Aboubakr Elnashar

1. DISCORDANCE
BETWEEN
FSH & AMH
Prof. Aboubakr Elnashar
Benha University Hospital,
Egypt
ABOUBAKR ELNASHAR

2. INTRODUCTION
 FSH and AMH
 Predict ovarian reserve at 2 different stages of
follicular development.
 FSH: reflect antral and postantral follicular
development
 AMH: representative of post primordial preantral
follicular pool
 AMH decreases as age increases
 FSH increases as age increases.
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3.  Acceptable measures of
 ovarian reserve
(ASRM, 2015)
 predicting response to ovarian stimulation
 Prediction of live birth
 evidence is controversial
 AMH is superior
[Barad et al 15].
 AMH,AFC, and quantity of oocytes retrieved were
the most reliable predictors of live birth
[Nelson et al 17].
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4.  Discrepancy
between the two markers: difficulty in
 Selecting starting dose of GnT
 Predicting
 response to ovarian stimulation
 LBR
 Counseling patients
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5. FREQUENCY
 20%
[Leader et al , 2014].
 43%
(Hussain et al 2013)
 30% of cycles
(Wang et al, 2018)
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6.  Gleicher et al, 2010
 small prospective study
 350 reached IVF, excluding women with PCOS.
 Normal AMH with abnormal FSH
 oocyte yield was diminished compared to normal age
specific AMH and FSH
 higher oocyte yield than a normal FSH with abnormal AMH.
 Above age 42 y
 normal as-FSH predicts good oocyte yields
even with abnormally low AMH.
 Under age 42 y
 discrepancies between as- FSH and as-AMH
remain similarly predictive of oocyte yields at all
ages.
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7.  Buyuk et al, 2011
 Reassuring AMH (> 0.6 ng/ml) & elevated FSH (>
10 mIU/ml) Vs. AMH levels < 0.6 ng/ml:
 higher oocyte yield
 greater number of day 3 embryos
 lower cycle cancellation rates
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8.  Hussain et al 2013
 107 women
 discordant groups: AMH/FSH one hormone
normal and the other abnormal
 required higher dose of gonadotrophins
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9. Hussain et al 2013
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10.  Wang et al, 2018
 140,000 cycles of ART at over 60 fertility centers.
 the largest study to evaluate LBR when AMH and
FSH results were either concordant or discordant.
 Patients were categorized into 4 groups:
 Good prognosis group (AMH ≥1 ng/ml; FSH < 10 mIU/ml)
 Poor prognosis group (AMH < 1 ng/ml; FSH ≥10 mIU/ml),
 Reassuring AMH group (AMH ≥1 ng/ml; FSH
≥10 mIU/ml),
 Reassuring FSH group (AMH < 1 ng/ml; FSH <
10 mIU/ml).
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11. Wang et al, 2018
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12.  Reassuring AMH predicted=High FSH, a high AMH
 rescues live birth probability (i.e. > 20%) across all
age groups.
 significantly higher LBR than the reassuring FSH
group
(22.8% vs 15.6%, p < 0.005).
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13.  Normal AMH is a better clinical predictor of cycle
success when AMH and FSH are discordant.
 AMH
 superior to FSH among all age groups.
 more important determinant of pregnancy outcome
than FSH.
 Irrespective of FSH value, a low AMH confers
 a lower likelihood of LBR among young patients.
This live birth likelihood is even lower for older
patients with low AMH.
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14.  Age, AMH, and FSH alone
 not sufficient to accurately predict the IVF success
rate.
 Model which incorporates
 These markers
 demographic information
 treatment outcomes:
 better predict the likelihood of success with IVF
 facilitate individualized patient counseling.
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15. CONCLUSION
 Discordant AMH & FSH:
 oocyte yield was diminished
 higher dose of gonadotrophins
 AMH appears to be a stronger predictor
 Reassuring AMH
 better clinical predictor of cycle success.
 AMH, and FSH alone
 insufficient to predict a patient’s likelihood of LBR.
 Prediction models incorporate
 these markers
 patient demographics
 treatment response are needed to provide
accurate prognostic guidance for infertility
specialists to facilitate patient counseling.
ABOUBAKR ELNASHAR

16. You can get this lecture and 420
lecture from:
1.My scientific page on Face book:
Aboubakr Elnashar Lectures.
https://www.facebook.com/groups/2277
44884091351/
2.Slide share web site
3. elnashar53@hotmail.com
4.My clinic: Althwara st, Mansura, Egypt
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