When Should I Check My Ovarian Reserve?

Ovarian Reserve

[ ovarian-reserve ]

noun

Refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs

Checking your ovarian reserve is simple, requiring a quick blood test to detect the level of Anti Mullerian Hormone (AMH) in the blood and a transvaginal ultrasound scan.

This is the easy part however the counselling and education is what really matters.

Why?

Although there are few physical risks to taking the test, there are emotional risks. Some medical professionals agree and some disagree on testing at an early age as low-level results may cause unnecessary distress for women and high levels in older women can be falsely reassuring. Too often, women get their “numbers” without a true analysis of what those numbers mean for them personally, or their fertility and family goals. The best way to understand this information is with the guidance of a fertility expert.

What is ovarian reserve testing?

Ovarian reserve testing or 'egg count' typically involves a blood test for Anti Mullerian Hormone AMH and an antral follicle count. An antral follicle count measures the resting follicles (eggs) in the ovaries while the AMH hormone, released by the granulosa cells of each pre antral and antral follicle, is a good indicator of the pool of eggs present or 'ovarian reserve' as we like to call it. As a woman ages this level decreases, indicating that the pool is slowly depleting.

What these tests DO and DON'T DO

These tests estimate egg count, the quantity, but do not assess the egg quality. Egg quality is a major factor when it comes to your fertility potential. Quality refers to the genetic make-up of the egg and it is fairly black-and-white, either "normal" (euploid) or “abnormal” (aneuploid) and unfortunately cannot be changed. A chromosomally normal egg has 23 chromosomes and when fertilized by the sperm, which also has 23 chromosomes, should result in a chromosomally normal embryo with a total of 46 chromosomes. With age, egg quality declines and the rate of abnormal eggs increases. This results in reduced chances of conception over time.

Egg Quality

With age, egg quality declines and the rate of abnormal eggs increases

Let's put things into perspective

If a woman for example, aged 25, has this test and is given a low result for her age, she may panic. In reality, some women with a low AMH are able to conceive as soon as they begin trying. If this young lady however does not wish to conceive in the near future, having this information is valuable as it will allow her to consider her options, perhaps speeding up family planning or considering fertility preservation. It will allow her to be proactive rather than reactive in the future, if she encounters problems conceiving.

“Remember: A low AMH does not mean that you are infertile!”

Now, imagine a woman who's 38. She has a higher than normal level of AMH for her age. She may be falsely reassured that her fertility is safe and put off starting her family for years. We know that fertility declines with age and significantly from 35 onwards. This woman should be counselled that the number may be high but the quality of those eggs will be deteriorating with time. She will benefit from counselling on family planning and her fertility preservation options.

“My advice - make sure you visit a reputable lab and have a doctor who can accurately interpret your results”

It may be better to go to a fertility specialist to guarantee this. This way you will have peace of mind knowing your 'figures' while also putting them into context. Having said all of the above, it is suggested to have this assessment in your late 20's to early 30's. If you do decide to preserve your fertility through egg freezing, general consensus is that doing this below the age of 35 yields better results. This is because both quantity and quality will be in your favour.

Look out for our podcast covering the pros and cons of ovarian reserve testing and what these result could potentially do for you. We hope this talk will equip you with all of the correct information you need to decide what is right for you. For more information on ovarian reserve testing, have a look at our article - What is Ovarian Reserve and what does it mean for Fertility?

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