Page modified at: 02/01/2010
How Long Does A Woman Have Left?
The most commonly used test to assess this ovarian reserve is the day 2-6 FSH test. This blood test determines the level of FSH between day 2-6. At this time the estrogen level is expected to be low, a critical feature, as FSH levels are subject to negative feedback. Generally FSH levels are expected to be below 10 miu/ml in women with normal reproductive potential (levels of 10-15 miu/ml are considered borderline). However, there is little warning about when ovarian reserve is likely to be exhausted and by the time FSH levels climb rapidly to above 40miu/ml it is usually too late for either natural attempts to become pregnant or for infertility treatment.
Inhibin-B is mainly produced by the granulosa cells in growing follicles and offers a more immediate assessment of ovarian reserve activity than other serum tests. A fall in day 3 inhibin-B levels may predict poor ovarian reserve before the expected rise in day 3 FSH but is still considered unreliable.
Anti-Müllerian hormone (AMH) is produced by the granulosa cells of the recruited follicles until they become sensitive to FSH. AMH has been identified as a regulator of recruitment, preventing the depletion of all of primordial follicle pool at once. AMH levels have been found to decline with advancing female age and AMH has been suggested as the best predictor of ovarian response. Although kits that measure AMF are available over the internet and from some chemist shops, in the absence of a proper assessment of the ovaries, they may give misleading reassurance to those who use them who may then “miss the boat”. This is particularly true for women with Polycystic Ovary Syndrome when misleadingly high levels of AMF are often present.
Body Clock Test
The combination of an untimed blood test to measure Anti-Mullerian Factor (AMF) and a Transvaginal Ultrasound Scan to assess the ovaries and their follicles (antral follicle count) can help predict how long a woman can delay her decision to try for a pregnancy or tell her whether she should start trying soon or freeze some of her eggs.