If you’ve had difficulty conceiving for at least a year, your ob-gyn will want to run some diagnostic tests to evaluate your (and your partner’s) fertility—including tests that estimate the number of eggs you have. But new research suggests the results of two of those tests may not mean as much as we once thought.
Early on in the process, you’ll typically get blood tests to look at your levels of follicle stimulating hormone (FSH) and anti-Mullerian hormone (AMH), which are thought to give some insight into your fertility and how many eggs you have. If your results show that you have high FSH and low AMH levels, doctors usually conclude that you have a low ovarian reserve (a.k.a. egg count) and your fertility isn’t as great as it could be.
The American Society of Reproductive Medicine estimates that between 8 and 15 percent of couples are unable to get pregnant each year, making this an issue plenty of people struggle with.
But being labeled “infertile” doesn’t mean you’ll never have kids. And experts remind us that one or two tests cannot determine the full picture of your fertility level on their own.
For the study, published this week in the journal JAMA, researchers collected fertility and conception data for 750 women between April of 2008 and March of 2016. All participants were between the ages of 30 and 44, without a history of infertility, and had been attempting to get pregnant for three months or less.
The researchers collected urine and blood samples from all participants, which revealed participants’ levels of FSH and AMH. Throughout the study, participants had to take pregnancy tests after each missed period. Participants were also required to keep track of their menstrual cycles, intercourse, medications, and pregnancy-test results. The researchers followed up with participants for up to 12 months.
Their results showed that the 84 women with low AMH levels were just as likely to become pregnant over the course of 12 months as the 579 with normal AMH levels. And the 83 participants with high FSH levels didn’t have a significantly different chance of becoming pregnant than the 654 with normal levels. The study authors concluded that “biomarkers indicating diminished ovarian reserve compared with normal ovarian reserve were not associated with reduced fertility.”
Your body holds on to your eggs in different stages. Some are held dormant in reserve, a few are recruited to begin maturing every month, and one makes it out in front of the pack to the fallopian tubes (to either be fertilized or give you a period). The main way that doctors assess a woman’s fertility is by evaluating her ovarian reserve, i.e. the ability of her ovaries to provide egg cells that go through this process to be fertilized and result in a healthy pregnancy, Aaron Styer, M.D., a reproductive endocrinologist and co-medical director of CCRM Boston, tells SELF.
But there’s really no way to directly assess the number or quality of eggs someone has in reserve, so every test doctors have to evaluate ovarian reserve is an indirect measure.
For instance, blood testing, typically done the third day of a woman’s cycle, includes AMH, FSH, and estradiol (a female sex hormone). Levels of FSH and estradiol give insight into the way a woman’s brain and ovaries communicate, and they can provide one indirect measure of her ovarian reserve, Dr. Styer says. Because the cells that support each egg produce AMH, “this hormone provides one of the more direct measurements of egg quality and quantity,” he says.
A vaginal ultrasound can give more information about a woman’s reproductive organs and whether there are any cysts, fibroids, or polyps, which could mess with her fertility, Thomas A. Molinaro, M.D., M.S.C.E., F.A.C.O.G., a reproductive endocrinologist at Reproductive Medicine Associates of New Jersey, tells SELF. It can also reveal her antral follicle count, another indirect measure of ovarian reserve, Jane Frederick, M.D., a board certified reproductive endocrinologist and fertility expert with HRC Fertility, tells SELF.
Doctors may also order a hysterosalpingogram (known as an HSG), an X-ray test during which dye is injected into the fallopian tubes. This allows doctors to look for blockages that could interfere with the fertilization of an egg, Dr. Frederick says.
Depending on your doctor, you’ll probably have several or all of these tests to evaluate your fertility level. And, in addition to all of this, your doctor will take your age into account because overall fertility declines with age, Edward Marut, M.D., of Fertility Centers of Illinois, tells SELF.
So, despite the new study, FSH and AMH levels are still helpful in painting a good picture for doctors when they’re used alongside other tests. “Literature that’s been around the last 30 years has supported their use,” Dr. Frederick says.
“Ovarian reserve measurements are important for patients who have not conceived on their own for several months and are deciding what treatment to undertake,” Dr. Marut says. “But the numbers can change month to month. Nothing is cast in stone.”
Plus, there are some outside factors that can alter your blood-test results. For instance, FSH levels can be falsely low if a woman is taking estrogen (like if she’s on the pill) or if she has a cyst that’s producing estrogen in her ovary, Dr. Molinaro says. And, if a woman is obese, her AMH levels may be “falsely reduced,” Dr. Styer adds.
Due to all of these possible complications, doctors take a look at many different elements to try to get a complete picture before taking action. So, if you’re concerned about your fertility, check in with your doctor to get some help in putting the pieces together.
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