amh

Many women interested in egg donation or egg freezing have IUDs for birth control, leading to questions about whether they need to have them removed before starting the process. The good news: research shows that having an IUD doesn't interfere with egg donation or egg freezing. Let's explore why IUDs are generally compatible with egg donation and what you should know if you're considering donating eggs.

Understanding IUDs and egg freezing and donation

IUDs (intrauterine devices) work differently from other forms of birth control. While some birth control methods prevent ovulation, IUDs primarily work by preventing fertilization and implantation. This means they don't affect your body's natural egg production or the ability to stimulate egg development during the donation process.

There are currently two types of IUDs available:

Hormonal IUDs:

• Mirena (releases 20 micrograms of levonorgestrel daily)
• Kyleena (releases 17.5 micrograms of levonorgestrel daily)
• Skyla (releases 14 micrograms of levonorgestrel daily)
• Liletta (releases 18.6 micrograms of levonorgestrel daily)

Non-hormonal IUD:

• Paragard (Copper IUD)

Both hormonal and non-hormonal IUDs are generally compatible with egg donation. However, some doctors may prefer patients to have it removed before a cycle as it may require higher dose of FSH. If you have specific questions about your type of IUD, discuss them with your fertility doctor and how it may relate to your medical history.

A look at the research

A large study from the University of California San Francisco looked at the outcomes of over 1,000 women undergoing egg freezing or donation. The research found no difference in the number or quality of eggs retrieved from women with or without hormonal IUDs. Even more encouraging, when these eggs were used in fertility treatments, the success rates were equivalent - showing that IUDs don't impact egg quality or future pregnancy potential.

The detailed findings showed remarkably similar outcomes:

• Total number of eggs retrieved
• Number of mature eggs
• Fertilization rates
• Pregnancy success rates
• Live birth rates

Because of this research, most doctors are comfortable allowing patients to proceed with egg freezing or donation while keeping an IUD in place. There's generally no need to remove it before starting the process unless you were planning to do so anyway.

Can you do an egg retrieval with an IUD in?

Yes, most doctors do allow you to keep your IUD in during the egg retrieval. When you donate eggs with an IUD:

• Your IUD can stay in place throughout the entire process
• The stimulation medications work normally
• The retrieval procedure isn't affected
• The IUD isn’t impacted
• Recovery remains the same

Read more in Egg Freezing and Birth Control: An Overview

Can I have my IUD removed during the egg retrieval?

If you've been planning to have your IUD removed anyway, you might consider asking your fertility doctor about removing it during the egg retrieval procedure. This can save you an extra appointment and make efficient use of the anesthesia you'll receive for the retrieval.

Can you check your egg count with an IUD?

Yes, you can get your ovarian reserve (egg count) tested while using an IUD. The two main fertility tests - AMH blood testing and antral follicle count via ultrasound - can both be performed with an IUD in place. 

However, one study looked at data from women on various types of birth control and found that hormonal IUD led to a small and temporary 6.7% lower AMH (there was not a significant difference with the copper IUD). 

If you are donating your eggs, most clinics require an AMH of at least 2. If your AMH comes back below that, you may be able to test again after removing the IUD. We have had donors who were able to bring up their AMH to a qualifying level just by removing their IUD.

Read more in Can Birth Control Affect Your AMH Levels?

How soon after getting an IUD can I donate eggs?

The good news is that there's typically no required waiting period between having an IUD placed and starting the egg donation process. Since IUDs begin working immediately after placement and don't interfere with your body's natural egg production, you can begin the donation process right away if you choose to do so. This is true for both hormonal IUDs (like Mirena, Kyleena, Skyla, and Liletta) and non-hormonal IUDs (like Paragard), as neither type affects egg quality or production. While some women may prefer to wait a few weeks to ensure they're comfortable with their IUD, this is a personal choice rather than a medical requirement. Your fertility doctor can help you determine the best timing based on your individual circumstances.

Birth control and the Split program

At Cofertility, we work with many egg donors who have IUDs. Our Split program allows women to freeze their eggs for free by sharing a portion with a family who could not otherwise conceive. The presence of an IUD doesn't affect eligibility for the program or impact the success rates.

Remember:

• No need to remove your IUD before donating unless directed otherwise by your doctor
• Research shows equivalent success rates
• Optional removal during retrieval if desired
• All forms of birth control should be discussed with your medical team

Next steps

If you're interested in egg donation or freezing and have an IUD:

1. Take this quiz to see if you qualify  
2. Learn more about the egg sharing process
3. Discuss any birth control concerns and medical history with your healthcare team

The choice to donate or freeze your eggs while having an IUD is safe and well-studied. Our team can help you understand your options and guide you through the process, whether you choose to keep or remove your IUD during the cycle.

Key take-aways

• Having an IUD does not disqualify you from donating eggs or affect your eligibility for egg donation programs.
• Both hormonal IUDs (Mirena, Kyleena, Skyla, Liletta) and non-hormonal IUDs (Paragard) are compatible with egg donation.
• You will likely not need to remove your IUD before starting the egg donation process - research shows IUDs don't interfere with donation.
• IUDs are not shown to have a negative impact on egg quality or the number of eggs you retrieve in a donation cycle.
• Your IUD stays safely in place during the egg retrieval procedure and isn't affected by the process.
• Hormone testing is okay with an IUD, though hormonal IUDs may slightly affect AMH levels (by about 6.7%).
• There are no known increased risks or complications for egg donors who have IUDs.
• You can start the donation process immediately after getting an IUD - there's no required waiting period.
• If desired, you may be able to have your IUD removed during the egg retrieval procedure while under anesthesia.
• After you complete your egg retrieval, you will get your menstrual cycle about two weeks later.

Anti-Müllerian hormone (AMH) has gained significant attention in the field of reproductive medicine as a valuable marker of ovarian reserve. It provides insight into egg quantity and can be useful in assessing fertility health and predicting the chances of egg freezing success. 

However, there are certain medications that can potentially influence AMH levels, raising questions about the accuracy and interpretation of AMH testing while on them. In this article, we will explore the relationship between medications and AMH levels, shedding light on the impact of specific drugs and discussing their implications for women's reproductive health.

What is AMH?

AMH is a hormone produced by the cells within ovarian follicles. Its primary role is to promote the growth and development of follicles. AMH levels are generally stable during the menstrual cycle, making it a reliable marker for assessing ovarian reserve. It is measured through a simple blood test and has become an important tool in fertility evaluations and treatment planning.

What causes AMH to change?

AMH levels naturally decline as we age. The highest levels of AMH are typically found in women during their early reproductive years, and the levels gradually decrease as we approach menopause… making age the most common reason for AMH to change.

But there are other reasons AMH may change over time. The most common reason is simply age. Since AMH is considered a reliable marker of ovarian reserve, which refers to the quantity of eggs remaining in the ovaries, this hormone naturally decreases as we get older.

Certain medical conditions, such as ovarian tumors, can also affect AMH levels. Additionally, treatments like chemotherapy or radiation therapy that target the ovaries can significantly reduce AMH levels.

While the direct impact of lifestyle factors on AMH levels is not yet fully understood, some studies suggest that factors such as smoking, obesity, and extreme exercise may be associated with lower AMH levels. However, more research is needed to establish definitive conclusions.

Lastly, certain medications can impact AMH levels. For example, oral contraceptives and drugs like clomiphene citrate used in fertility treatments can temporarily decrease AMH levels. On the other hand, supplements like DHEA (dehydroepiandrosterone) and vitamin D have been associated with increased AMH levels. We’ll go more into detail about these below.

Remember that individual variations exist, and AMH levels should be interpreted in conjunction with other fertility assessments to gain a comprehensive understanding of your reproductive health. If you have concerns about your AMH levels or fertility, it's best to consult with a fertility doctor for personalized guidance and recommendations.

What medications can affect AMH levels?

Several medications have been found to influence AMH levels, potentially complicating its interpretation as a marker of ovarian reserve. Here are some examples:

Oral birth control 

Oral contraceptives are commonly used for birth control and to regulate menstrual cycles. Studies have suggested that oral contraceptive use may lead to decreased AMH levels in the short term.

One study compared the AMH levels of 228 hormonal contraception users and 504 non-users. They found that users of birth control had 29.8% lower AMH concentrations. Because of this, the authors concluded that AMH may not be an accurate predictor for women using hormonal contraception.

You may want to consider the timing of the AMH test when using hormonal contraceptives. Estrogen can suppress the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are necessary for the development and maturation of follicles. 

As AMH levels are influenced by FSH and LH, you could wait for a few weeks after discontinuing birth control before measuring AMH levels for a more accurate assessment of ovarian reserve. Or, you could take the test knowing the results may be lower due to birth control. It’s best to discuss this with your doctor.  

Metformin

Metformin is a medication commonly used in the treatment of polycystic ovary syndrome (PCOS), a complex endocrine disorder associated with metabolic and reproductive disturbances, and for managing insulin resistance. Research has shown that metformin use may be associated with decreased AMH levels.

Clomiphene Citrate

Clomiphene citrate (brand name Clomid©), is a medication used to stimulate ovulation in women who are trying to conceive. Similar to metformin, clomiphene citrate has been associated with decreased AMH levels. When undergoing fertility treatments involving clomiphene citrate, you’ll want to take this potential impact into account when interpreting AMH results.

What supplements can affect AMH levels?

Dehydroepiandrosterone (DHEA)

DHEA is a natural hormone that can be converted into other hormones in the body, including testosterone and estrogen. Some studies have suggested that supplementation with DHEA may lead to increased AMH levels. These findings suggest that certain nutritional interventions may have a positive effect on ovarian reserve.

Vitamin D

Vitamin D is essential for overall health and has been linked to various biological processes in the body, including reproductive health. Some research indicates that vitamin D supplementation may lead to increased AMH levels. However, more studies are needed to fully understand the relationship between vitamin D and AMH levels.

Is there anything I can take to increase AMH levels?

While there are medications and supplements that have been associated with changes in AMH levels, the impact of these medications is typically temporary or specific to certain conditions. 

Currently, there is no definitive medication or treatment specifically designed to increase AMH levels. However, there are lifestyle factors that may positively influence overall reproductive health, such as maintaining a healthy weight, adopting a balanced diet, managing stress levels, and avoiding smoking and excessive alcohol consumption. These lifestyle choices can contribute to optimal ovarian function and potentially support healthy AMH levels.

Summing it up

AMH testing has revolutionized our ability to assess ovarian reserve and guide fertility treatment decisions. However, it's crucial to consider the potential influence of certain medications on AMH levels. Understanding how specific drugs and supplements may affect AMH results can help you interpret the findings accurately and make informed decisions about fertility treatments. 

Remember that these effects are usually temporary or specific to certain conditions. It's always best to consult with your fertility doctor who can provide personalized guidance based on your specific situation. 

Better yet, focusing on maintaining a healthy lifestyle, managing stress levels, and adopting a balanced diet can contribute to overall reproductive health and support optimal ovarian function. By staying informed and working closely with your healthcare team, you can navigate the complexities of AMH testing and make informed decisions about your fertility journey.

‍

Cofertility is a human-first fertility ecosystem rewriting the egg freezing and egg donation experience. With our Freeze by Co platform, women can freeze their eggs for free when they donate half of the retrieved eggs to a family who can’t otherwise conceive. We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive.

Anti-Mullerian hormone (AMH) is a hormone produced by the follicles in the ovaries (the fluid filled sacs that contain eggs). It requires a simple blood draw and is most often used as a marker of ovarian reserve. Ovarian reserve is the term for the number of healthy eggs left in your ovaries. Since people with ovaries are born with a fixed number of eggs, this number naturally declines over time. 

A low AMH level is usually related to natural aging, but it can also have other causes. In this article, we’ll explore what a low AMH result means and answer some common questions that can come up.

AMH and its role in fertility

So what exactly can AMH tell you about your fertility? As mentioned, your AMH level is positively correlated with the number of follicles you have in your ovaries. Simply put, the more follicles you have, the higher your AMH level typically is. As a result, AMH levels have been shown to be a good predictor of ovarian reserve and someone’s expected response to fertility treatments. 

In fact, several studies have shown that there is a strong correlation between what your AMH level is and the number of mature eggs retrieved during an egg freezing or in vitro fertilization (IVF) cycle. To learn more about those studies, check out AMH and Egg Retrieval Outcomes. 

