Patients are often concerned with IVF success rates and their own potential for success before initiating fertility treatment. A Reproductive Endocrinologist, also known as a fertility specialist, will typically perform a workup to evaluate a patient’s overall health as well as measure her ovarian reserve- the quantity and quality of the eggs in her ovaries. Ovarian reserve is one of the most accurate indicators of female fertility and can be measured in a few different ways. The fertility specialist may use one or a few measures to assess the patient’s current ovarian reserve and determine her potential response to the ovarian stimulation medications used during fertility treatment. The results of these tests help the fertility specialist gauge a patient’s potential success using IVF or other assisted reproductive technologies (ART).
A woman’s age is one of the strongest predictors of egg quantity and quality. Women are born with all of the eggs (oocytes) they will have in their lifetime, and over time both the quantity and quality of their eggs decrease. As most women know, one egg is ovulated during each monthly menstrual cycle. What many women are unaware of is that around 500 additional immature egg cells are also lost each month, due to a natural process called atresia. Additionally, over time, the quality of eggs remaining in the ovaries also decreases. Decreased egg quantity and quality makes pregnancy more difficult to achieve. In general, the younger the patient, the greater her chance for success in achieving pregnancy, whether naturally or with ART. Age should be considered along with physiological testing, as individual fertility can vary from patient to patient.
- FSH Level
Follicle-stimulating hormone (FSH) is a biochemical marker of ovarian reserve. FSH is produced by the pituitary gland and helps control the menstrual cycle and the production of eggs by the ovaries. When FSH is tested as a fertility indicator, it is measured via blood test on the third day of the menstrual cycle, and is both a qualitative and quantitative measure of ovarian reserve. In general, the lower the FSH level, the better. An FSH level below 14 mIU/ml is considered normal in our laboratory. A high FSH level could indicate that the pituitary gland is working too hard. FSH is the primary hormone that drives the ovaries. When the body senses that there are fewer eggs than necessary to reproduce, the pituitary gland churns out higher levels of FSH to stimulate egg production. So higher FSH levels indicate reduced ovarian reserve, while lower FSH levels suggest a greater ovarian reserve and a higher chance of success with IVF.
- AMH Level
Anti-Müllerian hormone (AMH) is a protein that is released by the granulosa cells of the eggs. AMH is also measured via blood test but can be tested at any time during a woman’s menstrual cycle. AMH correlates to the number of antral follicles, or egg-producing follicles, in the ovaries. Here we are looking for a higher test result, as higher amounts of AMH indicate a greater number of antral follicles available for stimulation with IVF medications, and a greater number of eggs that could be retrieved and utilized in an IVF cycle. In our laboratory, AMH results between 0.6 – 1.0 ng/ml are considered borderline and results of 1.0 ng/ml are considered normal. The results of both FSH and AMH tests will typically reveal a similar picture of ovarian reserve.
- Basal Antral Follicle Count
Basal antral follicle count (BAFC) is measured via ultrasound and is a quantitative measure of the eggs in the ovaries. A transvaginal ultrasound is performed so the fertility specialist can see the number of immature eggs within the follicles of the ovaries. Fertility specialists use ultrasonography to predict how well a patient’s ovaries will respond to fertility medication and to develop an accurate, individualized treatment plan for the patient.
A fertility specialist will consider the patient’s age and may measure FSH, AMH, BAFC or some combination of the three tests in order to assess ovarian reserve and predict potential success with IVF treatment. It should be noted that these tests are not limited to IVF patients alone- all women of reproductive age may utilize these tests to measure their current fertility status and gauge where they are on their own “biological clock,” in order to inform their future family-building plans.