1 times, last edit by "Maria72" (Aug 31st 2012, 1:47pm)


Maria72

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Thursday, September 6th 2012, 9:23pm

Why do I need to test for other hormones as well as FSH?

More than one hormone is needed to give a complete picture to your doctor, especially as hormones influence each other.
Your doctor will ask you to test LH, Estradiol (E2 for short) as well as FSH on day 1-3 of your cycle and progesterone on day 21 of your cycle or 7 days after the LH surge.

What does each hormone do?


FSH: stimulates the formation of a large follicle that is capable of ovulation and forming a corpus luteum in response to the mid-cycle surge of LH.

LH: triggers ovulation. Ovulation of mature follicles on the ovary is induced by a large burst of LH known as the preovulatory LH surge. The LH surge can be see as a 'positive' with an ovulation kit.

E2: is a type of estrogen. During the menstrual cycle, estradiol is produced by the growing follicle and triggers events that lead to the LH surge, inducing ovulation. It also prepares the womb lining for implantation, making it grow. High levels of E2 at the beginning of the cycle will artificially lower FSH levels.

Progesterone: helps prepare your body for conception and pregnancy and regulates the monthly menstrual cycle. Progesterone levels rise in the second half of the menstrual cycle, and following the release of the egg (ovulation), the ovarian tissue that replaces the follicle (the corpus luteum) continues to produce estrogen and progesterone. If implantation does not occur, estrogen and progesterone levels drop, the lining breaks down and your period starts again. Doctors test day 21 progesterone to confirm that ovulation has happened.

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