What your AMH level can’t tell you is the exact number of eggs you have left in your ovaries or what your chances of pregnancy are. There are a number of other factors like your age, overall health, and genetics that also affect the number and quality of eggs and your overall fertility. So while AMH can be a useful tool in assessing your fertility, it shouldn’t be the only factor when making decisions about fertility treatments.

What is a low AMH result?

As with most things in medicine, there’s no absolute answer here. What is considered a low, normal, or high AMH level depends on your age and the lab where you take the test. Since there is no international standard, it’s best to use the reference ranges that come with your test results.

In general, an AMH between 1.0 and 3.5 ng/mL is considered to be in the “normal” range, which means you’re likely to have a good response to fertility treatments. Anything below 1.0 ng/mL is considered low and a sign of a declining ovarian reserve.

What does a low AMH mean?

Having a low AMH level can be a sign that your ovaries are making less of the preantral follicles. The lower the number of follicles, the lower your ovarian reserve is. 

So what does this mean in terms of fertility?

First, having a lower AMH does not automatically mean you aren’t ovulating regularly or that you won’t be able to get pregnant naturally or with assisted reproductive technologies. However, research has found that what AMH is good at predicting is the response to ovarian stimulation and the number of eggs retrieved, regardless of a person’s age. So, someone with a higher AMH is generally expected to be able to get more eggs in one cycle than someone with a lower AMH. Because of this, fertility doctors typically use AMH levels (along with other information) to figure out the drugs and dosages you’ll need to maximize your response to ovarian stimulation medications. 

If you’re trying to conceive naturally, you’ll be glad to hear that multiple studies have shown that AMH does not correlate with how likely you are to actually get pregnant. In fact, one study looked at levels of AMH, FSH, and another ovarian hormone, inhibin B and tracked people for a year. They found that there was no correlation between someone’s ovarian reserve and their ability to conceive and that a low ovarian reserve was not associated with lower fertility. As a result, they did not recommend the use of FSH or AMH levels to “assess natural fertility.”

Reasons AMH would be low

There are a few reasons that could explain a low AMH. Let’s explore them.

Natural decline with aging

By far, the most common reason for a low AMH is age. People with ovaries are born with all the eggs that they’re going to have in their lifetime. These eggs are then slowly used up over time as you ovulate during each menstrual cycle until menopause is reached. As a result, ovarian reserve naturally decreases over time, meaning the AMH level also decreases. 

Hormonal birth control

Research suggests that hormonal birth control may affect AMH levels but it depends on the type of birth control. Specifically, birth control use is associated with a lower average AMH level than for people who are not on birth control, with the exact effect depending on the type of birth control. 

The amount of time you’re on birth control may also be a factor. Multiple studies have shown that AMH doesn't change if you use combined oral contraceptive pills for less than six months. However, you may have a lower AMH if you’ve been a long-term user of the pill (or other hormonal methods). Thankfully, this is temporary – AMH levels typically rebound after a person stops using birth control.

You can learn more about birth control and AMH here.

Tobacco use

Studies have shown that tobacco use, usually cigarette smoking, decreases AMH levels. This effect appears to be reversible though–it was only seen in people who were active smokers, not people who had previously smoked. 

Less common causes 

There are several other, less common causes for a low AMH level. These include:

• Genetic disorders that affect the X chromosome.
• Medical treatments like radiation or chemotherapy.
• Having surgery on your ovaries.
• Losing one or both of your ovaries.
• Autoimmune conditions.

Can I still donate my eggs with a low AMH?

If you are looking to donate your eggs, minimum AMH requirements are usually 2.0 or above. With Cofertility’s Split program, we require a minimum AMH of 2.0, though clinics may have their own unique requirements. This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.

What to do if you have a low AMH result

Finding out you have a low AMH can be disheartening, especially if you had future fertility plans that you’re worried may be affected. While there’s unfortunately not much that can be done to reverse a low AMH, there is still hope for starting a family someday even with a low AMH. With the exception of birth control or cigarette smoking, most studies have shown that lifestyle changes like diet or supplements have an insignificant effect on AMH levels but despite this, I promise it’s not all gloom and doom. 

Let’s go through a few things you can do as you move forward with this new information. 

Lean on your village

The first thing to do is take a deeeeeep breath… There are a lot of nuances involved here which can make it hard not to get lost in the weeds. Fertility is impacted by so many different things that you can drive yourself crazy trying to manage all of them. 

Having friends, family, and mental health specialists available to support you when you need it is going to be crucial. Navigating fertility is hard no matter what, so having people around you who you can lean on on bad days and celebrate with on good days will help immensely. 

Consult a fertility specialist

Speaking of your village, it should definitely include a fertility specialist. Consulting with a fertility doctor can help you better understand your reproductive health and provide guidance on any concerns or questions you may have. They’ll be able to review your specific options and work with you on a plan that helps you reach your family-building goals. This treatment plan will depend on a lot of things including how soon you want to have a child, how many children you want to have, your finances, and your desire to have a child who is genetically related to you. 

So does this mean I have to freeze my eggs ASAP?

This is typically the first question people ask and the answer is not necessarily. As mentioned before, there are many other factors involved in assessing your fertility and modern technology has allowed for advances that make family building a possibility for virtually everyone. Your fertility specialist will be able to discuss all the options for starting a family based on your unique family-building goals. This could certainly include freezing your eggs for later use but it could also mean trying to conceive unassisted, undergoing IVF with your own eggs or with donor eggs, using a gestational carrier, or even options beyond these. Again, this is something that will require you to examine your personal goals and work with your provider to figure out the best way to reach them. 

You are not a number

Repeat after me: you are more than one number! Your AMH level provides valuable insights into your ovarian reserve, but it’s just one piece of the puzzle when it comes to your fertility. AMH is always used as part of a full fertility evaluation, which often includes information about your medical history and age, a partner semen analysis, an ultrasound of the pelvis, an x-ray of the uterus and fallopian tubes, and/or additional lab work.

If that sounds like a lot, it is. This process can be overwhelming but focusing on the things that you can control can help you feel more grounded during your fertility journey, whatever that may look like.

How Cofertility can help

Cofertility is here to help you every step of the way on that journey. Our Split program offers women a chance to freeze their eggs for free when donating half the eggs retrieved to a family who cannot conceive otherwise. If you qualify for the program and decide to donate half of your retrieved eggs, every expense associated with the egg freezing procedure —  medications, supplements, travel if necessary, insurance, and 10 years of storage — are completely free of charge. We don’t even need a payment or credit card up front, as the family you match with covers all the expenses.

In our Keep program, you can freeze and store your eggs for your own future use, with lower prices on things like storage and medication. as well as our team’s support and access to our community.In addition, you’ll have access to our team’s support and access to our community where you can engage with other people freezing their eggs at the same time! 

Your journey is uniquely yours and our team is here to help you through it in whatever way you need.

In the world of reproductive health and fertility, there is a growing interest in understanding the quantity of eggs a woman has, also known as ovarian reserve. The concept of measuring ovarian reserve has gained popularity as more people seek to assess their fertility potential and make informed decisions about family planning. 

But can you truly measure how many eggs you have? Let's delve into the world of ovarian reserve testing and explore the possibilities and limitations.

How many eggs do females have?

Females are born with approximately one to two million oocytes, and it only goes down from here since no new eggs are made. But here's where it gets interesting.

Once we reach puberty, a process triggered by a complex interplay of hormones, only about 300,000 of these oocytes will remain. These precious few will have the opportunity to mature and potentially be released as eggs during our reproductive years. Our bodies typically release just one egg per menstrual cycle, and this process occurs approximately 400 times throughout our lifetime.

These remaining oocytes are not merely passive bystanders. Each one resides within a protective structure called a follicle, where it lies dormant and suspended in the middle of a cell division. Remarkably, the lifespan of an egg is one of the longest among the body's cells. However, this extended duration can also increase the chances of damage and genetic abnormalities as we age.

At menopause, which is defined as one year after your last menstrual period, the pool of remaining oocytes steadily declines until none remain. This natural process signifies the end of our reproductive years.

Understanding the intricacies of egg development and the limited supply available underscores the importance of considering fertility and family planning at an earlier age. Each egg is a precious resource, and its quality and viability can impact the chances of achieving a successful pregnancy. Exploring fertility preservation options, such as egg freezing, can provide women with greater control over their reproductive future.

While the numbers presented here provide a general understanding, it's crucial to remember that everyone’s ovarian reserve is unique. Factors like genetics, lifestyle, and overall health can influence the rate of egg loss and fertility potential. 

Egg count and age

As stated above, females are born with one to two million eggs. By puberty, only about 300,000 of these oocytes will remain. After starting the menstrual cycle, we lose about 1,000 immature eggs every month… meaning by age 37 there are around 25,000 eggs remaining. And by menopause, no more eggs remain.

Here is a rough chart of what this could look like for an individual. Keep in mind that everyone starts with a different number of eggs, and everyone’s rate of decline varies. This chart is just to give you an idea of what this egg count could look like: 

Measuring egg reserve (aka ovarian reserve)

Ovarian reserve refers to the number of eggs remaining in a woman's ovaries at a given time. It is one indicator of a woman's reproductive health, and can help guide fertility treatment decisions. The idea of quantifying ovarian reserve has gained significance as women strive to gain insights into their fertility and make proactive choices about their reproductive journey. And at the same time, at-home tests make it easier to measure your ovarian reserve.

Keep in mind that the number of eggs you have does not necessarily equate to your ability to conceive. Other factors, such as egg quality, the presence of any reproductive disorders, and the overall health of the reproductive system, play significant roles in fertility. Not to mention the health of the sperm! Some people have lower ovarian reserve but still achieve successful pregnancies, while others with a seemingly healthy ovarian reserve may face challenges in conceiving.

How to measure ovarian reserve

One of the most commonly used methods to measure ovarian reserve is through a blood test that evaluates specific hormone levels. These hormones include anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol. AMH, in particular, has emerged as a reliable marker of ovarian reserve, as it reflects the number of small follicles in the ovaries that contain immature eggs. Low levels of AMH may indicate a diminished ovarian reserve, while higher levels may suggest a larger pool of eggs.

While ovarian reserve testing provides valuable insights, it is not a crystal ball that can predict fertility outcomes with absolute certainty. Ovarian reserve is just one piece of the fertility puzzle, and other factors such as egg quality, uterine health, and sperm quality also play crucial roles in the conception process. Additionally, fertility is influenced by various external factors, including age, lifestyle, and underlying health conditions.

Fertility testing can provide a snapshot of ovarian reserve at a specific moment in time. Ovarian reserve naturally declines with age, and the number of eggs available for fertilization decreases over time. Therefore, it's crucial to interpret the results in the context of your age and overall health.

Egg reserve testing methods

Another consideration when evaluating ovarian reserve is the variation in testing methods and reference ranges used by different laboratories. Each laboratory may have its own set of standards and measurements, which can lead to variations in results. You may want to consult with a fertility doctor who is knowledgeable in reproductive medicine to interpret the test results accurately and provide personalized guidance (if you work with Cofertility, we can help you set this up).

So, can you measure exactly how many eggs you have?

While ovarian reserve testing can provide valuable information, determining the exact number of eggs a woman has remaining in the ovaries is not possible. 

Why? First of all, the number of eggs in the ovaries is not static but rather dynamic and constantly changing. We are born with a finite number of eggs, and this number gradually declines over time through a process called follicular atresia. This natural process of egg loss occurs throughout our reproductive years, and the rate of decline varies from person to person.

Second, the accuracy of measuring the exact number of eggs is hindered by the limitations of current medical technology. While imaging techniques like ultrasound can visualize the presence of ovarian follicles, they cannot precisely determine the number of eggs within each follicle. Additionally, even if the number of follicles can be counted, it does not equate to the exact number of eggs, as not all follicles contain a viable egg.

Ovarian reserve is just one piece of the puzzle

While ovarian reserve testing can provide valuable information, it is just one tool in the broader landscape of fertility assessment. A fertility doctor can consider your medical history, conduct a physical examination, measure your antral follicle count, and may recommend additional tests or imaging studies to provide a comprehensive assessment of your reproductive potential.

