Do I still have healthy eggs is a question that many infertile women ask, particularly those who are over 35 years of age.
Most women today are aware that fertility declines after age 30 and significantly declines after age 35. While this is true, most women remain very fertile till age 39. Certainly after age 40 many women will have difficulty conceiving.
In addition to age their 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 health of her eggs. As an FSH level rises above 10 Miu/ ML fertility begins to decline. Once the level is greater than 12 MRU per ML a women’s fertility is significantly diminished and if the level is over 16, the chance of conceiving is less than 5%. In addition to an FSH level, an estradiol level is measured at the same time, and again if the level is greater than 70 there is significant decrease chance of conceiving. These two tests have been the traditional markers of ovarian reserve.
Another test that is becoming more commonly used 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 decrease and the AMH production decreases. A normal level is greater than 2, and this would correlate with normal fertility. Levels in the 1-2 range is an intermediate range and fertility may be slightly diminished. Once the AMH level is less than 1, 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 have very high AMH levels due to having many healthy follicles.
Another test which correlates with the number of eggs that may be retrived during an IVF cycle is the antral follicle count (AFC). This test performed via vaginal ultrasound measures the number of little follicles < 5 mm 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 forty will have less than six total antal follicles. In women with polycystic ovarian syndrome is not uncommon to find greater than 25 antral follicles .
All three of these tests allow us to better determine the patient’s overall fertility and also allows us to determine an appropriate dose of medication for an IVF cycle. An FSH level>16, Estradiol level>70, an AMH level<1 or an antral follicle count less than 10, all point to a very low chance of conceiving. Unfortunately, once any of these tests point to diminished ovarian reserve, there is nothing anybody can to do to change this. Some patients believe that stress or diet can affect these levels but there is no data that supports this.