Ladies, did you know that when you’re born you already have all the eggs your body will ever produce? You enter the world with hundreds of thousands of eggs that will remain inactive until puberty. This is a key reason why fertility declines more quickly with age among women. While men’s bodies continually produce sperm, a woman cannot make more eggs.
AMH testing, which tests for Anti-Mullerian Hormone, can reveal important information about how many eggs you have left and how healthy they are. Consider beginning your fertility journey by starting with this important test.
Age: A Key Fertility Predictor
For women, age is the single most important predictor of fertility. In her twenties, a woman has about a 25% chance of getting pregnant each menstrual cycle. At 30, the chances decline to about 20%. And by 40, the figure is just 5%.
So why does age matter? There are a few factors at play here. First, women lose as many as a thousand eggs each month. Eventually, a woman’s ovarian reserve will simply run out. Second, women inevitably go through menopause, which marks the end of fertility. After menopause, a woman has completely depleted her reserve and cannot get pregnant unless she has frozen her eggs. Third, egg quality tends to decline with age.
Other factors can also play a role. Health overall can decline with age, and a woman’s hormones may shift as she approaches menopause. These factors can make it even more difficult for a woman to get and stay pregnant. They also increase the risk of birth defects, stillbirth, preterm labor, and other negative pregnancy outcomes. We can do a lot to address these risk factors, but once a woman has depleted her ovarian reserve, her chances of a successful pregnancy are zero without donor eggs.
Some women suffer from a condition called premature ovarian failure, or ovarian insufficiency. This causes diminished ovarian reserve -- fewer eggs than a woman could be expected to have for her age. The fewer eggs a woman has, the lower her chances are of a pregnancy and the more likely it is that the remaining eggs are of lower quality. So infertility testing should look not only at the role of age but also at the possibility that a woman has premature ovarian failure.
About 1% of women in their thirties have premature ovarian failure. Some women with premature ovarian failure enter menopause early and stop menstruating. More frequently, a woman’s cycles become irregular. And sometimes, there are no noticeable changes aside from the difficulty of getting pregnant.
AMH Testing and Ovarian Reserve
The right testing can provide information about your ovarian reserve. You can use this information to make fertility and family planning decisions, and also to diagnose infertility.
Anti-Mullerian Hormone (AMH) is a hormone secreted by developing eggs in the ovary. Very low levels of AMH indicate that a woman may have a lower ovarian reserve, potentially undermining fertility. To read the results, a doctor compares the woman’s numbers to averages for other women her age. This average is important because a woman in her 40s will have lower numbers than a woman in her 20s.
The procedure is simple, requiring only a blood sample. If your doctor is testing you for other causes of infertility, they can also measure AMH. The real trick with AMH testing is reading the numbers, so it’s important to choose a fertility clinic that has a high success rate among women with diminished ovarian reserve. If tests results are not correctly read, a common cause of infertility could go undetected -- or you could be diagnosed with a type of infertility you do not have.
AMH testing is important for women considering IVF, as well as any couple who has tried longer than six months to get pregnant.
Some women also use AMH testing to test for future fertility. The theory here is that certain AMH levels might mean a woman’s fertility is declining at a more rapid rate than usual. It makes intuitive sense, but so far research has not supported this theory. One recent study found that AMH testing can only measure current ovarian reserve. It’s important to choose a fertility clinic that stays on top of the most recent research and puts it in context for your needs.
Other Tests to Consider
In addition to AMH testing, two other tests can provide important information about ovarian reserve. In most cases, a fertility specialist will recommend doing all three tests.
The two other tests include:
- Follicle Stimulating Hormone (FSH) test: During the first half of a woman’s cycle, when her body is preparing to release an egg, the body secretes FSH to encourage ovulation. As a woman’s ovarian reserve declines, her body secretes more FSH in an attempt to encourage egg release. High levels of FSH often indicate a low ovarian reserve, especially if other tests, including AMH testing, suggest there’s a problem.
- Inhibin B test: Inhibin B helps suppress FSH. On day three of a woman’s cycle, inhibin B levels provide important information about ovarian reserve. Lower inhibin B levels may indicate a fertility problem.
Depending on your symptoms and overall health profile, it’s important to also consider other tests. No single test can tell you conclusively whether or not you can get pregnant. So it’s critically important to choose a skilled fertility clinic that knows how to interpret testing results.
Most Common Causes of Infertility
Diminished ovarian reserve accounts for about 30% of infertility cases. However, it’s important to keep in mind that fertility exists on a continuum. Some women’s ovarian reserves are more severely diminished than others. That means some women with diminished ovarian reserve can still get pregnant, while others cannot.