‍

Cofertility is a human-first fertility ecosystem rewriting the egg freezing experience. With our Freeze by Co platform, women can freeze their eggs for free when they donate half of the retrieved eggs to a family who can’t otherwise conceive. We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive.

If you are considering starting a family or have concerns about your fertility, understanding the concept of ovarian reserve is essential. Ovarian reserve refers to the quantity of eggs (oocytes) available for fertilization. It serves as a key indicator of your reproductive potential and can play a crucial role in fertility treatment decisions. 

In this guide, we will delve into the topic of ovarian reserve, exploring its significance, how it is assessed, factors that affect it, available options for optimizing fertility, and emotional considerations related to fertility journey.

First off, what does your ovarian reserve mean?

Simply put, your ovarian reserve is your fertility potential, which is influenced by a variety of factors, including age, genetics, and certain medical conditions.

As we age, our fertility naturally declines. This is totally normal, and due to fewer eggs in the ovaries, a decrease in egg quality, and an increase in chromosomal abnormalities of the remaining eggs. These collective factors contribute to lower pregnancy rates and higher miscarriage rates as we approach age 40.

While the decline in fertility happens to ALL of us, the specific age when we can no longer conceive varies from individual to individual. And in some cases, it may be earlier than we expected.

To assess your fertility potential, including your ovarian reserve, several tests are available that can give us clues to our reproductive capabilities. These tests can also help fertility doctors, like myself, evaluate the likelihood of successful pregnancy, and guide you in making informed decisions regarding family planning and fertility treatments.

How do I know my ovarian reserve?

If you want to know your ovarian reserve, it’s best to set up time for a fertility assessment with a fertility doctor (reach out – we can help with this!). 

There are two ways a doctor can help assess your ovarian reserve, including:

Blood hormone tests

Hormone tests, including follicle-stimulating hormone (FSH), estradiol, luteinizing hormone (LH), anti-Müllerian hormone (AMH), and estradiol, provide valuable information about ovarian function and egg supply. While AMH can be taken any time, FSH and LH are typically performed on specific days of the menstrual cycle to obtain accurate results.

Antral follicle count

Transvaginal ultrasound is used to visualize the ovaries and count the number of antral follicles present. Antral follicles are small, fluid-filled sacs that contain immature eggs. The count of antral follicles serves as an indirect indicator of ovarian reserve.

By combining the results of hormone tests and ultrasound assessments, we can estimate your ovarian reserve and provide insights into fertility potential.

What is a normal ovarian reserve?

Determining what constitutes a “normal” ovarian reserve involves comparing your results to established reference ranges for your age. Age-specific reference ranges serve as benchmarks to evaluate your ovarian reserve relative to peers of the same age group. Keep in mind that ovarian reserve will gradually decline for everyone – it’s the timing and pace of change that differs. 

For example, in younger women, a higher number of antral follicles (small fluid-filled sacs containing immature eggs) and lower levels of certain hormones like FSH may be considered within the normal range. However, as a woman ages, it is expected that the number of antral follicles will decrease and hormone levels, such as FSH, may increase.

While age is a significant factor, other individual factors should also be taken into account when interpreting ovarian reserve results. Factors such as medical history, previous fertility experiences, underlying medical conditions, and fertility goals play a role in assessing the overall fertility potential. These additional factors can influence the interpretation of ovarian reserve results and help guide fertility treatment decisions tailored to the specific needs of the individual.

What causes decreased ovarian reserve?

Decreased ovarian reserve can result from various factors, including:

• Age: As we age, the quantity and quality of eggs naturally decline. The aging process gradually reduces the quality of eggs and ovarian reserve, making it more challenging to conceive.
• Smoking: Cigarette smoking has been linked to a higher rate of diminished ovarian reserve. Chemicals in tobacco smoke can accelerate the depletion of eggs and negatively impact ovarian function.
• Cancer treatment: Some cancer treatments, such as chemotherapy and radiation therapy, can have damaging effects on the ovaries. These treatments may cause a decrease in ovarian reserve and compromise fertility.
• Pelvic Surgery: Surgical procedures involving the ovaries or other pelvic organs can inadvertently damage or remove ovarian tissue. This can lead to a decrease in ovarian reserve and potentially affect fertility.
• Autoimmune diseases: Certain autoimmune conditions, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis, can impact ovarian function and diminish ovarian reserve.
• Genetic conditions: Certain genetic disorders, such Fragile X syndrome, and other chromosomal abnormalities, can be associated with decreased ovarian reserve. These conditions may affect the development and function of the ovaries.

While these factors are known to contribute to diminished ovarian reserve, individual experiences vary. You may have none of the above conditions, and still face premature ovarian failure (POF). Or you may have one of the above factors, and have no problems at all getting pregnant. Sometimes, it just comes down to luck.

What does it mean if I have a high ovarian reserve?

A high ovarian reserve refers to a situation where there is an abundant number of eggs in the ovaries. While ovarian reserve naturally declines with age, certain factors can contribute to a higher ovarian reserve in some people.

One factor associated with a high ovarian reserve is younger age. Those in their 20s and early 30s generally have a higher number of eggs compared to those in their 40s, resulting in a larger ovarian reserve. Additionally, genetic factors can influence ovarian reserve, and some may have a naturally higher number of follicles and eggs in their ovaries.

Another factor that can contribute to a higher ovarian reserve is polycystic ovary syndrome (PCOS). PCOS is a hormonal disorder that can lead to the development of multiple small follicles on the ovaries. Those diagnosed with PCOS often have a higher number of immature follicles in their ovaries, which can translate into a higher ovarian reserve.

While a high ovarian reserve can be advantageous for fertility, it does not guarantee successful conception or a higher chance of pregnancy. Other factors, such as egg quality and hormonal balance, also play significant roles in achieving pregnancy.

At-home ovarian reserve tests

There are at-home options for ovarian reserve testing. However, keep in mind that most fertility doctors will want to re-do these tests. So taking a test at home, may mean paying for a test twice.

Ovarian reserve and egg freezing

Ovarian reserve plays a significant role in the process of egg freezing, also known as oocyte cryopreservation. Egg freezing involves the retrieval and freezing of your eggs for future use, preserving your fertility potential at a younger age. 

Assessing ovarian reserve before undergoing egg freezing is crucial for determining the quantity of eggs available for freezing. Those with a higher ovarian reserve generally have a greater number of eggs suitable for freezing, increasing their chances of successful future pregnancy. 

On the other hand, those with diminished ovarian reserve may have fewer eggs available for freezing, necessitating careful consideration of the potential outcomes and options. Understanding your ovarian reserve provides valuable information to help guide the egg freezing process and optimize the chances of achieving successful future pregnancies when the frozen eggs are thawed and used in assisted reproductive techniques.

Freeze your eggs with Cofertility

We’d love the opportunity to support you on your egg freezing journey.

Cofertility is a human-first, tech-enabled fertility ecosystem that provides people agency over if, how, and when they have babies — today or someday. We have two programs for egg freezers:

1. The Split program, which offers women a chance to both freeze their own eggs and donate half the eggs to a family who cannot conceive otherwise. If you qualify for the program and decide to donate half of your retrieved eggs, every expense associated with the egg freezing procedure —  medications, supplements, travel if necessary, insurance, and 10 years of storage — are completely free of charge. We don’t even need a payment or credit card up front, as the family you match with covers all the expenses.
2. Our self-pay Keep program allows women to freeze their eggs and keep them all for their future use. Through Keep, we offer our members partnerships and discounts to lighten the financial load of egg freezing, as well as access to our member community.

The benefits for of working with Cofertility include:

• Power of choice: Freeze your eggs more affordably or, if you qualify, freeze for free when you give half to a family who can’t otherwise conceive.
• Community: Our inclusive online spaces allow you to connect with others going through the process in our private online community.
• Compassion: We’ll always treat you with care, and our Split program gives you the opportunity to make someone’s family building dreams a reality.
• Data-driven: We provide you with trustworthy guidance and evidence-based research so you can make informed decisions about your fertility.
• Free egg freezing: Freeze and store your eggs for 10 years, entirely for free if you qualify for our Split program.

Ready to learn about more affordable (even free!) egg freezing with Cofertility? Fill out this quick quiz to learn about our accessible egg freezing options and see if you qualify for our programs — it only takes one minute.

One of the key factors in determining whether egg freezing is a viable option is the level of a hormone marker for ovarian reserve, called Anti-Mullerian Hormone (AMH). In this article, we will discuss what AMH is and how (if at all) it is correlated with the number of eggs you can expect to have retrieved during egg freezing.

First off, what is AMH?

Anti-Müllerian Hormone (AMH) is a hormone that is produced by the granulosa cells in the ovarian follicles. The level of AMH in your blood is used as an indicator of your ovarian reserve, or the number of eggs remaining in your ovaries. Generally, the higher the level of AMH, the greater the number of eggs you have in your ovaries. Conversely, a lower level of AMH suggests a lower ovarian reserve. Since females are born with a fixed number of eggs, this number naturally declines over time. 

Does AMH tell you how many eggs you have?

Your AMH level corresponds to how many eggs you have (your ovarian reserve), but it can’t tell you the exact number of eggs. That being said, AMH levels have been shown to be a good predictor of ovarian reserve and response to fertility treatment. There are other factors such as age, overall health, and genetics that can also affect the number and quality of eggs. So while AMH can be a useful tool in assessing your fertility, it should not be the only factor considered when making decisions about fertility treatment.

Does AMH predict the number of eggs you will retrieve?

The overall success of an egg freezing cycle largely depends on the number and quality of eggs retrieved. Studies have shown that AMH levels can be used as a predictor of egg quantity, and can thus help to predict the potential success of egg freezing. Those with higher AMH levels tend to have better outcomes with egg freezing, as they are likely to have more eggs retrieved and a higher chance of success in future fertility treatments. 

But by no means does a high AMH level guarantee a lot of eggs during an egg retrieval procedure for fertility treatments. The number of eggs retrieved during an egg freezing cycle depends on several factors, including your age, ovarian response to stimulation medications, any other underlying medication conditions, and the skill of the fertility doctor performing the procedure.

When eggs are retrieved, only a portion of those eggs will be mature. A mature egg is one that’s ready and able to be fertilized. At most clinics, any non-mature eggs are discarded, though you can talk to your clinic about whether they’re open to freezing those too. 

Is AMH correlated with the number of eggs retrieved during egg freezing?

Multiple studies have shown a strong correlation between AMH levels and mature eggs retrieved during egg freezing or IVF.

Let’s look at a few of the studies:

‍

The study: Correlation between anti-Müllerian hormone, age, and number of oocytes [1]

Who: 1500 patients in Brazil between July 2012 and April 2019

The findings: “A positive correlation was found between serum AMH levels and total number of retrieved and mature oocytes from stimulated cycles”

‍

The study: Different anti‐Műllerian hormone (AMH) levels respond to distinct ovarian stimulation methods in assisted reproductive technology (ART) [2]

Who: 1,112 patients undergoing an egg retrieval as part of ART

The findings: “AMH showed a stronger correlation with egg number compared with age over a wide age range”

‍

The study: Relationship Between Anti-Müllerian Hormone and In Vitro Fertilization-Embryo Transfer in Clinical Pregnancy [3]

Who: 314 infertility patients with an average age of 31.0 ± 4.5 years

The findings: “the AMH level of women of all ages was positively correlated with the number of retrieved oocytes “

‍

The study: Antimullerian hormone (AMH) is a predictor of the number of eggs retrieved and D3 embryos in women with fluctuating and persistently elevated FSH levels [4]

Who: 58 women with fluctuating and persistently high serum day 3 (D3) FSH.

The findings: “These data demonstrate for the first time that serum AMH is a prognostic indicator independent of age and FSH of the number of eggs retrieved”

‍

The study: Random anti-Müllerian hormone (AMH) is a predictor of ovarian response in women with elevated baseline early follicular follicle-stimulating hormone levels [5]

Who: 73 women undergoing ART with elevated early follicular FSH levels

The findings: “Random AMH levels were strongly correlated with the number of oocytes retrieved during an ART cycle among women with elevated FSH”

AMH and egg freezing

As we’ve covered, AMH can be used as an indicator of ovarian reserve and response to fertility treatments like egg freezing. While AMH cannot tell you the exact number of eggs you have, studies have shown that it can be used as a predictor of egg quantity, which is crucial for the success of egg freezing. 

