Did you know that tests exist to tell you how fertile you are?
Your ability to become pregnant depends on your chronological age and biological age.
Your chronological age reflects your current age, while your biological age is in reference to your ovarian reserve (the quantity of and quality of oocytes at a certain time point). Chronological age increases year after year, while biological age decreases year after year until menopause.
When women are undergoing infertility evaluation, a flurry of testing is usually done. This may includes particular tests like:
- Anti-müllerian hormone (AMH)
- Follicle stimulation hormone (FSH)
AMH and Fertility
AMH is produced by developing follicles, and serves as an indicator of ovarian function. An AMH greater than 0.8-1.0 ng/mL is suggestive of a normal ovarian reserve (the ability of your ovaries to provide eggs that are capable of being fertilized and resulting in a pregnancy).
Your AMH levels will gradually decrease after peaking at around 25. Around 5 years before menopause, AMH levels decrease below the detectable limit.
Studies have also shown that low AMH is associated with increased risk of miscarriage. Women with an AMH of 0.4% had over twice the risk of miscarriage, with the increased risk primarily associated with clinical pregnancy loss.
AMH does not tell you how many eggs you have left or give you information about your egg quality. Ideally it should be run with other markers (like FSH and estradiol).
FSH and Fertility
FSH is a hormone produced in the pituitary and stimulates ovarian follicles to grow and develop. In some women, the pituitary secretes a lot of FSH to get the ovary to respond. This usually happens when your ovarian reserve starts to decline. When FSH is over 10mIU/mL, it’s suggestive that ovarian reserve is in decline.
Overall, AMH decreases as you age and FSH increases as you age.
Testing AMH and FSH
If you are sent for testing to better understand your fertility, most of the tests will be done on day 3 of your period (ex. 3 days after you start your period).
FSH needs to be tested on Day 3, whereas AMH remains stable throughout your period. It’s independent of any other hormones (ex. FSH, LH and estradiol are usually tested together). AMH is also more predictive of hyper-response and ovarian hyperstimulation syndrome risk during IVF than FSH.
Getting your AMH tested may sound frightening especially as it tells you about your ovarian reserve – and this can cause a lot of undue stress in people hoping to achieve fertility. Nevertheless, this is something that your Naturopathic Doctor can test for you (and should be done with other tests to get a more representative picture of what’s going on).
Iwase, Akira et al. “Clinical Application Of Serum Anti-Müllerian Hormone As An Ovarian Reserve Marker: A Review Of Recent Studies”. Journal Of Obstetrics And Gynaecology Research, vol 44, no. 6, 2018, pp. 998-1006. Wiley, doi:10.1111/jog.13633.
Wang, Shunping et al. “Discordant Anti-Müllerian Hormone (AMH) And Follicle Stimulating Hormone (FSH) Among Women Undergoing In Vitro Fertilization (IVF): Which One Is The Better Predictor For Live Birth?”. Journal Of Ovarian Research, vol 11, no. 1, 2018. Springer Nature, doi:10.1186/s13048-018-0430-z. Accessed 13 Jan 2019.
Zamah, A. Musa, and Mary D. Stephenson. “Antimüllerian Hormone And Miscarriage: Fifty Shades Of Gray…”. Fertility And Sterility, vol 109, no. 6, 2018, pp. 1008-1009. Elsevier BV, doi:10.1016/j.fertnstert.2018.02.140.
Zhu, Jieru et al. “Chronological Age Vs Biological Age: A Retrospective Analysis On Age-Specific Serum Anti-Müllerian Hormone Levels For 3280 Females In Reproductive Center Clinic”. Gynecological Endocrinology, vol 34, no. 10, 2018, pp. 890-894. Informa UK Limited, doi:10.1080/09513590.2018.1462317.