The Female Evaluation

Through a time-efficient evaluation pathway, the causes of female infertility can often be determined within a couple of cycles. At IVFMD we prefer a proactive and time-efficient approach to diagnose your infertility problems.

Since age-related infertility is one of the biggest challenges that a woman has to face, we assess your ovarian reserve as the first step.

 Ovarian Reserve Testing

Antimullerian Hormone Level

Anti Mullerian Hormone (AMH) is a substance secreted by the follicles of the future generations, not by the follicles in the current cycles, and thus is a very direct indicator of your remaining egg reserve. By measuring the blood level of AMH, we can have a rough idea of how much eggs you have left.

Whereas before we could only quantify ovarian reserve as ‘low’ or ‘normal’, we can now estimate egg reserve as low, borderline, normal, high, or very high.

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.

Please note: While the AMH level may serve as a good indicator of egg quantity, it cannot predict egg quality, which is a function of time.

Below is a table that lists the AMH values and the corresponding egg reserves using our own experience at IVFMD.

 

 
AMH (ng/ml) Ovarian Reserve
Over 8 Very high or PCOS
5 to 8 High
1.5 to 5 Normal
1.0 to 1.5 Borderline
0.5 to 1.0 Low
Below 0.5 Very low

 

Basal Antral Follicle Count

Basal antral follicle count (AFC) is the total number of young follicles seen on both ovaries by sonogram during the first few days of the cycle. In other words, basal AFC reflects the number of eggs that are available in every cycle and thus is an indirect reflection of the ovarian reserve.

If your egg reserve is great, Mother Nature will be generous and give you 12 to 20 eggs per cycle, from which one egg will have a chance to become mature and released during ovulation.

Conversely, if your ovarian reserve is low, only a few eggs will be available from the egg bank for use during each cycle. It seems as though Nature is trying to conserve eggs in order to prevent premature menopause.

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 to be normal.

At IVFMD we have found that a combination of AMH level and basal antral follicle count provides a fairly accurate assessment of the egg reserve, with the AMH level being the yardstick for long term reserve (ovarian saving account) and basal AFC reflecting short term reserve (ovarian checking account).

antral follicle count AFC

 

Basal FSH Level

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 gland 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. Therefore, a high FSH level during the first 3 days of the cycle 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 a 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 dropped to a very low threshold. The AMH level and basal AFC, on the other hand, provide a more accurate clinical picture of the ovarian reserve so that proactive treatment can be recommended as early as necessary.