The relationship between AMH levels and the number of eggs retrieved during egg freezing is positive, with higher AMH levels generally indicating more eggs retrieved. However, there are other factors that can affect the number and quality of eggs produced, including age, overall health, and genetics. Thus, while AMH can be a useful tool in assessing fertility, it should not be the only factor considered when making decisions about fertility treatment. 

Freeze your eggs with Cofertility

Regardless of your AMH level, we’d love the opportunity to support you on your egg freezing journey. 

Through our Split program, qualified freezers can freeze their eggs for free when donating half of the eggs retrieved to a family who can’t otherwise conceive. 

Through our Keep program — where you keep 100% of eggs retrieved for your own future use — we offer exclusive discounts on expenses, such as frozen egg storage. Keep members also still gain free access to our Freeze by Co Community, a safe space for those engaging in the egg freezing process (or gearing up for it) to connect and lean on each other. 

By making egg freezing easier and more accessible, our programs further strengthen the American Society of Reproductive Medicine (ASRM)’s Committee Opinion that egg freezing can help promote social justice and strengthen gender equality.

If you don’t know your AMH and you’re interested in getting it tested as a baseline assessment, reach out and we’ll share next steps. 

‍

Read more:

• Which Matters More for Fertility: AMH or age?
• What AMH Level Do I Need to Freeze My Eggs?
• Do’s and Don’ts During Egg Freezing: Alcohol, Baths, Exercise, and More

‍

Sources:

1. Kozlowski IF, Carneiro MC, Rosa VBD, Schuffner A. Correlation between anti-Müllerian hormone, age, and number of oocytes: A retrospective study in a Brazilian in vitro fertilization center. JBRA Assist Reprod. 2022;26(2):214-221. Published 2022 Apr 17. doi:10.5935/1518-0557.20210083
2. Ishii R, Tachibana N, Okawa R, et al. Different anti-Műllerian hormone (AMH) levels respond to distinct ovarian stimulation methods in assisted reproductive technology (ART): Clues to better ART outcomes. Reprod Med Biol. 2019;18(3):263-272. Published 2019 Apr 4. doi:10.1002/rmb2.12270
3. Sun XY, Lan YZ, Liu S, Long XP, Mao XG, Liu L. Relationship Between Anti-Müllerian Hormone and In Vitro Fertilization-Embryo Transfer in Clinical Pregnancy. Front Endocrinol (Lausanne). 2020;11:595448. Published 2020 Dec 4. doi:10.3389/fendo.2020.595448
4. Buyuk E, Seifer DB, Grazi R, Lieman H. Antimullerian hormone (AMH) is a predictor of the number of eggs retrieved and D3 embryos in women with fluctuating and persistently elevated fsh levels. Fertility and Sterility. Published 2010 Sep. doi.org/10.1016/j.fertnstert.2010.07.417 
5. Buyuk E, Seifer DB, Younger J, Grazi RV, Lieman H. Random anti-Müllerian hormone (AMH) is a predictor of ovarian response in women with elevated baseline early follicular follicle-stimulating hormone levels. Fertil Steril. 2011;95(7):2369-2372. doi:10.1016/j.fertnstert.2011.03.071

People come into the doctor’s office often with concerns that they may never be able to have children, either because of their age or because of their lab results. The result they are usually referring to is their anti-Müllerian hormone (AMH) test. When an AMH comes back less than promising, people get anxious real quick.

But a single hormone level can never tell you that you can or cannot get pregnant. There is more to fertility than a person’s hormone level or their age, though the two are important. Let’s dig deeper into AMH and age and what they can really tell us about fertility. 

What is AMH?

An AMH test is a simple blood test commonly used to assess ovarian reserve. Ovarian reserve is defined by the National Cancer Institute as “the total number of healthy, immature eggs in the ovaries” but I find this to be a bit misleading. Let me explain why.

AMH is released by antral follicles, which are small, fluid-filled sacs in the ovaries that each contain a single oocyte (immature egg). Your AMH level is positively correlated with the number of antral follicles you have in your ovaries. Simply stated, the more follicles you have, the higher your AMH level typically is. 

The actual number on an AMH report is typically a single digit number that, again, corresponds to the number of healthy follicles you have but it isn’t the actual total number in your ovaries if we were to count them. For example, an AMH of 3.5 does not mean you have 3.5 follicles. It does mean that you likely have the expected number of healthy follicles in your ovaries and we expect that each of those follicles contains an egg that has the potential to lead to pregnancy. And since AMH is thought to be stable throughout the menstrual cycle, it’s considered to be the best lab indicator we have for a person’s reproductive potential (in combination with age). 

What AMH is actually very good at is predicting the timing of menopause. Research shows that AMH becomes very low or undetectable about five years before menopause. Other research has shown that the time of menopause may be predicted with a mathematical model using only one AMH value and the age of the patient. 

TL;DR? Your actual AMH number is not the total number of healthy follicles (with eggs in them) that you have, but it does correspond to your overall ovarian reserve, or your reproductive potential based on the number and quality of eggs you have. AMH is actually a better predictor of the timing of menopause, since it becomes very low or undetectable about five years beforehand.

AMH and age

So how does AMH relate to your age? ​​In younger people, a gradual increase in AMH levels is seen from the first day of life. Maximum levels are reached in the teenage years and they stay pretty steady until around the age of 25. After that, AMH and age are inversely correlated, meaning that as a person gets older, their AMH goes down. Additionally, the rate at which someone’s AMH goes down varies from person to person so it’s impossible to guess where someone’s AMH will be in the future.

What is a normal AMH for my age?

Unfortunately, there is no international standard for AMH levels. However, some studies have tried to assess AMH levels and create models for what is considered normal for specific ages. One study looked at the median AMH levels (in ng/mL) in 2,741 participants. Their results are listed below:

• Under 25 = 5.13
• 25 = 5.42
• 26 = 4.91
• 27 = 4.12
• 28 = 4.96
• 29 = 3.87
• 30 = 3.53
• 31 = 3.59
• 32 = 3.44
• 33 = 2.70
• 34 = 2.49
• 35 = 2.58
• 36 = 2.28
• 37 - 1.85
• 38 = 1.66
• 39 = 1.72
• 40 = 1.27
• 41 = 1.26
• 42 = 1.20
• 43 = 0.81
• >43 = 0.72

If you have a lower or higher AMH than the numbers above going into your 30s or 40s, I encourage you not to freak out! Remember that these are medians, which means many people have AMH levels above or below them. Multiple studies have shown that AMH doesn’t correlate with how likely you are to get pregnant. In fact, one study looked at AMH, FSH, and inhibin B levels and tracked people for a year. They found that there was no correlation between someone’s ovarian reserve and their ability to conceive and that a low ovarian reserve was not associated with lower fertility. As a result, they did not recommend the use of FSH or AMH levels to “assess natural fertility.”

Lastly, It’s also important to keep in mind that the interpretation of AMH levels is laboratory assay-dependent. This means it can be different from lab to lab and test to test. Your provider should give you the reference range for their specific lab. If you get your AMH tested in one lab and then get it tested at another lab later, let your provider know before comparing those numbers. 

Is AMH or age better at predicting egg quality?

Based on the research, AMH levels alone probably do not accurately reflect egg quality. Though, when AMH is combined with age, it can be a better indicator than when it’s used alone. There is unfortunately no single test or number that can tell you with certainty how likely you are to get pregnant.

Age, on the other hand, has been proven by countless research studies to be one of the biggest determinants of egg quality. As a person ages, their eggs are more likely to become aneuploid, meaning they’re “genetically abnormal.” This can lead to difficulties with both getting and staying pregnant (i.e, higher risk of miscarriages). Once a person reaches their mid to late thirties, research shows that the quality and quantity of eggs declines rapidly. 

Unfortunately, there’s not a lot we can do about aging or about the decline in AMH that goes with it. However, it does no good to stress about either of these numbers. As stated earlier, AMH and age are each just one value your provider looks at to assess your overall reproductive potential. Neither value alone can completely predict your chances of conceiving naturally and neither defines your fertility.

Is AMH or age better at predicting how many eggs will be retrieved during egg freezing?

A lower ovarian reserve can mean fewer eggs are retrieved during egg freezing. This means both age and AMH factor into the success of an egg freezing or IVF cycle. 

Research has found that AMH is a good predictor of the response to ovarian stimulation and the number of eggs retrieved, regardless of a person’s age. Because of this, fertility doctors typically use your AMH levels (along with other biomarkers) to determine the drugs and dosages you will need to maximize your response to ovarian stimulation. 

Now, what about a correlation between AMH and actual babies born (live birth rate)? Well, while AMH does seem to have some association with live birth rates after IVF, its ability to actually predict a live birth is not that great. This is especially true for younger people. A 2021 study found that AMH is a good predictor of live birth in older (>39 years old), but not younger, people. They found that younger participants (≤38 years old) could get pregnant even with low AMH levels as long as they had frequent egg retrievals. This is a great example of how age and AMH can both impact fertility.

At what AMH level should I freeze eggs? 

So when should you consider freezing your eggs? Honestly, the sooner the better. There is no specific AMH level at which you have to freeze your eggs. However, we know AMH only goes down as a person gets older, so the earlier you’re able to freeze your eggs, the better your response to the medications will be and, hopefully, the more eggs you’re able to have retrieved to keep your options open later.

When thinking about your AMH, these general guidelines for AMH values (ng/mL) and egg retrieval can be helpful:

• AMH <0.5 = predicts difficulty getting more than three follicles to grow in one egg retrieval cycle (this in turn reduces the chance for pregnancy with IVF)
• AMH <1.0 = suggests a limited egg supply and a short window of opportunity to conceive
• AMH 1.0 - 3.5 = suggests a good response to ovarian stimulation
• AMH >3.5 = suggests an ample egg supply (also indicates that your doctor may need to be cautious in order to avoid ovarian hyperstimulation syndrome (OHSS), a possible complication of ovarian stimulation)

So can you still freeze your eggs if your AMH is low? The simple answer is yes, you can. But you will be more likely to need more than one cycle to reach the ideal number of eggs.

You are not a number

With all the nuances involved here, it’s important not to get lost in the weeds. Fertility is impacted by so many factors that you can drive yourself crazy trying to manage all of them. Remember, you are more than any number. This process can be overwhelming, but focusing on the things that you can control can help you feel more grounded during your fertility journey, whatever it may look like. 

Freeze by Co is here to help you every step of the way on that journey. Our Split program allows people between 21 to 34 years old to have the chance to freeze their eggs for free! In a “Split” cycle, you would donate half of the eggs retrieved to a family that’s trying to conceive and freeze the remaining half for yourself. If you’re over 34, you can still participate in the Keep program up to age 40. In the Keep program, you’re able to freeze your eggs and keep them all for yourself, on your timeline. In addition, you’ll have access to our online support community, the Nest. This valuable resource lets you engage with other people freezing their eggs at the same time! 

Whatever your journey looks like, our team is here to guide you through it and keep your family-building options open.

The AMH (anti-mullerian hormone) test is just one of many tests you may get when seeking answers about your fertility. But we know you’re not about to head to the doctor’s office for a blood draw without understanding what you’re getting yourself into. So here’s the full scoop on what to expect.

The lowdown on the AMH test

Think of the AMH blood test as a peek into a woman’s ovarian reserve. Here’s how it works: The AMH hormone is secreted by follicles in the ovaries. As you may know, follicles are the beginnings of human eggs, and a woman only has a finite number of eggs—the number of eggs decreases with age. This test measures the level of AMH in your blood.

“A higher level of AMH correlates to a higher ovarian reserve, or as we say, ‘the more gas left in the tank,’ says Dr. Joshua Hurwitz, MD, senior physician and partner at Reproductive Medicine Associates of Connecticut (RMACT).

About those eggs...

Unfortunately, women with a lower ovarian reserve may retrieve fewer eggs during egg freezing, so understanding your ovarian reserves is an important step in informing yourself and your doctors about what’s going on in your body. That way, you can make the right plans for you, depending on your goals.

