Determining Next Steps

Fertility Assessment

Two main features of reproductive aging are the decline in the number of eggs and a decline in egg quality. Those in their 30’s may benefit from a fertility assessment in order to have an understanding of their reproductive potential.

Fertility Assessment Process:

  • Call SRM to schedule an Antimullerian Hormone (AMH) blood test. This test can be done at any time in your menstrual cycle and does not matter if you are on any hormonal birth control method. AMH is a hormone found only in ovarian follicles (eggs) and correlates with egg supply.
  • The second appointment is a phone call with a Nurse Practitioner to review the results and briefly discuss options.
  • This test does not provide a full fertility evaluation. If you are trying to conceive, please schedule a New Patient Visit for a complete evaluation and consultation.

 

This chart illustrates the likelihood of pregnancy per month when actively trying to conceive based on age. It also explains the rise in miscarriage rates as we get older because of the increased number of abnormal eggs, the primary reason for miscarriages.

AGE303540>42
% Pregnancy/month15 - 20%10 - 15%5 - 8%4%
% Miscarriage15 - 20%20 - 25%30 - 40%>50%
% Genetically Abnormal Embryos25 - 30%40 - 60%70 - 80%>80%

These pictorial ovals demonstrate an ovary and shows how an ovary at age 30 is much larger than an ovary at age 45. It also highlights how the total number of eggs decrease with age and the total number of abnormal eggs increase with age. The dots represent the follicles that can be seen on ultrasound, the half-shaped moon represents the overall egg supply that cannot be seen on ultrasound.

Follicles seen on ultrasound reflect a small fraction of the residual pool.

*Note, this illustration is an average. The absolute number and quality of eggs diminishes with age, but the number of follicles is variable for everyone. A younger person may have a lower number of antral follicles but the quality is still good versus an older person with a higher number of eggs but poor egg quality.

AMH Results

  • AMH >2 is considered within normal limits, consider re-assessing ovarian reserve in one year.
  • AMH 1-2 is borderline and is consistent with a mild or moderate decline in egg quantity. If attempting pregnancy and not successful within six months, recommend scheduling a new patient visit to discuss whether additional testing or fertility treatment may be beneficial.
  • AMH <1 is consistent with a significant decline in egg quantity.  Recommend consultation with a reproductive endocrinologist to discuss options.

Reproductive aging is one of the main predictors of whether or not one will be able to conceive.   There is an expected natural decline in fertility with advanced aging. The rate of this decline, however, cannot be predicted for a given individual.

A Fertility Assessment is a test for ovarian reserve / egg supply ONLY and does not evaluate for any other potential cause of infertility including problems with ovulation, the uterus, fallopian tubes, sperm quality, etc. that would be discussed at a new patient visit.

A Fertility Assessment is for those who are not yet trying to conceive. If you and a partner have been attempting pregnancy for >6 months (if age 35 of older) or >12 months (younger than 35) please schedule a New Patient Visit for a full fertility workup.