Prognosis following in vitro fertilization-embryo transfer (IVF-ET) in patients with elevated day 2 or 3 serum follicle stimulating hormone (FSH) is better in younger vs older patients: Article

Here is a summary of a paper by Check et. al. puvblished in Clin Exp Obstet Gynecol 2002; 29:42-4.
Please note that the article is old (2000) and therefore pregnancy rates are expected to be higher in 2012. Overall the result is meaningful though. also note that the pregnancy rates in the study are per transfer and therefore do not include cancelled transfers. Also live birth  rates are expected to be lower.

IVF success/transfer	FSH <12	FSH >12
Age  <38	32%	28.6%
Age >38	30.3%	5.5%

Ivf Prognosis based on FSH and AMH levels

IVF Prognosis	FSH normal	FSH abnormal (high)
AMH normal	Good	Reduced
AMH abnormal (low)	Very Reduced	Poor

This table summarizes oocyte production based on (day 3) FSH and AMH (Anti Mullerian Hormone ) values. It appears , based on the study (referenced below) that AMH is the better predictor.  Please note that this table is relevant up to the age of 42yo. After 42 the disparity between FSH and AMH does not seem to matter and patients with "good" FSH levels do better , regardless of AMH values.

Reference:

Gleicher N, Weghofer A, Barad DH. Discordances between follicle stimulating
hormone (FSH) and anti-Müllerian hormone (AMH) in female infertility. Reprod Biol
Endocrinol. 2010 Jun 17;8:64. PubMed PMID: 20565808; PubMed Central PMCID:
PMC2894827.

What is a "good" FSH level? Age Specific FSH levels

 

Serum follicle stimulating hormone (FSH) level is  measured on day three ( or 2 or 4) of the menstrual cycle. (First day of period flow is counted as day one. Spotting is not considered start of period.) If a lower value occurs from later testing, the highest value is considered the most predictive. FSH assays can differ somewhat so reference ranges as to what is normal, premenopausal or menopausal should be based on ranges provided by the laboratory doing the testing. Estradiol (E2) should also be measured as women who ovulate early may have elevated E2 levels above 80 pg/mL (due to early follicle recruitment, possibly due to a low serum inhibin B level) which will mask an elevated FSH level and give a false negative result.

High FSH strongly predicts poor IVF response in older women, less so in younger women. One study showed an elevated basal day-three FSH is correlated with diminished ovarian reserve in women aged over 35 years and is associated with poor pregnancy rates after treatment of ovulation induction(6% versus 42%).

This study by Gleicher et al assessed what normal values for FSH should be according to age. As you can see below the normal values are way below what  we normally tell patients: less than 9  mIU/ml .

Since normal b-FSH levels rise with female age, these levels should represent a more accurate represent- tation of ovarian function than currently used universal cut-off levels for all ages. Women who exceed their age-specific cut off levels, should be suspected of demon- strating PREMATURE OVARIAN AGING and should, therefore, immediately, be directed towards further diagnostic evaluation.


AGE SPECIFIC b-FSH LEVELS


< 33 Years              33-37 Years                   38-40 Years           ≥ 41 Years
< 7.0 mIU/ml        < 7.9 mIU/ml                 < 8.4 mIU/ml      < 8.5 mIU/ml


abstract below  (source fertility and sterility)

We evaluated a study group of 434 consecutive patients under age 41 years with baseline (b-) FSH levels of <12 mIU/ml (considered to represent “normal” ovarian function), who underwent ovarian stimulation for IVF with an ovarian stimulation protocol consisting of long GnRH-agonist or antagonist suppression and modal gonadotropin stimulation of 300IU of FSH/HMG per day. We assessed IVF cycle outcomes, including oocyte yields, based on age-specific b-FSH levels, defined as levels ≤ the 95% confidence interval of the mean (95% C.I.) for each age group. In the literature production of fewer than 5 oocytes in response to ovulation induction is considered to be evidence of ovarian resistance. We consider women under the age of 41 who produce fewer than 5 oocytes to have POA. Women with b-FSH levels above the 95% CI for their respective age groups were considered to be at increased risk of premature ovarian aging (POA). A logistic regression model for the presence of fewer than 5 oocytes at retrieval was performed using SPSS for Windows15.0. Continuous variables are presented as mean ±1 SE.