Probably the most common reason to have an AMH blood test is as part of a fertility evaluation for any female patient interested in egg freezing or IVF, says Dr. Hurwitz. Any woman who’s trying to understand her future fertility potential could decide to have her AMH levels tested as well. In other words, you also might want to get the AMH blood test if you fall into any of these categories:

• You’re considering becoming an egg donor
• You might be freezing your eggs
• You’re thinking about getting pregnant and want to know if there’s a reason to act quickly

This isn’t like looking into a crystal ball. While having a normal ovarian reserve gives you a snapshot of what your fertility looks like now, it’s not a guarantee for what will happen in the future. Still, the results could help a woman more confidently decide to wait to try to become pregnant, or to freeze her eggs for potential use in the future, says Dr. Hurwitz.

What AMH do I need to freeze my eggs?

Research has found that AMH is a good predictor of the number of eggs retrieved during egg freezing, independent of age. Because of this, a fertility doctor will use your AMH levels (amongst other biomarkers) to determine the drugs and dosages during the procedure. 

In general, says Hurtwitz, patients can interpret their AMH level this way:

• Above 1.0 ng/ml (nanograms per deciliter): Normal
• Below 1.0 ng/ml: Showing weakness in the ovarian reserve
• Below 0.5 ng/ml: Showing severe weakness in the ovarian reserve

But know that a very high level of AMH could be a sign of polycystic ovary syndrome (PCOS), which may require specific fertility treatment and/or medications. When AMH is over 5.0 nanograms per deciliter, for example, Dr. Hurwitz says it’s worth addressing if there are other potential signs of PCOS. Also, FYI: younger women tend to have higher AMH levels, and older women tend to have lower AMH levels.

What AMH do I need to donate my eggs?

If you are looking to donate your eggs, minimum AMH requirements may be slightly higher. For example, with Cofertility’s Split program, we require a minimum AMH of 2.0, though clinics may have their own unique requirements. This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.

AMH as part of a full work-up

It’s important to know that the AMH really isn’t a one-and-done test. It’s often done as part a full fertility evaluation, which may also include:

• Hysterogram (a.k.a. Sonohystogram or SHG), an ultrasound in which saline is added to the uterus (sort of a weird sensation but not so bad), so doctors can see inside and identify any problems with the uterus or fallopian tubes.
• Semen analysis, a test of a male partner’s sperm that gauges sperm count, as well as motility (the way they move) and morphology (size, shape and structure). Guys are so lucky this is their only major test.
• Hysterosalpingogram (HSG), an X-ray of the uterus and fallopian tubes (with a liquid dye in your bod!), which also can help identify or rule out certain problems.

In fact, the AMH probably isn’t the only ovarian reserve test you’ll get. It’s often done alongside:

• FSH blood test, another blood test. This is used to measure a different hormone called the Follicle Stimulating Hormone. FSH is released at the beginning of the menstrual cycle, so you’ve got to have your blood drawn at day 2, 3, or 4 of your period. A high level of FSH is associated with low ovarian reserve, and a low level of FSH is associated with a normal ovarian reserve.
• Basal Antral Follicle Count, an ultrasound in which the doctors will count the number of follicles they can see. The more follicles, the greater the ovarian reserve.

A woman’s age is also a huge factor in ovarian reserve and is really the most accurate way of gauging the quality of the remaining eggs, says Dr. Hurwitz.

It’s painless (mostly)

Since this is just a low-key blood test, there’s really not much to worry about. It can be done at any time during your menstrual cycle, and you don’t need to prep for it by fasting or in any other way. Think of it like getting a blood draw at your annual physical. You’ll have blood taken as usual through a needle into a syringe, and a Band-Aid will be placed on the site. Then, you’ll be able to go about your day as normal.

Dr. Hurwitz says his patients usually receive their AMH test results within a few days up to about a week, and they’re given over the phone by a nurse who can answer any questions they may have about their AMH levels. Then, after all their initial testing is done, the doctor sits down with his patients and discusses the results of all their tests to give a 360-degree picture of their fertility status. 

Plotting your next steps

AMH level alone won’t tell you what your next steps will be. If you’ve had all the ovarian reserve testing done, there isn’t anything further that needs to be measured in that regard.

Remember, AMH level should never be the sole measure of a woman’s fertility. In fact, one recent Journal of the American Medical Association study found that AMH levels didn’t predict which women would get pregnant over the course of a year. This is a reassuring sign for women who have low AMH levels, but Dr. Hurwitz notes that it doesn’t mean that the AMH test results aren’t important. They can help your doctor understand what’s going on in your body.

Taking your AMH results into consideration with all your other test results and health history,  you and your doctor will come up with a course of action. There’s no one answer for what this will be based on AMH level, but a low ovarian reserve might prompt a woman to begin egg freezing sooner. 

Interested in freezing your eggs? We can help! Our Freeze by Co is a better approach to egg freezing, and free when you give half to a family who can't otherwise conceive

Fertility is one of those topics that most of us are taught to ignore until we’re actively trying to get pregnant. But as more women take ownership of their reproductive plans—whether through egg freezing or simply learning more about their options—there’s growing interest in testing fertility early. The promise of data is appealing: if you could find out where you stand, maybe you could make clearer decisions about your timeline, your body, and your future.

But the reality is a bit messier. Yes, there are ways to test aspects of your fertility. But there’s also a lot that can’t be measured—at least not with the kind of certainty many people expect. Some tests give useful insights. Others are often misunderstood. And some questions still don’t have reliable answers, no matter how many labs you send your blood to.

In this article, we break down what you can and can’t learn about your fertility from today’s most common tests, especially if you’re in your 20s and thinking about options like egg freezing. We’ll also cover how to think about those results, what they actually mean for your future fertility, and what they don’t tell you.

You can test your ovarian reserve

Let’s start with the most talked-about test: Anti-Müllerian Hormone (AMH). This is a hormone produced by small follicles in your ovaries. The more of these follicles you have, the higher your AMH level tends to be. That makes it a useful proxy for ovarian reserve, or the estimated number of eggs you have left.

AMH will not tell you the exact number of eggs you have remaining, but it can be used to reliably predict how you’ll respond to fertility treatment. If you’re considering egg freezing, for example, a high AMH might suggest you’ll produce more eggs during a stimulation cycle, which could mean fewer cycles overall. A lower AMH might signal the opposite.

That said, AMH doesn’t predict whether you can get pregnant unassisted. It also doesn’t reflect egg quality. Many people with low AMH conceive without issues, and many people with high AMH still face fertility struggles.

In short: AMH is helpful for understanding how your ovaries might respond to medication, but it’s not a fertility report card. It’s a piece of the puzzle, not the whole picture.

You can check your follicle count, but it varies

Another test used to assess ovarian reserve is the antral follicle count (AFC), which is done via vaginal ultrasound. AFC is the number of small follicles in your ovaries that are visible on an ultrasound at the start of your menstrual cycle.

• Antral = fluid-filled, early-stage follicles
• Follicle = a tiny sac that contains an immature egg
• Count = how many are seen on the scan

AFC gives your doctor an idea of how many eggs your ovaries might be able to produce that month and helps estimate your overall ovarian reserve. Like AMH, this gives a snapshot of the eggs your body might recruit that month.

A higher count usually means a better response to egg freezing medications. It can also confirm whether your AMH results are in line with what your ovaries are actually doing.

But this test depends a lot on timing and technique. Different providers might get slightly different counts, and the number can fluctuate month to month. So while it’s useful when paired with other data, it’s not always consistent on its own.

You can evaluate your hormone levels, but they’re not always predictive

In addition to AMH, your provider may check other hormone levels at the start of your cycle (It is especially important that FSH and E2 are tested in the early follicular phase, as they cannot be reliably interpreted if done at a random phase of the cycle):

• FSH (follicle-stimulating hormone): Higher levels can suggest your ovaries are working harder to produce eggs, which may point to lower ovarian reserve.
• Estradiol (E2): This form of estrogen is measured alongside FSH to interpret the results accurately.
• LH (luteinizing hormone) and TSH (thyroid-stimulating hormone): These are sometimes included to rule out other hormonal conditions.

These blood tests are relatively easy to obtain and often included in a fertility workup. But their meaning can vary depending on when they’re taken and your cycle regularity. Like AMH, they don’t offer a yes-or-no answer about whether you’re fertile, they just add context.

There’s no test for egg quality 

This is where things get tricky. While you can estimate how many eggs you might have, there’s no current test that can measure the quality of your eggs. Egg quality mostly refers to whether an egg has the correct number of chromosomes. As people age, their eggs are more likely to develop abnormalities that make fertilization or a healthy pregnancy less likely.

Right now, the only way to assess egg quality is by making embryos. But even then, it’s difficult to know if the quality issue is from the egg, sperm, or a combination of both. 

Statistically speaking, younger people are more likely to have higher-quality eggs. But that’s a generalization, not a guarantee. Two people the same age can have different egg quality, and there’s no blood test that can measure this with accuracy.

So when people say, “Your egg quality declines with age,” they’re right. But when someone says, “You can test your egg quality,” they’re overselling it.

You can’t test how long you’ll be fertile

This is another common misconception. You might think that by testing your AMH or other hormones, you can predict how many fertile years you have left. Unfortunately, fertility doesn’t follow a strict countdown clock.

AMH gives a rough estimate of ovarian reserve, but it can’t tell you exactly when you’ll hit menopause, or when your eggs will stop being viable. Some people with high AMH experience early menopause. Others with low AMH get pregnant without issue. There’s too much individual variation to make long-term predictions with confidence.

Egg freezing can give you more options in the future—but it’s not a guarantee. The number and quality of frozen eggs, your age at the time of freezing, and your overall health all factor into how likely those eggs are to result in a baby later.

You can assess whether your fallopian tubes are clear

One test that often gets less attention in fertility conversations—but can be important—is the hysterosalpingogram (HSG). This is a specialized X-ray that looks at the inside of the uterus and fallopian tubes. It’s typically done by injecting a dye through the cervix and using imaging to see how the dye moves through the reproductive tract.

The goal is to check whether there are any blockages or structural issues that could prevent sperm and egg from meeting. If the dye flows freely through the fallopian tubes and into the abdominal cavity, that’s a good sign. If it doesn’t, it could indicate a blockage that might affect natural conception.

An HSG doesn’t give information about eggs, hormones, or ovulation, but it does offer a window into the physical pathways that make pregnancy possible. If you’ve had pelvic infections, endometriosis, or abdominal surgery in the past, your doctor may recommend this test as part of your fertility workup.

What about at-home fertility tests?

You’ve probably seen ads for at-home fertility tests promising insights into your reproductive future. Most of these kits check AMH, and some also offer hormone panels that include FSH, LH, and estradiol.

These can be helpful for getting started, especially if you’re not ready to visit a fertility clinic. But they’re not a substitute for a full medical evaluation. They also shouldn’t be used to make major decisions in isolation. If a test shows low AMH, it doesn’t mean you can’t get pregnant. And if it shows high AMH, it doesn’t mean you’re off the hook for thinking about fertility down the line.

Think of these kits as entry points—tools to start a conversation with a qualified provider, not definitive answers.

So what should you do with this information?

If you’re in your 20s, you’re in a good position to be proactive. Even though you can’t test everything, there’s value in learning what you can and starting the conversation early.

AMH and AFC can help you understand how your body might respond to treatment. Hormone panels can uncover issues you might not be aware of. And a consultation can give you space to ask questions and make a plan that fits your goals—even if that plan is just to wait and check back in a year.

It’s okay not to have all the answers. The idea isn’t to predict your future. It’s to give yourself more room to navigate it with intention.

Final thoughts

Fertility testing has come a long way, but it still has limits. You can measure ovarian reserve, hormone levels, and follicle counts. But you can’t test egg quality, predict exactly how long you’ll be fertile, or know for sure whether you’ll get pregnant naturally.

Still, having more information can be empowering—especially if it helps you make decisions on your own timeline. Whether you’re thinking about egg freezing or just want to understand your body better, asking questions now can open more doors later.

At Cofertility, we’re here to make those conversations easier, more transparent, and less intimidating. If you're considering egg freezing and want to understand what testing can (and can't) tell you, we’re happy to help you get started.

If you’re thinking about freezing your eggs, you’ve probably heard about the concept of “egg quality.” Maybe a friend mentioned it, or your doctor brought it up during a consultation. It’s one of those fertility buzzwords that can feel vague and hard to pin down. What does “egg quality” actually mean? And more importantly, is there a way to find out what yours is?