There are other factors to consider here as well, for instance, if a woman has few eggs and her partner has a low sperm count, the odds of a successful pregnancy become lower. Likewise, a woman who has few eggs and another condition, such as a luteal phase defect, will have more difficulties getting pregnant, especially without treatment.
Because infertility issues interact with and multiply one another, it’s important to pursue comprehensive fertility testing. Based on your symptoms, risk factors, and fertility history, a doctor will recommend a course of treatment.
Some common infertility tests include:
- Comprehensive medical history: Your doctor will want to know about your menstrual cycles, STD history, pregnancy history, and any chronic diseases or unusual symptoms. It’s important to be totally honest because your doctor will make other testing recommendations based on this information.
- Pelvic exam and pap smear: This allows a doctor to look for structure anomalies, and signs of inflammation and some STDs.
- STD testing: STDs are a major cause of infertility. Left untreated, some STDs can cause a disorder called pelvic inflammatory disease that damages the reproductive organs and makes pregnancy more difficult.
- Hormone testing: Your hormone levels can affect how frequently and whether you ovulate, as well as your body’s ability to sustain a healthy pregnancy. Blood testing at various times in your cycle can reveal important fertility information.
- Imaging tests of reproductive organs: Some tests allow a doctor to see your reproductive organs and look for damage. A simple in-office procedure called a hysterosalpingogram can tell a doctor whether you have blocked or damaged tubes. Some tests can also tell whether endometriosis has damaged your reproductive organs or makes implantation of a healthy pregnancy less likely.
- Testing for illnesses: Some illnesses, such as autoimmune diseases and infections, can damage fertility. So infertility testing should also include testing for common illnesses, as well as an assessment of overall health. If you are overweight, for example, your doctor might recommend becoming more physically active or losing weight.
Occasionally, a doctor might also ask you to track your menstrual cycles for a month. This provides additional data that can be used to construct a personalized treatment plan.
The right treatment should address each fertility issue, so it is important to get a comprehensive diagnostic workup. Only then can your doctor assemble an appropriate treatment plan.
Sometimes testing can’t determine the cause of infertility. This is known as unexplained infertility. Some of the same treatments that work for other fertility issues also sometimes work for unexplained infertility. So ask your doctor which treatments are likely to be more effective and whether more specialized testing might reveal the cause of infertility.
How Can Men Get Tested?
We know it takes two to make a baby. Yet in the popular imagination, infertility is still a woman’s issue. Nothing could be further from the truth. Infertility can be due to an issue with the man, the woman, or both. That means that, even if a doctor uncovers an issue with the woman, there might still be a problem with the man. Male, female, and shared infertility account for roughly equal percentages of all infertility cases. So don’t leave the man out of the equation.
Male infertility testing tends to be less invasive and expensive than female infertility testing, especially if you’re only doing the most basic tests.
Male infertility testing includes three key pieces:
1. Comprehensive medical history: including sexual history.
- Any preexisting illnesses or other medical issues.
- Erectile dysfunction and sexual issues such as impotence or difficulty ejaculating.
- Retrograde ejaculation that causes men to ejaculate into their own bodies.
2. Physical examination:
- A doctor will look for signs of obvious issues. One common problem is varicocele. A varicocele is a swollen vein that can lower sperm count.
- STDs and physical injuries that can make sex and ejaculation more difficult.
3. Semen analysis: looks at the characteristics and health of the man's sperm.
- Sperm motility -- which is a measure of the sperm’s ability to swim to the egg.
- Sperm count -- the total number of sperm per ejaculation.
- Sperm morphology -- such as unusual texture or pH issues that may damage sperm or make pregnancy more difficult to achieve.
Depending on your physical examination, medical history, and your partner’s test results, a doctor may also test your semen for other issues.
When to Consider Seeing a Fertility Specialist
A fertility specialist is uniquely equipped to recommend the right fertility tests, interpret the results, and assemble a comprehensive treatment plan. Especially when you’re concerned about issues such as diminished ovarian reserve, time is of the essence. Fertility declines with age, so you should not delay treatment.
Many couples feel that seeing a fertility specialist is giving up. Others fear that the treatment will be expensive and exhausting. Yet wasted time can cost you your fertility, and many fertility treatments are surprisingly affordable. Don’t waste precious months getting advice from the internet or your gynecologist. Your best shot at parenthood comes from an expert.
So see a fertility specialist if you’re over 35 and have tried longer than six months, or are under 35 and have tried longer than a year.
The Center of Reproductive Medicine is here and ready to help. Let us show you a path to parenthood. Give us a call today.