Egg Quality and Testing for Ovarian Reserve
So much of what we do in the field of fertility is interconnected. I often see patients who have been trying to get pregnant for months (or years) and are seeking answers as to why it hasn’t happened! I also see patients who have gone through the painful experience of miscarriage (sometimes multiple). Starting a fertility evaluation early can help identify what challenges may be causing the difficulty in conceiving.
One of the first steps we do to evaluate fertility is to check hormone levels and perform a fertility ultrasound. Below are just a few of the key hormones we check initially when evaluating for fertility challenges.
Follicle Stimulating Hormone (FSH) is a gonadotropin hormone released by the pituitary gland to encourage egg maturity and development. A high FSH early in the menstrual cycle is a warning sign of diminished (or decreased) ovarian reserve. I describe it to patients like the ovaries are getting less responsive to the brain signals telling them to ovulate and they are needing more encouragement to do their job. This means the pituitary gland has to pump out more FSH to get the ovary to develop a mature egg, resulting in a higher FSH level.
Estradiol needs to be checked at the same time as the FSH level in order to ensure that the FSH result is accurate. A high estradiol level can lower the FSH level and make it look lower than it is. High estrogen levels early in a cycle can be a sign of early follicle recruitment and egg development, which can be a warning sign of diminished ovarian reserve. Therefore, elevated FSH with low estradiol OR normal FSH with elevated estradiol can both be signs of diminished ovarian reserve.
Anti-Muellerian Hormone (AMH) is a blood test that can give us a peek into egg quantity (and maybe quality, the jury is still out). AMH is a hormone made by supporting cells around the eggs, and in theory, the higher the AMH, the higher the reserve of eggs available. AMH is a relatively new test to the field of fertility and “normal” levels are still being determined.
Partnering with a fertility specialist to determine which tests are right for you is a great first step! Choosing a practitioner who embraces a holistic approach and one that will individualize your care is crucial to getting the fertility care you need.
About The Author
Dana Ramsey is a Certified Nurse Midwife and has spent the past 15 years helping women navigate their gynecology, pregnancy, postpartum, and menopausal challenges. Dana is dedicated to helping her patients overcome conditions impacting their ability to conceive and maintain a successful pregnancy.