Egg quality refers to how likely an egg is to result in a healthy embryo and, eventually, a live birth. It’s not something we can measure directly—there’s no perfect test or score that tells you how “good” your eggs are. But we do have tools to assess your fertility potential, and there are signs and indicators that can give us insight into how your body is responding.

In this article, we’ll walk through what egg quality really means, why it matters, how it changes over time, and the testing options available today. We'll also talk about what to consider when thinking about fertility preservation—and how Cofertility can support you in taking next steps.

What we mean by “egg quality”

In medical terms, egg quality refers to the genetic and cellular health of an egg. A high-quality egg is one that has the right number of chromosomes and is capable of being fertilized, developing into a healthy embryo, and implanting in the uterus.

Eggs with abnormal numbers of chromosomes—called “aneuploid” eggs—are less likely to lead to a successful pregnancy. These eggs may not fertilize, may result in failed embryo development, or may lead to miscarriage if implantation does occur. In some cases, chromosomal abnormalities that originate in the egg can carry through to a developing embryo and lead to a live birth with a genetic condition. Down syndrome (Trisomy 21) is the most widely known example of this, but there are many other conditions that can arise from chromosomal abnormalities. This is why egg quality plays such a big role in fertility, even for people who are ovulating regularly or who feel perfectly healthy.

Unfortunately, there’s no simple blood test or ultrasound that can tell us with certainty which of your eggs are chromosomally normal. Egg quality can only truly be confirmed by creating embryos and performing genetic testing on them, which isn’t part of the typical egg freezing process. But there are other ways to estimate your fertility potential.

Age matters most

Of all the factors that impact egg quality, age is by far the most significant. People with ovaries are born with all the eggs they’ll ever have, and both egg quantity and quality decline over time.

Most people see a gradual decline starting in their early 30s, with a more noticeable drop-off around age 35. By age 40, a higher percentage of eggs are likely to be genetically abnormal. That doesn’t mean you can’t get pregnant or that all your eggs are “bad”—but it does mean fewer of your eggs may be capable of resulting in a live birth.

To put this age-related decline into perspective, here’s what the numbers actually look like:

• At age 25, approximately 20-25% of eggs may be chromosomally abnormal.
• At age 35, this increases to about 40-50%
• At age 40, that figure is up to roughly 70-80%
• At age 43, over 90% of eggs may be chromosomally abnormal

Egg quality is the main reason that IVF success rates drop with age, and why freezing your eggs earlier can increase your odds of having more usable eggs down the road.

Egg quantity vs. egg quality

It’s easy to confuse egg quantity with egg quality, especially since both tend to decline together. But they’re not the same thing.

Egg quantity refers to the number of eggs you have left—your “ovarian reserve.” The most commonly used tests to assess this are AMH (anti-Müllerian hormone) and antral follicle count, which can give us insight into your egg supply. These tests are useful for predicting how many eggs you might produce during a stimulation cycle, which is helpful when planning for egg freezing or IVF.

But these tests don’t tell us anything definitive about the quality of your eggs. It’s entirely possible to have a high AMH and still have a higher percentage of chromosomally abnormal eggs. On the flip side, someone with low ovarian reserve may still have good-quality eggs—it just may take more cycles to find them.

Can you test your egg quality?

Here’s where it gets tricky. There is no test that gives a direct readout of egg quality unless you’re creating and doing genetic testing on embryos. But here are some of the indirect ways we can get clues:

Age

As mentioned, this is the strongest predictor of egg quality. Most fertility specialists use age as a starting point when estimating how many eggs you may want to freeze for a future pregnancy.

Embryo development (in IVF)

If you go through IVF and fertilize your eggs, you can get information about how well your eggs developed into embryos. Some embryos can be biopsied and tested (PGT-A) to check for chromosomal normalcy. This gives a more direct window into egg quality—but it’s not part of standard egg freezing.

Ovarian reserve testing

While it doesn’t tell us about quality, ovarian reserve testing (AMH, FSH, AFC) gives us an idea of your egg quantity. If your numbers are unexpectedly low for your age, it may be worth exploring your optionsmore quickly, especially if you’re considering freezing your eggs.

Cycle response

If you go through an egg freezing cycle, how your body responds to stimulation medications (how many eggs mature, hormone levels during the cycle, etc.) can also offer insight. At Cofertility, we support you through every part of the cycle and help explain what your results might mean.

What affects egg quality besides age?

While age is the biggest factor, other things can also impact egg quality over time. Some are within your control, others aren’t.

• Smoking, whether that’s nicotine or marijuana, is consistently linked to lower egg quality and earlier menopause.
  
• Certain medical conditions, like PCOS, endometriosis, or autoimmune disorders, may affect egg health.
  
• Chemotherapy or radiation treatments can damage eggs or reduce ovarian reserve.
  
• Environmental exposures to endocrine-disrupting chemicals may play a role, although research is still ongoing.

There's growing interest in how lifestyle, diet, and supplements may support egg health. While there's no magic food or pill that guarantees higher-quality eggs, taking care of your overall health—getting enough sleep, avoiding smoking, managing stress, and maintaining a balanced diet—can support your fertility.

How Cofertility can help

If you’re thinking about freezing your eggs, understanding your fertility is the best place to start. At Cofertility, we’re here to guide you through the process with clarity and support—not pressure.

Through our Split and Keep programs, we offer egg freezing in a way that puts you in control:

• With our Split Program, you can freeze your eggs for free when you donate half to a family who can’t otherwise conceive. This model attracts people motivated by shared values—not just financial incentives—and gives donors a way to preserve their own fertility without the high cost.
  
  
• Our Keep Program is designed for those who want to freeze and keep all of their eggs. We help you navigate the process, connect you with partner clinics, and offer a support team to answer your questions at every step.
  

Our team includes experienced nurses (like me), fertility doctors, and donor coordinators who are here to help you feel informed—not overwhelmed. Whether you're ready to move forward or just want to ask questions, we’re here when you’re ready.

Final thoughts

There’s a lot of noise out there about egg quality—and it can be hard to separate fact from fear. While there’s no single test to measure it, your age, hormone levels, and cycle response can all offer clues. If you’re curious about your fertility, or planning ahead for the future, taking steps to learn more now can give you more options later.

Freezing your eggs isn’t the right decision for everyone. But if you’re considering it, Cofertility can help you do it in a way that’s empowering, transparent, and supported by people who care.

You deserve to make these decisions with clarity and confidence—not confusion. Let us help you get there.

If you just started researching egg freezing, you might feel like you’ve been introduced to a whole new language. Whether clinical in nature or just shortened slang, with egg freezing comes its own terminology. And even if you’ve already educated yourself on what’s involved with egg freezing, chances are, you’ll come across an acronym you’ve never heard of. 

Fear not. Below, you’ll find a comprehensive list of acronyms, abbreviations, and terms you should know when diving into an egg freezing cycle. Read this, and soon you’ll rattle off egg freezing lingo like a pro. 

Hormones and general fertility 

• AMH: One of the first hormones your reproductive endocrinologist will investigate, Anti-Müllerian Hormone is measured early in a woman’s cycle to determine her ovarian reserve. A higher AMH level correlates to a higher ovarian reserve, or in other words, more eggs.
• CD: "Cycle day"—or the day of one's menstrual cycle, with CD1 = the first day of a period. Understanding your cycle length is super important, as it may indicate your most fertile window of dates. It will also help you determine any irregularities to consider as you embark on an egg freezing cycle. 
• DPO: "Days past ovulation." In a typical menstrual cycle, women can expect their period at 14DPO.
• Dx: Diagnosis, the medical identification of a condition or issue affecting fertility, which may impact decisions regarding egg freezing and related treatments.
• E2: Estradiol, a female hormone that's produced by ovarian follicles and determines how well a woman is responding to controlled ovarian hyperstimulation with fertility drugs. If you're freezing your eggs, you’ll have several routine monitoring appointments that include ultrasounds and bloodwork that measures estradiol levels. The higher the estradiol, the more follicles that are likely developing and (fingers crossed) the more eggs that may be retrieved.
• FSH: Follicle stimulating hormone, a hormone released from the pituitary gland to stimulate the ovaries or testicles. When getting an initial fertility workup, you'll get tested for your existing FSH. If you're taking FSH as a drug as part of your egg freezing protocol, it's also known in the United States as Follistim, Gonal-F or Bravelle.
• hCG: Human Chorionic gonadotropin, a hormone produced by an implanting embryo. If this hormone is present in a woman's blood, it indicates a possible pregnancy. It can also be given to women undergoing an egg freezing cycle to trigger ovulation right before a retrieval procedure.
• LH: Luteinising Hormone, a hormone released by the pituitary gland to stimulate the gonads (ovaries and testicles). If you're freezing your eggs, you'll have levels of this hormone measured often via bloodwork in order to determine ovulation timing.
• LMP: "Last menstrual period," or the start date of a woman's last menstrual period.
• MII: Metaphase II, the stage of egg maturation where the egg is ready for (hypothetical) fertilization, with chromosome alignment necessary for successful embryo development.
• PCOS: "Polycystic ovarian syndrome," a condition where the ovaries develop many small cysts, which results in irregular periods and ovulation. It can contribute to future infertility, so if you know you have PCOS, regardless of whether you’re freezing your eggs or not, chat with a reproductive endocrinologist to ensure a safe and healthy plan.
• TSH: Thyroid stimulating hormone, a hormone produced by the pituitary gland meant to stimulate the release of thyroid hormone by the thyroid gland. Recent research has suggested that slightly low TSH may associate with fertility challenges.

Egg freezing 

• AFC: “Antral follicle count,” a count of the number of small follicles in a woman's ovaries, seen via ultrasound early on in her cycle. Used to measure ovarian reserve, you'll have a lot of these if you're freezing your eggs to monitor how you're responding to ovary-stimulating medication.
• ART: “Assisted reproductive technology,” including any procedure involving egg retrievals and manipulating eggs and sperm outside the body. It includes things like egg freezing, gamete intrafallopian transfer (GIFT), in vitro fertilization (IVF), and zygote intrafallopian transfer/tubal embryo transfer (ZIFT/TET). 
• BCP: Birth control pills. If you’re freezing your eggs, your doctor may prescribe these as part of a medicated cycle in order to regulate the timing
• COH: “Controlled ovarian hyperstimulation,” when several follicles mature simultaneously in response to fertility drug treatment. The key word here is controlled. Your follicle growth will be carefully monitored by your doctor, who will adjust your medication protocol accordingly to stimulate or halt further growth.
• ER: "Egg retrieval" — not "emergency room!" An ER will be performed as part of an egg freezing cycle, and may also be referred to as a VOR (“Vaginal Oocyte Retrieval”).
• IM: Intramuscular, a method of injecting medication directly into a muscle. This method is often used for hormone treatments during the egg freezing process.
• OC: “Oocyte Cryopreservation,” which is another term for egg freezing. 
• OHSS: “Ovarian hyperstimulation syndrome,” a condition where the ovaries become excessively swollen and painful due to the overproduction of eggs from fertility medications. This is very rare, but can happen.
• REI: "Reproductive endocrinologist," or a doctor who specializes in treating male and female fertility.
• SD1: “Stimulation Day 1,” or the first day of medication administered to stimulate the ovaries for egg production during the egg freezing process.
• SQ: Subcutaneous (also abbreviated as SC), a method of injecting medication into the fatty tissue just under the skin, commonly used for administering fertility hormones during an egg freezing cycle.
• TVUS: “Transvaginal Ultrasound,” an imaging technique used to visualize the ovaries and follicles internally, providing information about egg development and ovarian health. If you’re undergoing an egg freezing cycle, you’ll have a lot of these, but they are quick and painless. 

Egg donation

• DE: “Donor eggs,” or eggs provided by another woman to be fertilized with sperm and transferred to the uterus of an intended parent or gestational carrier.
• IP: “Intended parent,” which is a person who becomes the legal parent of a child born through third party reproduction.

If you’re feeling totally overwhelmed by all that’s involved with egg freezing, we’ve got you covered. Take our quiz to see how you may qualify for our more accessible egg freezing opportunities, including our Split program, through which you can freeze your eggs for free when you donate half to another family who can’t conceive. 