Normal Anti Mullerian Hormone (AMH, Antimullerian Aormone) levels (values)  by age

In an excellent article in Fertility and Sterility the  median levels for Antimullerian Hormone were  provided by analyzing the age specific  database of a large blood laboratory. As we all know AMH is a good predictor of fertility reserve ( the higher the better). But what is a normal value? the obvious response is that it varies with age and its values decline with age. Thanks to this article we now get a good perspective on how to  interpret this test.  As most screening tests  Antimullerian Hormone (AMH)  is very informative when it is very low ( =less fertile) .
Fertility and Sterility  Pages 747-750, February 2011

Age	n	Median	Yearly average decrease	Mean	Yearly average decrease	1 SD	Yearly average decrease
24	228	3.4		4.1		3.0
25	284	3.2		4.1		4.0
26	366	3.2		4.2		3.9
27	471	2.9		3.7		2.9
28	587	2.8	−0.2	3.8	−0.2	4.7	−0.2
29	732	2.6		3.5		3.6
30	867	2.4		3.2		3.2
31	925	2.2	−0.2	3.1	−0.2	2.9	−0.2
32	865	1.8		2.5		2.3
33	940	1.7		2.6		4.0
34	1,019	1.6		2.3		2.3
35	1,161	1.3		2.1		2.5
36	1,097	1.2		1.8		2.0
37	1,234	1.1		1.6		1.8
38	1,233	0.9	−0.1	1.4	−0.2	1.9	−0.2
39	1,170	0.8		1.3		1.6
40	1,088	0.7		1.1		1.3
41	893	0.6		1.0		1.1
42	664	0.5		0.9		1.2
43	489	0.4	−0.1	0.7	−0.1	0.9	−0.1
44	323	0.3		0.6		1.2
45	227	0.3		0.5		0.9
46	115	0.2		0.4		0.6
47	69	0.2		0.4		0.4
48	41	0.0	−0.1	0.2	−0.1	0.3	−0.2
49	22	0.1		0.1		0.1
50	10	0.0		0.0		0.0

AMH hormone levels as a predictor of age at menopause

Huge hype today as time Magazine reports about an article from a the in the Journal of Clinical Endocrinology and metabolism.
The scientific article is titled Relationship of Serum Anti-Mullerian Hormone Concentration to Age at menopause. The Abstract of the article is below.

BACKGROUND: Serum anti-Müllerian hormone (AMH) levels are highly correlated with antral follicle counts (AFC), while being menstrual cycle independent and easily measurable. However, AMH, unlike AFC, has not been tested as yet as a predictor of reproductive status. By relating AMH levels to the age distribution of reproductive events like onset of menopause we tested this hypothesis. METHODS: AMH levels were measured in 144 fertile normal volunteers and used to determine an estimate of mean AMH as a function of age. Data on onset of menopause were obtained from the population-based Prospect-Epic cohort. Estimation of an AMH threshold to predict menopause was done by maximum likelihood using the observed (EPIC) and predicted (AMH) distributions of age at menopause. Predictions of age at menopause follow from an individual woman's AMH relative to percentiles of the distribution of AMH for a given age, and the corresponding percentiles of the predicted distribution of age at menopause. RESULTS: There was good conformity between the observed distribution of age at menopause and that predicted from declining AMH levels. CONCLUSION: The similarity between observed and predicted distributions of age at menopause supports the hypothesis that AMH levels are related to onset of menopause. Results of this study suggest that AMH is able to specify a woman's reproductive age more realistically than chronological age alone.

Let me explain the whole thing in simple words. AMH is produced by the ovaries(just as eggs are) as a woman ages the ovaries shrink so threre are less eggs and less AMH. We have known this fact for a long time . What the people in the study have done is they compared numbers in ovulating women to a control group of menopausal women from a different population. So it was not a prospective study. The right way to do this study would be to follow the same women for 20 years or more until they reach menopause.
Thus the study does not add much to our knowledge: as a general rule if you ovaries are getting smaller prematurely or you produce less eggs prematurely or your day 3 fsh goes up prematurely you are more likely to undergo menopause earlier.
So pretty much no news for most women. I think that it is common knowledge that fertility declines with age the decline is sharper after the age of 35 so if you are interested in knowing your status you can go to any reproductive endocrinologist and get any or all of these tests.

Link to Times article