Ovarian Reserve Tests

There are three important tests of ovarian reserve, and you may have heard their acronyms: Anti-Mullerian Hormone (AMH), Follicle Stimulating Hormone (FSH), and Antral Follicle Count (AFC).AMH is a small molecule that works inside the ovary for the follicles (the fluid filled spaces around the eggs) to signal to each other. When there are more follicles in the “resting pool of eggs” every month, the measurable AMH in the blood is higher. AMH typically runs between 0 and 4. When someone is in her 40s we frequently see numbers less than 1.0. An average number in one’s 20s is around 4.0. And 2-3 is normal in your 30s. FSH is the hormone your brain uses to talk to your ovaries. At the beginning of every menstrual cycle (when you are still having your period from the cycle before), your brain and your ovaries are engaged in some serious communication. When ovaries are healthy with high numbers of resting eggs, the brain has to only send out small pulses of FSH to start the process of selecting the dominant egg for that month. The resting eggs in the ovaries send out small amounts of estrogen, which then rises significantly as the dominant egg emerges. In women with healthy ovaries, both FSH and estrogen should be low for several days at the beginning of the cycle. Everything is quiet, like a simmering pot. This is why we check FSH and estrogen on day 3 of your cycle. FSH values less than 10 and estrogen levels less than 60 are normal. If we see a high FSH value on that day, it means that your brain has to shout at your ovaries to get them to respond—this is what happens when the egg pool is smaller. If we see a high estrogen level on that day, it means your body already has chosen its dominant egg for that month—also a sign of a diminishing pool of eggs.AFC is not a blood test, it is a count of the small follicles performed by your fertility doctor with a transvaginal ultrasound. Quite simply, we can see the number of eggs that your body has accessible every month. This number is the number most closely correlated with the number of eggs you can expect to retrieve during an IVF cycle.One important thing to remember is that these tests of ovarian reserve are not perfect. The best way for your doctor to see how your body will respond to fertility medications is to actually devise a treatment protocol and see how it goes. Everyone is different and everyone will respond differently to medications. This is why your doctors at RFC will so closely monitor your fertility treatment cycle—so that we can make personalized adjustments as needed.