We’re wishing you the best of luck on your egg freezing journey! 

Ever scrolled through that health and wellness side of social media and stumbled upon something called AMH? Maybe your best friend casually mentioned getting her AMH tested, and you were too embarrassed to ask what the heck she was talking about. You're young, you feel great, and having babies isn't even on your radar right now. But here's the thing: understanding this thing called AMH could be a major game-changer for your future.

What is AMH?

AMH stands for Anti-Müllerian Hormone.  Think of it as a little signal your ovaries send out. This hormone level tells your doctor about how many eggs you have left – also known as your ovarian reserve. Basically, AMH is one clue into your fertility.  And, here's why you should care even if kids aren't on your mind yet.

Why does AMH matter in your 20s and 30s?

AMH can be a helpful biomarker for your health and fertility. Why?

1. Knowledge is power: Knowing your AMH levels gives you valuable insights into your reproductive timeline. It helps you make informed decisions about when you might want to start a family and whether fertility preservation options (like freezing your eggs) might be something to consider down the road.
2. Fertility isn't forever: You might think of your 20s as your prime fertility years, and while you're not wrong, it's not the full picture.  Your fertility peaks in your early 20s and starts a gradual decline in your mid-30s. For some people, this decline is faster, and AMH levels can give you a heads-up.
3. Unexpected roadblocks: AMH testing can help detect potential fertility issues early on, like Polycystic Ovarian Syndrome (PCOS) or premature ovarian insufficiency. Getting this info sooner rather than later can help you take steps to manage these conditions and protect your fertility.

What can AMH test results tell you?

So what exactly can AMH tell you about your fertility? Your AMH level is positively correlated with the number of follicles you have in your ovaries. Simply put, the more follicles you have, the higher your AMH level typically is. As a result, AMH levels have been shown to be a good predictor of ovarian reserve and someone’s expected response to fertility treatments. 

In fact, several studies have shown that there is a strong correlation between what your AMH level is and the number of mature eggs retrieved during an egg freezing or in vitro fertilization (IVF) cycle. To learn more about those studies, check out AMH and Egg Retrieval Outcomes. 

What your AMH level can’t tell you is the exact number of eggs you have left in your ovaries or what your chances of pregnancy are. There are a number of other factors like your age, overall health, and genetics that also affect the number and quality of eggs and your overall fertility. So while AMH can be a useful tool in assessing your fertility, it shouldn’t be the only factor when making decisions about fertility treatments.

So, you got your AMH tested. Now what? Here's a basic breakdown of what those numbers usually mean: 

• Normal AMH means you're right on track for your age – good news!  
• High AMH might suggest a good number of eggs remaining, and potentially even point towards conditions like PCOS where your egg count is unusually high. 
• Low AMH could mean you have fewer eggs remaining than typical for your age group.  It might signal a faster decline in fertility, but it doesn't mean you can't get pregnant at all.  

Remember, your AMH level is just one piece of the fertility puzzle. Other factors like your overall health, other hormone levels, family history, and lifestyle habits matter too!

What are normal AMH numbers?

What is considered a “normal” AMH level depends on your age, as well as the lab where you take the test. Since there is no international standard, it’s best to use the reference ranges included on the test results (your doctor can share those with you if you did a test through a clinic). 

In general, however, an AMH between 1.0 and 3.5 ng/mL suggests a “normal” range that is likely to have a good response to egg freezing.

Common reasons for high AMH

The most common reason for high AMH is that you are very fertile and likely to retrieve more eggs in an egg freezing cycle.  But, it does not necessarily mean that the eggs are of good quality. Egg quality is determined by factors such as your age, genetics, and environmental factors, and cannot be measured directly by AMH levels.

But a high AMH level may also indicate PCOS, which is a hormonal disorder that affects 8–13% of females of reproductive age. Those with PCOS typically have high levels of androgens (male hormones) and may have irregular periods, acne, and excess hair growth. Patients with an average AMH level ≥ 4.45 ng/ml have a 9.35 times higher likelihood of developing PCOS, but not all patients with a high AMH have PCOS.

In rare cases, abnormally high AMH could be a sign of an ovarian tumor. Certain types of ovarian tumors, such as granulosa cell tumors, can produce high levels of AMH. 

Read more in: What Does a High AMH Result Mean?

Common reasons AMH would be low

By far, the most common reason for a low AMH is age. People with ovaries are born with all the eggs that they’re going to have in their lifetime. These eggs are then slowly used up over time as you ovulate during each menstrual cycle until menopause is reached. As a result, ovarian reserve naturally decreases over time, meaning the AMH level also decreases. 

Research suggests that hormonal birth control may affect AMH levels but it depends on the type of birth control. Specifically, birth control use is associated with a lower average AMH level than for people who are not on birth control, with the exact effect depending on the type of birth control. 

The amount of time you’re on birth control may also be a factor. Multiple studies have shown that AMH doesn't change if you use combined oral contraceptive pills for less than six months. However, you may have a lower AMH if you’ve been a long-term user of the pill (or other hormonal methods). Thankfully, this is temporary – AMH levels typically rebound after a person stops using birth control.

‍

There are several other, less common causes for a low AMH level. These include:

• Genetic disorders that affect the X chromosome
• Medical treatments like radiation or chemotherapy
• Having surgery on your ovaries
• Losing one or both of your ovaries
• Autoimmune conditions

Read more in: What Does a Low AMH Result Mean?

Factors that can influence AMH levels

It's important to know that some things can temporarily or even permanently change your AMH:

Birth control

Certain types of birth control can suppress your natural AMH levels. One study looked at data from women on various types of birth control and found: 

• Combined oral contraceptive pill led to 23.7% lower AMH
• Progestin-only pill led to 14.8% lower AMH
• Vaginal ring led to 22.1% lower AMH
• IUD led to 6.7% lower AMH
• Implant led to 23.4% lower AMH
• Copper intrauterine device led to 1.6% lower AMH

The authors concluded that birth control use is associated with a lower mean AMH level when compared to those who are not on contraceptives, with variation depending on the type of birth control

Health conditions

Things like PCOS, endometriosis, vitamin D deficiency, or even a recent ovarian surgery can impact your AMH levels.

Chemotherapy 

Chemotherapy treatments for conditions like cancer can significantly lower AMH levels. Research indicates that pre-chemotherapy AMH levels may be helpful in predicting ovarian function and potential fertility after treatment. A prospective study of women treated with chemotherapy for early breast cancer showed that long-term ovarian function after treatment was predictable using serum AMH levels before treatment. 

Obesity

Studies suggest a connection between obesity and lower AMH levels, though the exact relationship is complex. Obesity is linked to hormonal imbalances and inflammation, which can disrupt ovarian function and potentially affect AMH production. However, it's important to note that not everyone with obesity experiences lowered AMH, and other factors could also be at play. More research is needed.

Smoking

Studies have also shown that tobacco use, usually cigarette smoking, decreases AMH levels. This effect appears to be reversible though–it was only seen in people who were active smokers, not people who had previously smoked. 

What is a good AMH level for egg freezing?

Research has found that AMH is a good predictor of the response to ovarian stimulation and the number of eggs retrieved. Because of this, fertility doctors typically use your AMH levels (along with other biomarkers) to determine the drugs and dosages you will need to maximize your response to ovarian stimulation. 

Now, what about a correlation between AMH and actual babies born (live birth rate)? Well, while AMH does seem to have some association with live birth rates after IVF, its ability to actually predict a live birth is not that great. This is especially true for younger people. A 2021 study found that AMH is a good predictor of live birth in older (>39 years old), but not younger, people. They found that younger participants (≤38 years old) could get pregnant even with low AMH levels as long as they had frequent egg retrievals. 

Does AMH predict the number of eggs you will retrieve during egg freezing?

The overall success of an egg freezing cycle largely depends on the number and quality of eggs retrieved. Studies have shown that AMH levels can be used as a predictor of egg quantity, and can thus help to predict the potential success of egg freezing. Those with higher AMH levels tend to have better outcomes with egg freezing, as they are likely to have more eggs retrieved and a higher chance of success in future fertility treatments. 

But by no means does a high AMH level guarantee a lot of eggs during an egg retrieval procedure for fertility treatments. The number of eggs retrieved during an egg freezing cycle depends on several factors, including your age, ovarian response to stimulation medications, any other underlying medication conditions, and the skill of the fertility doctor performing the procedure.

When eggs are retrieved, only a portion of those eggs will be mature. A mature egg is one that’s ready and able to be fertilized. At most clinics, any non-mature eggs are discarded, though you can talk to your clinic about whether they’re open to freezing those too. 

Multiple studies have shown a strong correlation between AMH levels and mature eggs retrieved during egg freezing or IVF.

Let’s look at a few of the studies:

The study: Correlation between anti-Müllerian hormone, age, and number of oocytes 

Who: 1500 patients in Brazil between July 2012 and April 2019

The findings: “A positive correlation was found between serum AMH levels and total number of retrieved and mature oocytes from stimulated cycles”

‍

The study: Different anti‐Műllerian hormone (AMH) levels respond to distinct ovarian stimulation methods in assisted reproductive technology (ART) 

Who: 1,112 patients undergoing an egg retrieval as part of ART

The findings: “AMH showed a stronger correlation with egg number compared with age over a wide age range”

‍

The study: Relationship Between Anti-Müllerian Hormone and In Vitro Fertilization-Embryo Transfer in Clinical Pregnancy 

Who: 314 infertility patients with an average age of 31.0 ± 4.5 years

The findings: “the AMH level of women of all ages was positively correlated with the number of retrieved oocytes “

‍

The study: Antimullerian hormone (AMH) is a predictor of the number of eggs retrieved and D3 embryos in women with fluctuating and persistently elevated FSH levels 

Who: 58 women with fluctuating and persistently high serum day 3 (D3) FSH.

The findings: “These data demonstrate for the first time that serum AMH is a prognostic indicator independent of age and FSH of the number of eggs retrieved”

‍

The study: Random anti-Müllerian hormone (AMH) is a predictor of ovarian response in women with elevated baseline early follicular follicle-stimulating hormone levels 

Who: 73 women undergoing ART with elevated early follicular FSH levels

The findings: “Random AMH levels were strongly correlated with the number of oocytes retrieved during an ART cycle among women with elevated FSH”

Read more in AMH and Egg Retrieval Outcomes

What AMH do I need to donate my eggs?

Through Cofertility’s Split program, qualified freezers can freeze their eggs for free when donating half of the eggs retrieved to a family who can’t otherwise conceive. In the context of donating through our Split program, having an appropriate level of AMH is important. Fertility doctors typically consider an AMH level above 2.0 ng/ml as a good indicator for egg donation, and this is the benchmark used at Cofertility. Note that some clinics have a higher requirement.

This level suggests that you are likely to respond well to fertility treatments and produce a sufficient number of eggs for both donation and personal use. This allows us to proceed with the egg retrieval process in a manner that is both safe and effective.

However, if your AMH level is lower than this, it does not necessarily mean you cannot freeze your eggs. You can still qualify for our Keep program — where you keep 100% of eggs retrieved for your own future use — we offer exclusive discounts on expenses, such as frozen egg storage. Keep members also still gain free access to our Freeze by Co Community, a safe space for those engaging in the egg freezing process (or gearing up for it) to connect and lean on each other.

Everyone is unique, and AMH is just one factor of many that we consider during the evaluation process. You can learn more about qualifications for our Split program here. 

When should I test my fertility? 

So, when is the “right” age for testing your fertility, anyway? 

It depends.

And ultimately, it’s up to you! It’s your body, and your data, and there is no one-size-fits-all answer. We’re firm believers that knowledge is power and you deserve this information. Studies do show that our ovarian reserve declines with age — in other words, it’s a good idea to assess your fertility potential sooner rather than later. That way, if you do want to preventatively freeze your eggs, you can do so while your ovarian reserve is still higher. 

According to the American Society for Reproductive Medicine (ASRM), the optimal time to freeze your eggs is in your 20s and early 30s. This study also indicated that, as we get older, our chances of needing to do multiple egg freezing cycles increase in order to achieve a 70% live birth rate. We know we’re a bit of a broken record here, but: the younger you are, the healthier and more plentiful your eggs are.

Should I test my fertility at home or in a clinic?

