Whether you're actively trying to conceive, thinking about your future fertility, or just curious about your reproductive health, understanding your fertility biomarkers can provide valuable insights. These tests offer a window into your ovarian reserve and reproductive function.
What is Ovarian Reserve?
Ovarian reserve refers to your remaining egg supply and their quality. Women are born with all the eggs they'll ever have - about 1-2 million at birth. By puberty, this decreases to around 300,000-400,000, and the number continues to decline with age.
Importantly, ovarian reserve testing tells you about egg quantity, not quality. Age remains the best predictor of egg quality, which is why these tests should always be interpreted in context of your age.
Key Fertility Biomarkers
AMH (Anti-Mullerian Hormone)
AMH is produced by cells in your ovarian follicles and is considered the best marker for ovarian reserve.
What it measures: The number of small antral follicles in your ovaries, which correlates with your remaining egg supply.
Typical ranges by age:
- Under 30: 2.0-6.8 ng/mL
- 30-35: 1.5-4.0 ng/mL
- 35-40: 1.0-3.5 ng/mL
- Over 40: 0.5-1.5 ng/mL
Key points:
- Can be tested any day of your cycle
- Lower AMH suggests fewer eggs remaining
- Higher AMH can sometimes indicate PCOS
- AMH doesn't predict your ability to get pregnant naturally
AMH is Not a Fertility Test
A low AMH doesn't mean you can't get pregnant naturally. Many women with low AMH conceive without difficulty. AMH is most useful for predicting response to fertility treatments like IVF.
FSH (Follicle Stimulating Hormone)
FSH is produced by your pituitary gland and stimulates your ovaries to develop follicles each cycle.
What it measures: How hard your body is working to stimulate egg development. Higher FSH often means your ovaries need more stimulation, suggesting lower reserve.
When to test: Day 2-5 of your menstrual cycle (during your period)
Typical ranges:
- Normal/Good: Less than 10 mIU/mL
- Fair: 10-15 mIU/mL
- Diminished reserve: Greater than 15 mIU/mL
Important considerations:
- FSH can vary cycle to cycle
- Should be interpreted with estradiol (high estradiol can falsely lower FSH)
- Less reliable than AMH for ovarian reserve
LH (Luteinizing Hormone)
LH triggers ovulation and supports the early stages of pregnancy.
What it measures: Pituitary function and, combined with FSH, can help identify hormonal imbalances.
When to test: Day 2-5 for baseline; can also track the LH surge to predict ovulation
What to look for:
- Normal baseline: 2-15 mIU/mL
- LH:FSH ratio greater than 2:1 may suggest PCOS
- LH surge (3x baseline) indicates ovulation within 24-48 hours
Estradiol (E2)
The primary form of estrogen, produced by your developing follicles.
When to test: Day 2-5 of your cycle (baseline)
What to look for:
- Baseline should be 25-75 pg/mL
- High baseline estradiol (>80 pg/mL) with normal FSH may indicate diminished reserve
- Elevated early estradiol can suppress FSH, masking a problem
Additional Fertility Tests
Progesterone
Tested around day 21 (or 7 days after suspected ovulation) to confirm ovulation occurred.
- Greater than 3 ng/mL suggests ovulation occurred
- Greater than 10 ng/mL indicates strong ovulation
Prolactin
High prolactin can interfere with ovulation. Testing is important if you have irregular periods or difficulty conceiving.
Thyroid Panel
Thyroid disorders can affect fertility and pregnancy outcomes. TSH should ideally be under 2.5 mIU/L when trying to conceive.
Interpreting Your Results
Normal Results
Normal ovarian reserve markers are reassuring but don't guarantee fertility. Many other factors affect your ability to conceive.
Abnormal Results
Abnormal results don't mean you can't have children. They provide information to help guide decisions:
- You might consider trying to conceive sooner rather than later
- Egg freezing could be an option to preserve fertility
- If you need fertility treatment, your doctor can plan accordingly
When to Test
Consider fertility testing if:
- You're curious about your fertility timeline
- You're over 35 and thinking about having children
- You have a family history of early menopause
- You've had ovarian surgery or cancer treatment
- You have irregular periods or suspected PCOS
- You've been trying to conceive for 6-12 months without success
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