Fertility Tests for Women

Anti-Mullerian hormone (AMH) is a hormone in your blood that gives us an indication of your “Ovarian Reserve” or the number of eggs in your ovaries.

Every woman is born with her lifetime supply of eggs and these diminish in number and also in quality as she gets older. In general, a woman’s fertility peaks in her 20s, and begins to decline after this, more dramatically after age 35. This decline makes it more difficult for a woman to have a baby as she gets older, so much so that female age is the most predictive factor of the ability to conceive.

Every woman is born with a different ovarian reserve and this reserve declines as you age, which makes it harder to have a baby as you get older. The decline in ovarian reserve happens quicker for some than for others. The average woman will experience decline by her late thirties, but some will experience this much earlier.

AMH, alongside a fertility focused ultrasound scan, will give enormous insight into your reproductive health and future options. AMH can give you a better picture of your likely outcomes for egg freezing or IVF treatment, menopause timing, and conditions like polycystic ovarian syndrome (PCOS) or premature ovarian insufficiency (POI). Understanding your AMH level can help inform your timeline for family planning, but it is important to note that your AMH cannot tell you if you will or won’t conceive. A low AMH means a low number of eggs are available in each cycle, and that window of time you have to create your family may be shorter.

Women are born with all the eggs we’ll ever have, and because the body is very inefficient with its use of eggs, the number declines throughout our lives, and very rapidly so after age 35. While we can’t change AMH results, it’s important to keep in mind what AMH does and does not tell us. AMH gives us an insight into how many eggs are available to you in each cycle: how many are in the crop developed by your ovaries each month. A low AMH means a low number of eggs are available in each cycle, and that window of time you have to create your family may be shorter. It doesn’t tell us, however, if you will or won’t conceive. Remember too that if you do receive values that are lower than expected for your age, the quality of your eggs is also a factor, which is even more important than the number.

You can’t change the value of your AMH, but you can change your plan to work with what you have. Your AMH level can give you a better understanding of your reproductive health and help you plan ahead in many ways. There isn’t any way to improve it, but the important thing to remember is that AMH is one piece of the fertility puzzle. Put together with a scan at a fertility clinic, it will give you important information you can use to discuss with your doctor to make informed decisions about fertility preservation or fertility treatment.

Protecting your fertility by having health checks at a fertility clinic should be as routine as general health checks, whether or not you are actively trying for a baby. You can have your fertility assessed from your twenties onwards. You can discuss starting a family (alone or with a partner) or preserving your fertility.

If you are trying for a baby, see a specialist when:

• You are under 35 and have been trying to conceive for 12 months
• You are over 35 and trying to conceive for 6 months
• You are over 40 and trying to conceive

Getting Older

Female age is the most predictive factor of the ability to conceive. The younger you are, the more likely your eggs are numerous, healthy and normal, making it easier to produce a pregnancy. As you age, the quantity of those eggs decreases and so does the number of eggs that are of normal quality that could produce a pregnancy. Lifestyle factors can have an impact on your eggs as well. Smoking, drug use, excessive alcohol intake and excess weight can all be detrimental to your fertility and to your eggs.  Healthy lifestyles can increase your chance of pregnancy.   

Ovulation Problems 

Ovulation is the key to pregnancy. Women with a monthly cycle will ovulate 12 times a year, so in reality, there are only 12 opportunities to get pregnant in a year. Many couples miss these ovulation opportunities because they are unaware that the window of time when they are fertile is in the days before ovulation. If they wait until the days after ovulation to try, they will be passed the fertile window and will have missed that month’s opportunity to get pregnant. If there is an issue with ovulation, however, we can intervene with a simple treatment to make sure that ovulation happens.

Tubal Problems 

When you ovulate, the egg is released into one of your Fallopian tubes. If sperm is present, it is fertilised in the tube and then travels to the uterus to implant. Anything that blocks the Fallopian tubes will create fertility difficulties. Blockages can be created by issues such as previous Pelvic inflammatory disease (PID) as it can cause scarring in the tissue; certain STIs such as chlamydia or gonorrhoea can cause scarring or pelvic inflammatory disease; fibroids can block the tubes, particularly if they attach to the uterus; past abdominal surgery or past ectopic pregnancy can scar the fallopian tubes.

Endometriosis 

Endometriosis is a condition where the endometrial tissue that is found in the lining of the womb grows outside of the womb. Endometrial tissue can be found on the ovaries, in the Fallopian tubes, on the bowel, or in the pelvic cavity. Each month, hormones released by the body cause this tissue to build up causing pain, inflammation and scarring which can impact fertility. 

Sexual Dysfunction 

Some women experience involuntary tightening of the walls of the vagina during sex. This is called ‘vaginismus’. Vaginismus can interfere with sex by causing pain during penetration, and it can make penetrative sex impossible for some.

Sometimes it is a combination of these factors that leads to female subfertility. In many cases, however, no reason can be found and it is called “Unexplained Infertility”. 

The short answer is as early as possible. The right time will vary from person to person and will also depend on your personal circumstances and life plans, but ideally, women would start thinking about freezing their eggs in their twenties. The younger you are when you freeze your eggs, the more likely you are to have a greater number of eggs to freeze. In turn, this will increase your chances of a successful outcome from treatment at a later stage. The aim of freezing your eggs is to have the eggs available as your backup plan: hopefully, you will never need them.

If you want a family in the future, or even think you might want one, it’s really important to assess your fertility potential periodically from your twenties. That information will give you a baseline and tell you if there are any issues. Ideally, fertility health checks at a fertility clinic would be as routine as general health checks such as cervical smears. Of course, tracking your AMH isn’t the full picture and should be looked at in conjunction with an ovarian scan as these will help assess ovarian reserve and help you make decisions about your future.

If you’re not ready for a baby right now, or not in a relationship, freezing your eggs in your twenties can be a way to safeguard your future fertility. Being proactive about your fertility can make all the difference when you are ready.

Not at all. The point of fertility testing is to know where you stand and to give recommendations. We provide honest advice, based on your results and scientific evidence. If you are testing with a partner, we will assess your results together. We may simply give you reassurance, advice on when exactly in your cycle to try so that you can conceive unassisted, or suggest a simple intervention. We will not suggest treatments unless they are necessary. We may also suggest fertility preservation if you don’t want to start your family straight away.

Care at Waterstone Clinic is individual to you: we will build a plan together with you.

If you are confident that this is the best plan for you right now, then fertility testing is crucial to know where you stand. However, fertility testing won’t tell you what your fertility will be like in five years. Our best advice here is to sit down with your partner and discuss how many children you want in your future family: Would you both like more than one child? have you discussed the implications of waiting to start your family? Are you prepared to undergo fertility treatment if it’s required?

Having a fertility test now will give you an idea of how realistic your plan may be, but keep in mind that five years is a long time in fertility. Waiting until 35 to start your family, which is the age that fertility declines rapidly, could risk your dream of having more than one child.

Being aware of your fertility is always the first step, and it might be wise to explore fertility preservation to avoid disappointment later. Your results will tell you your current status and together with your doctor, you can discuss your plans and make decisions that are right for you both.