Conducting a fertility assessment can help you understand various things based on what your goals are. Here are a few examples:
"I'm not trying to get pregnant, just want to know how fertile I am."
Fertility testing can help you understand:
How many fertile years might I have left before I hit menopause (estimated)?
Am I at risk of reaching menopause early?
Am I at risk of reproductive issues like PCOS?
"Am I a candidate for egg freezing?"
Once you’ve reviewed your fertility tests with your doctor, he or she will be able to advise on questions like:
What type of outcome can I expect?
How many cycles will I need to get the result I desire?
Am I at a high risk for Ovarian Hyperstimulation Syndrome (OHSS)?
Are there any other risks that are specific to me?
"I'm trying to get pregnant."
Whether you're just getting started or you've been trying for a while and are figuring out next steps, your doctor may want to run a variety of hormone tests as well as ultrasound tests. Because you are trying to actually carry a baby, there are some additional considerations that will go into an ultrasound such as: the condition and size of the ovaries; checking the growth of follicles in the ovary; the condition of the lining within the uterus, uterine structural issues; and, any abnormal growths in the organs such as uterine fibroids and ovarian cysts. At this stage, you can help uncover:
Are there any hormonal issues that are/will preventing me from creating quality eggs?
Are there any "structural" issues that might prevent me from having a healthy baby?
Do I have any reproductive issues that I might need to address?
What does a basic fertility test include?
The gold standard of fertility assessment involves two relatively simple things: a hormone blood test and a transvaginal ultrasound of your ovaries.
1. Anti-Mullerian hormone (AMH) blood test
To conduct a thorough fertility test, most doctors will request that you start by getting a blood test to measure your anti-Mullerian hormone (AMH) levels. This is one of the two main tests used by doctors to understand how many eggs you may still have left in your ovaries, which forms part of what is often referred to as your “ovarian reserve.”
Put simply, AMH is a hormone emitted by the immature follicles resting inside your ovaries. The more resting follicles you have, the higher your AMH levels, and vice versa. Seeing as your follicle count decreases with age, you can expect that your level of AMH will decline accordingly. But for some people, this rate of decline comes sooner than later.
It should also be noted that AMH testing is not a perfect science. Your AMH levels may be affected by factors such as oral contraceptives and smoking. And, this test only hints at the quantity of eggs you have left, which ignores an equally important factor, the quality. Regardless of its limitations, it will help your doctor advise on whether egg freezing is a good option for you.
If you aren’t able to get your AMH levels tested beforehand, the clinic can most likely take a blood sample during your consultation. Just make sure to bring copies of your test results or have them emailed to the fertility clinics before your consultation.
What about at-home fertility tests?
You may have noticed a few companies popping up that offer at-home fertility tests. We’re all for being proactive about your fertility and taking steps to do so, and these tests can be a good way to start getting informed. However, they should be used with caution. This mostly stems from the fact that your results should not be viewed in a vacuum by untrained eyes, or the results taken out of context. Fertility doctors are specifically trained to utilize a variety of tests and medical history to best interpret the results.
Although AMH hormone tests are good for measuring, well, your AMH levels, researchers have found there’s little correlation between these egg store test scores and your chances of actually getting pregnant. In a study of women who were trying to get pregnant naturally, low AMH levels indicating diminished ovarian reserve were not associated with infertility. Basically, ovarian reserve tests are a good measure of how many eggs you have left (and could be a good indication of how you might respond to ovarian stimulation in an egg freezing cycle), but that alone doesn’t predict your reproductive potential, or rather, your fertility.
Be careful not to come to any conclusions based on the results of one of these tests alone. Always seek a full consultation with a fertility specialist doctor.
“I did an AMH test and the results came back suggesting that I was completely infertile at age 34! While I wasn’t ready for kids at that moment, I knew I wanted them one day and I was totally crushed. Because I was ‘infertile’ I decided to be a little more liberal in the bedroom with a guy I was very casually seeing. And then, literally the next month I was pregnant. I was totally unprepared for a child, emotionally or practically, but I felt like it could be my only chance. I might be an extreme case, but one little stick changed the entire course of my life.” - Malia, 36
2. Antral follicle count (AFC) ultrasound
In addition to the screening tests already mentioned, most doctors will want to conduct an ultrasound to determine something called your antral follicle count (AFC). This, combined with the results from your anti-Mullerian hormone (AMH) test are considered the best means in which to understand your fertility.
To get this measurement, the doctor or an ultrasound technician will take a look at your ovaries. This could be a transabdominal ultrasound (like the ones you’ve probably seen used on pregnant women in movies), but most often they will use a “transvaginal” ultrasound (this is effectively a wand-like object covered in a condom and lubrication, which is inserted into your vagina). You might feel a pressure sensation but it’s not generally painful. While the doctor or technician moves the wand around to get a good look at both your ovaries, she or he is looking to measure the quantity and size of your follicles (I.e. the fluid-filled sacs that contain your eggs).
How many antral follicles are considered “normal?” Doctors on our expert panel say that this number can fluctuate from zero to 30 for a woman the same age but for the purposes of egg freezing, they like to see an AFC of >10. Keep in mind that this only tells part of the story behind your fertility potential.
DOCTOR INSIGHT: “Antral follicle counts can vary from provider to provider, as there is no real accepted consensus on how small is too small to count as an antral follicle. Also, the antral follicles present in an ovary at any one moment in time are always in transition. Some are just coming into the antral pool and some are on their way to the fate of almost all antral follicles and eggs within: reabsorption by the body. We cannot tell the difference. This is why I tell my patients that I do the count as a guideline to choose the dose of stimulation medication for them and to help to set a “ballpark” estimation on the final number of eggs we might obtain at a subsequent egg freezing cycle.” - Dr. Carolyn Givens, Pacific Fertility Center, San Francisco, CA
Fertility tests can help you understand your ovarian reserve but there is no correlation between ovarian reserve and your ability to get pregnant
That's worth repeating: Research has shown that there is NO correlation between the ovarian reserve and the ability to get pregnant. So, if your fertility tests have indicated that you have a diminished ovarian reserve — low AMH — you are no less likely to get pregnant than women with a normal AMH level.
So, although AMH is a great way to predict how close you are to menopause or what your egg yield in an ovarian stimulation cycle, it’s not a good biomarker for actual conception. Women with low ovarian reserves may conceive naturally without issue.