What do the results tell us?

“Ovarian Reserve” is the term used to describe how well your ovaries are working with regard to egg production and egg quality.

Every woman is born with a different ovarian reserve and this reserve declines with advancing age. This deterioration makes it increasingly harder for a woman to have a baby as she gets older.

The decline in ovarian reserve happens faster for some women than for others; it causes fertility problems for the average woman by her late thirties, but unfortunately for some women, a critical change has already occurred by their early thirties.

Follicle Stimulating Hormone (FSH)

As part of your fertility assessment, your levels of FSH will be measured to assess ovarian activity. FSH must be taken on day 2, 3 or 4 of your menstrual cycle. High levels of FSH indicate a decline in ovarian function. A disadvantage of FSH is that levels can fluctuate from cycle to cycle, which may cause confusion.

Anti-Müllerian Hormone (AMH)

AMH is a more convenient and specific blood test for quantifying ovarian reserve. It is produced by the granulosa cells of antral follicles in the ovary. The antral follicles are small fluid-filled sacs that each contain an immature egg. The AMH level therefore correlates closely to the number of antral follicles (potential eggs) in your ovaries.

The blood test for AMH can be carried out on any day of your menstrual cycle. Levels do not fluctuate from one cycle to another, making AMH a more reliable measure of ovarian reserve than FSH.

The AMH level is reported in units called picomoles per litre (pmol/L) and the number can be compared to the normal range and according to your age to give you an indication of your ovarian reserve compared with that of the normal population. There are four fertility ranges into which your result may fall:

 

Optimal fertility range 40.04 – 67.9 pmol/L
Satisfactory fertility range 21.98 – 40.03 pmol/L
Low fertility range 3.08 – 21.97 pmol/L
Extremely low fertility range 0.0 – 3.07 pmol/L

 

A normal AMH result gives reassurance that you have good ovarian activity and that there is no urgency to move to fertility treatment. If you were required to have IVF/ICSI treatment for other reasons (eg. poor sperm quality, blocked Fallopian tubes) a normal AMH result indicates that you should have a good response to the hormone stimulation (a higher number of eggs for collection), increasing your chances of having a baby from this treatment.

If AMH levels are found to be low you will find it harder to have a baby, either naturally or with fertility treatment, compared with women with normal AMH levels. Low AMH levels also indicate a degree of urgency with regard to starting fertility treatment; the concern would be that deferring treatment could result in a smaller chance of success.

Transvaginal Utrasound Scan

This is a relatively quick and straightforward investigation that yields detailed information about several aspects of your reproductive health. The uterus (womb) can be checked for any abnormalities, with particular focus on the endometrium (lining of the womb) and the presence of fibroids, polyps or structural abnormalities that may impact on your chance of conceiving. A blockage in the Fallopian tube cannot be seen specifically by ultrasound, but an enlarged fluid-filled tube can indicate a likely blockage that would require Further Investigations.