What is fertility testing?
In reality, fertility of a women is a continuum and not something that categorizes well.
A certain value from a blood test can cause feelings of panic by placing you in a particular category (“low responder”! “high FSH”! “diminished ovarian reserve”!) whereas in reality there is very little difference in fertility potential between you and someone belonging to the neigboring category (“normal ovarian reserve”, “normal fertility” etc.).
As I keep writing all over my blog, young women should know the status of their ovarian reserve. There is nothing which will better help you plan your career and relationships than knowing how many eggs you have left. But how do you find out about this?
Just yesterday a 32-year old woman wrote to me to say that a well-known RE recommended egg donation only based on one single blood test: AMH (value was 0,68 ng/ml which is here in Europe still considered very hopeful) and no other hormones were tested?! And I’m speaking about the US, not any third-world country (please read here about why women in the US are advised to go for egg donation earlier and discouraged from using their own eggs).
In order to get a good estimate about your fertility potential, you need more data than a simple AMH-test. When it comes to estimating fertility, there are no shortcuts and only one or two hormones are not enough to get a reliable picture.
How fertility testing actually works?
If you are over 35 and want to know how many eggs you have left, here is which steps you should take:
1. Talk to an expert and formule the right question.
Ask for a good and reliable RE and find a good fertility clinic. When you check in, they will first ask you general questions about your fertility journey and your family history. It may sound simple, but in reality it does take an expert to sense at this stage whether there is a reson to dig deeper and whether there may be some infertility issues on the horizon.
2. Insist on having an ultrasound and counting antral follicles. Many experts view antral follicle count as the most reliable test of remaining ovarian reserve. Here is my favorite video where you can see how it’s done.
Ultrasound will show you how active your ovaries are, but also give you the information on the lining of your uterus, as well as about any obvious abnormalities which could compromise the implantation and pregnancy in the future.
3. Hormonal check. FSH and AMH are of course the most important ones. Together, they give a great estimate on what time is your biological clock showing.
AMH, or anti-Müllerian hormone is a substance produced by granulosa cells in small ovarian follicles (only in the small ones <8mm, to be precise).
The levels are fairly constant throughout the cycle and the AMH can be measured on any day (so if you go on your cycle day 3, which is the best day for testing FSH, you can get both values out of a single blood draw).
4. Chech your partner’s fertility (sperm count, viability, and other parameters). If you are missing that piece, you are missing a complete information on your your fertility as a couple. Meaning, if your partner has any uncovered mild sperm issue and you are trying to get pregnant with him, missing this information could cost you a lot of time and prevent you from getting pregnant naturally.
But when is the right time to see a specialist? My take on that is, if you are over 35, you should not wait longer than six months before finding out the status of your fertility. But even if you are younger – any time that you are thinking of having a baby is the right time to check on how many eggs you have!
The thing is – just in case there are any issues with your fertility, you want to have enough time to be able to fix them. Maybe it’ll be a small tweak and take only a few months of individually adapting your diet and supplements to get you pregnant (here is how to write me an email if you have any questions on that), or maybe there will be fertility treatments involved; in any case, you want to have time and not get overpowered by the situation.