Ovarian Reserve Testing
Ovarian reserve testing evaluates several hormone levels between days 2, 3 or 4 of your menstrual cycle. At Shady Grove Fertility, our clinicians perform this testing to determine the quantity of eggs you have remaining.
Common indicators for IVF treatment
On day 2, 3, or 4 of your menstrual cycle, a clinician will take a blood sample to test levels of the following:
E2 (estrogen): the main female reproductive hormone secreted from the ovary.
FSH (follicle-stimulating hormone): releases from the brain and stimulates the ovary to recruit and mature an egg. High FSH levels can indicate to your physician that the hypothalamus and pituitary glands are working harder than normal due to a decrease in ovarian reserve (egg supply). FSH levels can vary from cycle to cycle, so if your physician finds your level to be lower than expected based on your age, he or she may recommend repeating the test in the following month.
AMH (anti-Müllerian hormone): AMH is the most accurate predictor of a woman’s egg supply. This test can be more accurate than FSH because there is no fluctuation from month to month and the test is not dependent on a woman’s menstrual cycle, which means women can have the test at any point. AMH is secreted by the small antral follicles found in the ovaries at the start of the cycle. A higher AMH level would indicate a large number of antral follicles and a strong ovarian reserve whereas a lower value would lead your physician to believe there has been a decrease in the ovarian reserve.
LH (luteinizing hormone): LH is produced in the pituitary glands. A surge of the LH hormone indicates ovulation is about to occur. The increased levels of LH provide final maturation to the egg within the follicle and set ovulation in motion by releasing a mature egg.
A transvaginal ultrasound can view the uterine and ovarian anatomy and allow a physician to count the small resting (antral) follicles. The antral follicle count is a very good predictor of the status of the woman’s ovarian reserve and is also a good indicator of how she will respond to fertility medication.
The results from ovarian reserve testing can help dictate the treatment plan that your physician may suggest. The results of the bloodwork and ultrasound together will tell your physician the following about your ovarian reserve and lead to these potential treatment suggestions:
Normal ovarian reserve: When all hormone levels are considered to be in the appropriate range for conception, your physician will then look to other tests, your medical history, and your partner’s information to determine a diagnosis. Depending on the findings of the other tests, oftentimes your physician will suggest starting with a basic form of treatment like intrauterine insemination (IUI). In situations where a severe male factor is present or both Fallopian tubes are blocked, his or her initial recommendation may become in vitro fertilization (IVF) to give the patient the best chance of success.
Low ovarian reserve: When women have a low ovarian reserve, this can often be due to advanced age but can sometimes happen for no known reason. Treatment options can range from in vitro fertilization (IVF) to donor egg treatment. A woman interested in checking the status of her ovarian reserve that is found to be declining may opt to freeze her eggs in order to help ensure that she will have eggs available in the future when the time is right for her to move forward.
PCOS indication: While SGF physicians do not use AMH with the expressed intent of diagnosing polycystic ovary syndrome (PCOS), very high AMH levels, combined with a patient’s medical history, can indicate a possible PCOS diagnosis. Women found to have PCOS usually have a variety of treatment options available to help them conceive. If your fertility evaluation finds no other barriers to conception, such as a male factor or blockages in the Fallopian tubes, your physician may suggest basic treatment such as intrauterine insemination as a starting point for treatment.