Hormonal Testing

rmany_99412781Your Fertility Check-up

Your physician will evaluate ovarian reserve and ovulatory status. Ovarian reserve is the number and condition of the woman’s eggs in her ovaries. Usually, a large number of eggs increase the probability of successful conception. Ovulation describes the process in which an egg matures and is released each month during a woman’s menstrual cycle.

There are several blood tests that provide detailed information about ovarian reserve.  These tests refer to “Day 3 Blood Work” because they are drawn between the 2nd and 4th day of your cycle, usually on the 3rd day. Day 3 blood work tests provide measurements of the following three hormones:

FSH – Follicle Stimulating Hormone is a pituitary hormone that stimulates the growth of the ovarian follicle which contains the egg. Elevated FSH levels may indicate a decrease in egg quality or number or reduced ovarian reserve.

E2 – Estradiol is a hormone made by the follicle that helps stimulate the lining of the uterus or endometrium where the embryo implants. Estradiol production is higher during reproductive years.

LH – Luteinizing Hormone helps cause the ovary to produce estrogen and to release a mature egg (ovulation).

TSH and Prolactin are often measured at the time of the Day 3 tests.

TSH – Thyroid Stimulating Hormone is a pituitary hormone that helps evaluate thyroid function to diagnose overactive/underactive thyroid. Both conditions can negatively affect ovulation.

Prolactin – Prolactin is a hormone produced by the pituitary that plays an important role in preparing the breasts during pregnancy for nursing. An inappropriate elevation at times other than pregnancy may interfere with normal ovulation which affects the ability to conceive.

AMH (anti-Müllerian hormone) – most accurately identifies a woman’s egg supply and is the most accurate test. It is not dependent on a woman’s menstrual cycle, so the test can occur at any point in the cycle. A lower AMH level may indicate a decrease in the ovarian reserve. AMH is produced at the start of the cycle by the small antral follicles in the ovaries. The higher the AMH level, the larger the amount of antral follicles exists. AMH is a substance produced by granulosa cells in ovarian follicles that advance from the primordial follicle stage. These follicles are microscopic and are not visible by ultrasound. Pre-antral and small antral stages (less than 4mm diameter) of development result in the highest AMH production. As follicles grow, production decreases and eventually stops.

The Effect of AMH Levels on IVF

Women who have higher AMH levels usually have better outcomes with ovarian stimulation for IVF with a higher volume of eggs retrieved. AMH levels do not indicate the quality of a woman’s eggs, but a higher volume of eggs at the time of IVF egg retrieval can influence a higher likelihood of producing at least one embryo that is viable enough to lead to IVF success.

Because doctors have not used the AMH test routinely, results that indicate normal levels are not well defined. More frequent use of the AMH test will help define what normal results look like. The most important feature of this test is that it can be administered at any time during a woman’s cycle.

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