Ovarian reserve testing: the key to future fertility
At IVFMD we use several different tests to assemble a picture of current and future fertility.
Anti mullerian hormone, AMH
Anti mullerian hormone or AMH is a substance secreted by young ovarian follicles (4 mm or less in diameter). Its level has been shown to correlate well with egg reserve. An advantage of measuring AMH is that the level can be drawn at any time of the cycle, unlike the FSH level (the existing test for ovarian reserve), which must be checked during the first 3 days of the cycle. Based on our experience, an AMH level of 1.5 ng/ml or higher is probably normal.
Below is a table that lists the AMH values and the corresponding egg reserves, using our own experience at IVFMD. While the AMH level may serve as a good indicator of egg quantity, it cannot predict egg quality, which is a function of time.
|AMH Level (ng/ml)||Ovarian Reserve|
|Over 5.0||High (often PCOS)|
|0.1 or less||Near menopause|
Basal antral follicle count, AFC
Basal antral follicle count or AFC is the total number of young follicles seen on both ovaries by sonogram during the first few days of the cycle. Similar to the AMH level, the AFC has been shown to be predictive of ovarian response to stimulation medications, the number of eggs collected, and the chance of pregnancy in an IVF cycle. An AFC of 12 or higher is considered normal. At IVFMD, we have found that a combination of the AMH level and the basal antral follicle count provides an accurate assessment of egg reserve.
Basal follicle stimulating hormone, FSH
Basal follicle stimulating hormone or FSH) level has served as an indirect indicator of egg reserve for many years. FSH is secreted from the pituitary to recruit eggs from the ovaries. When the egg reserve declines with age, the pituitary compensates by secreting an increasing amount of FSH in order to ensure the availability of eggs in every cycle. A high FSH level during the first 3 days of the cycle, therefore, reflects a diminishing egg supply. A baseline FSH level of 10 mIU/ml or lower is considered normal. A baseline level of 15 mI U/ml or higher is abnormal and is associated with very low chance of pregnancy even with aggressive treatment.
In our experience, the FSH level serves as a late warning for decreasing ovarian reserve because it starts to rise only when the egg count has decreased to a very low threshold. The AMH level, on the other hand, provides a more detailed depiction of the ovarian reserve to give a more accurate clinical picture so that a proactive treatment plan can be recommended early whenever necessary.