Do I Still Have Healthy Eggs?
Do I Still Have Healthy Eggs?
Among women, fertility begins to decline after age 30, and significantly declines after age 35. In fact, the overall number of eggs a woman has, and the quality of those eggs, diminish over time. The proportion of euploid (normal, healthy) embryos goes from about 76% among 25 to 30-year-olds to 52% among 35 to 40-year-olds. That percentage drops significantly after age 40.
If you are wondering, “Do I still have healthy eggs?” you’re not alone. Patients of all ages come to us to take control of their fertility. We help identify the cause of infertility and put patients on the right treatment path for their unique needs. Here’s how we test the number of healthy eggs a patient has so we can determine how to best treat their infertility.
Testing FSH Level
There are a number of hormone tests that we use to help our patients get a better understanding of the number of healthy eggs they have, also called ovarian reserve. The most common test is measuring a follicle-stimulating hormone—or FSH level—in the first two or three days of the menstrual cycle. This level is inversely related to the women’s fertility and the health of her eggs. As an FSH level rises above 10 Miu/ ML, fertility declines. Once the level is greater than 12 MRU per ML, a woman’s fertility is significantly diminished. If the level is over 16, the chance of conceiving is less than 5%.
Testing Estradiol Level
In addition to an FSH level, an estradiol level is measured simultaneously. Again, if the level is greater than 70 there is a significantly decreased chance of conceiving. These two tests have been the traditional markers of ovarian reserve.
Testing AMH Level
Another test that is becoming more common in the U.S., and is used in Europe on nearly all patients, is an anti-mullerian hormone (AMH) level. This hormone is produced by the healthy cells surrounding healthy eggs. As a patient ages, the number of follicles decreases, and AMH production decreases. A normal level is greater than two and correlates with normal fertility.
Levels between one and two is an intermediate range, and fertility may be slightly diminished. Once the AMH level is less than one, the chance of conceiving is very low. Unfortunately, most women over 40 years of age will have an AMH level that is less than one. Many experts suggest that an AMH level may be more helpful in women under 40 to determine if a woman has had premature diminished ovarian reserve. Interestingly, women with polycystic ovarian syndrome (PCOS) have very high AMH levels due to having many healthy follicles.
Another test, which correlates with the number of eggs that may be retrieved during an IVF cycle, is the antral follicle count (AFC). This test is performed via vaginal ultrasound and measures the number of little follicles less than 5mm in each ovary. Ideally, a patient should have at least five antral follicles in each ovary. If the patient has less than 10 total antral follicles, her chance of conceiving while undergoing an IVF cycle is very low.
Unfortunately, many women over the age of 40 will have less than six total antral follicles. In women with PCOS, it is not uncommon to find greater than 25 antral follicles.
If you’ve received unexpected or disappointing results from these tests, you have options. All four of these tests allow us to better determine a patient’s overall fertility and allows us to determine an appropriate dose of medication for an IVF cycle. Our team of fertility doctors has helped patients successfully grow their families, and we can help you, too. We’ve served as a trusted partner to countless patients on their journey to parenthood.