At-home fertility tests have gained popularity in recent years due to their convenience and privacy. These tests typically involve collecting blood or urine samples and mailing them to a laboratory for analysis. On the other hand, in-clinic fertility tests are conducted at a medical facility, where specialized equipment and healthcare professionals are available.

The pros of at-home fertility tests include:

• Convenience and privacy: Samples can be collected in the comfort of your home.
• Cost-effective: At-home tests are often more affordable than in-clinic procedures.
• Early assessment: At-home tests allow you to gain insights into your fertility potential before actively trying to conceive. Plus, you won’t have to wait to get squeezed in for an appointment at the clinic!

The pros of testing your fertility at a clinic:

• A broader scope: At-home tests may not provide a comprehensive evaluation of fertility health, while testing your fertility at a clinic provides a more comprehensive picture of your fertility. An important note is, when testing your fertility at a clinic, you’ll also undergo a transvaginal ultrasound, where the technician or doctor will be able to get a view of what’s going on in those ovaries and the number of follicles available this cycle.
• Better accuracy: Some at-home tests may have varying levels of accuracy when compared to in-clinic tests.
• Facetime: At a clinic, you’ll have the ability to chat directly with a doctor, before and after your results.

Although at-home fertility tests are a great way to get a peek behind the curtain of your fertility, they aren’t without limitations. For starters, according to recent studies, measuring AMH alone may not predict your time to pregnancy. As mentioned above, testing your fertility with a doctor at a clinic will likely provide a more comprehensive picture of your fertility outlook, especially as they consider your medical history, and conduct a physical exam and transvaginal ultrasound. Of course, you’ll also get professional interpretation of the results that you may not receive with an at-home fertility test. 

All of that being said, any fertility testing (whether at home or in a clinic) only measures your fertility at that given point in time. It should not be taken as a guarantee for future outcomes. It also can’t tell you anything about your egg quality, which cannot be truly observed until it comes time to actually fertilize those eggs. 

You are not a number

Repeat after me: you are more than one number! Your AMH level provides valuable insights into your ovarian reserve, but it’s just one piece of the puzzle when it comes to your fertility. AMH is always used as part of a full fertility evaluation, which often includes information about your medical history and age, a partner semen analysis, an ultrasound of the pelvis, an x-ray of the uterus and fallopian tubes, and/or additional lab work.

If that sounds like a lot, it is. This process can be overwhelming but focusing on the things that you can control can help you feel more grounded during your fertility journey, whatever that may look like.

Read more:

• Which Matters More for Fertility: AMH or Age?
• What AMH Level Do I Need to Freeze My Eggs?
• What Does a High AMH Result Mean?
• What Does a Low AMH Result Mean?
• Birth Control and AMH Levels
• What Medications and Supplements Affect AMH Levels?
• What AMH Do I Need to Donate my Eggs?
• AMH and Egg Retrieval Outcomes

Are you ready to embark on a journey through the fascinating world of female fertility hormones? We've got all the details on those tiny chemical messengers that hold the key to your reproductive prowess. Whether you're curious about boosting your chances of egg freezing success or simply want to understand the inner workings of your amazing body, this article will dive into a hormonal adventure that will leave you feeling empowered and in control. Let’s go!

Anti-Mullerian Hormone (AMH)

What it is

The most talked about hormone of them all: AMH. AMH is produced by the developing follicles in the ovaries and serves as an biomarker of ovarian reserve. It helps estimate the quantity of eggs remaining in the ovaries and is commonly used in assessing how well your body will respond to IVF or egg freezing. 

Normal AMH levels

You can take an AMH test any time in your cycle. In general, AMH levels can be interpreted by:

• Above 1.0 ng/ml (nanograms per deciliter): Normal
• Below 1.0 ng/ml: Showing weakness in the ovarian reserve
• Below 0.5 ng/ml: Showing severe weakness in the ovarian reserve

Keep in mind that lab numbers can vary. Your blood test results will show the lab’s normal range on the report.

What AMH can tell you

As we age, our AMH levels naturally decrease until we hit menopause and our AMH reaches 0. While the decline in fertility happens to ALL of us, the specific age when we can no longer conceive varies from individual to individual. And in some cases, it may be earlier than expected. AMH can give us insight into where we are on that journey.

While AMH is pretty awesome, there are two things it can’t tell us: (1) it can’t tell us the quality of the eggs remaining and (2) it can’t tell us our chances of getting pregnant unassisted.

Estrogen

What it is

Estrogen hormone is the ultimate multitasker, responsible for so many amazing things. It's the power behind that glowing, radiant skin and full, thick hair. And it also takes charge of thickening the uterine lining each month, which either sets the stage for a growing embryo, or culminates in your period.

Estrogen is actually a collective term used to describe a group of hormones that play a vital role in the female reproductive system. It includes three types of hormones: 

• Estrone (E1) which is the only type of estrogen that our bodies keeps making even after menopause
• Estradiol (E2) causes the maturation and release of the egg as well as the thickening of the uterus lining each month
• Estriol (E3) is really only present during pregnancy, and helps the uterus grow and stay healthy

Estrogen levels fluctuate throughout the menstrual cycle, with estradiol being the dominant form during the follicular phase (leading up to ovulation) and progesterone taking the lead during the luteal phase (after ovulation). Understanding the dynamics and functions of estrogen and estradiol can help shed light on the intricate mechanisms underlying female reproductive health.

Altogether, estrogen plays a key role in regulating the menstrual cycle, supporting the growth and development of the uterus and breasts, and maintaining bone health.

Normal E2 levels

Estrogen levels fluctuate throughout your life, often aligning with other hormones that regulate crucial bodily functions, such as the menstrual cycle. These dynamic changes in estrogen levels are considered a normal part of the body's hormonal rhythm. 

Estradiol (E2) is the hormone most often tested for fertility. E2 levels vary widely through the menstrual cycle, and are expected to fluctuate from test to test. A normal range is considered:

• Premenopausal: 30 to 400 pg/mL (110 to 1468.4 pmol/L)
• Postmenopausal: 0 to 30 pg/mL (0 to 110 pmol/L)

There can be variations in the normal value ranges for laboratory tests, as different laboratories may use different measurement methods (e.g. saliva, blood prick, or venipuncture) or test different samples. Your doctor will be able to provide you with accurate interpretation and insights based on your individual circumstances.

What E2 can tell you

If you consistently test on the lower range, it may indicate the onset of menopause, premature ovarian failure, or low estrogen from rapid weight loss or anorexia. If your results are higher, it may suggest a tumor of the ovary.

Follicle-Stimulating Hormone (FSH)

What it is

‍FSH is the ultimate fertility cheerleader. Like the squad captain, FSH leads the charge in the growth and development of those ovarian follicles, which contain the eggs. It's the one shouting, "Let's grow those eggs, ladies!" 

Our FSH levels change throughout the menstrual cycle, with the highest levels happening just before ovulation (when an egg is released by the ovary).

Normal FSH levels

For fertility testing, you need to have the FSH blood test on day 3 of your menstrual cycle (day 1 is the day your period begins). In general, normal FSH levels are:

• Premenopausal: 4.7 to 21.5 mIU/mL
• Postmenopausal: 25.8 to 134.8 mIU/mL

Keep in mind that lab numbers can vary. Your blood test results will show the lab’s normal range on the report.  

What FSH can tell you

‍Higher-than-normal levels of FSH can be a sign of infertility due to premature ovarian failure or menopause. It could also be due to certain types of tumors in the pituitary gland, or due to Turner syndrome.

Lower levels could mean pregnancy, being very underweight or having had recent rapid weight loss, not ovulating, or that parts of the brain are not producing normal amounts of hormones. If you have abnormal results, your doctor will discuss your situation and next steps. 

Luteinizing Hormone (LH)

What it is

This hormone takes center stage and demands attention as it triggers the grand finale of the menstrual cycle: the release of a mature egg. LH sends that egg on its way, ready for its moment in the spotlight and a chance at fertilization.

While LH has a major job for our reproductive system, it’s actually secreted by a tiny structure in your brain called the pituitary gland.

Normal LH levels

LH fluctuates throughout your cycle, and the ranges are:

Premenopause: 5 to 25 IU/L

Postmenopause: 14.2 to 52.3 IU/L

Remember, lab numbers can vary. Your blood test results will show the lab’s normal range on the report.  

What LH can tell you

Abnormal LH levels can indicate ovulatory disorders, such as polycystic ovary syndrome (PCOS) or hypothalamic amenorrhea. 

LH testing (via urine test strips) can also help to predict ovulation. By detecting the LH surge each cycle, these test strips give us a glimpse into our fertile windows, or when we’re most likely to get pregnant. 

Progesterone

What it is

Progesterone swoops in after ovulation (which, remember, was ushered in by LH) to prepare the uterine lining, transforming it into a cozy, welcoming haven for a potential embryo. Progesterone is crucial for early pregnancy, helping maintain the thickened endometrium. But if an egg isn’t fertilized during that cycle, progesterone levels decrease, your uterine lining thins, and your period begins. 

Normal progesterone levels

• Pre-ovulation: less than 1 nanogram per milliliter (ng/mL) or 3.18 nanomoles per liter (nmol/L)
• Mid-cycle: 5 to 20 ng/mL or 15.90 to 63.60 nmol/L
• Postmenopausal: less than 1 ng/mL or 3.18 nmol/L
• Pregnancy 1st trimester: 11.2 to 90.0 ng/mL or 35.62 to 286.20 nmol/L
• Pregnancy 2nd trimester: 25.6 to 89.4 ng/mL or 81.41 to 284.29 nmol/L
• Pregnancy 3rd trimester: 48 to 150 to 300 or more ng/mL or 152.64 to 477 to 954 or more nmol/L

What progesterone can tell you

While LH tests can help us predict when we’re about to ovulate, progesterone tests can help confirm if we actually did ovulate. 

If you have low progesterone and aren’t pregnant, you may have symptoms like irregular periods, infertility, mood changes, trouble sleeping, or hot flashes.

If you have low progesterone and are pregnant, it could mean a higher risk of miscarriage or an ectopic pregnancy.

Prolactin

What it is

Prolactin is the hormone that orchestrates the magic of breastfeeding. It causes the breasts to grow and make milk during pregnancy and after birth. While its primary role lies in the breastfeeding realm, elevated levels of prolactin when not pregnant or postpartum can sometimes interfere with ovulation and menstrual regularity.

Normal prolactin levels

Made in the the pituitary gland, normal levels of prolactin are:

• Nonpregnant: less than 25 ng/mL (25 µg/L)
• Pregnant: 80 to 400 ng/mL (80 to 400 µg/L)

Keep in mind that lab numbers can vary. Your blood test results will show the lab’s normal range on the report. Talk to your doctor about your specific results.

What prolactin can tell you

Abnormally high levels of prolactin when you are not pregnant could mean a condition called hyperprolactinemia, which is actually quite common. Believe it or not, about a third of women in their childbearing years with irregular periods (but perfectly normal ovaries) have hyperprolactinemia. Hyperprolactinemia could mean trouble getting pregnant. Not to mention, your boobs might start producing milk when you're not even expecting it (hello, galactorrhea!).

High prolactin levels can also throw a wrench in the normal hormone production, messing with the likes of estrogen and progesterone. And when that happens, it can disrupt ovulation or lead to irregular or missed periods. 

Thyroid-Stimulating Hormone (TSH)

What it is

This hormone ensures that our thyroid gland, that tiny powerhouse in our neck, is working harmoniously. Thyroid health is crucial for maintaining menstrual regularity and fertility, so when TSH steps onto the scene, you know it's time to keep that thyroid in check!

Normal TSH levels

Another hormone produced by the pituitary gland, TSH can give us insight into thyroid disorders, such as hypothyroidism or hyperthyroidism.

• Nonpregnant: 0.27 – 4.2 uIU/mL.
• First trimester (9 to 12 weeks): 0.18 – 2.99 (uIU/mL).
• Second trimester: 0.11 – 3.98 uIU/mL.
• Third trimester: 0.48 – 4.71 uIU/mL.

What TSH can tell you

Low levels of TSH typically indicate hyperthyroidism, or overactive thyroid, when your thyroid gland is making excess thyroid hormone. On the other hand, high levels of TSH may suggest an inadequate production of thyroid hormone, leading to a condition called hypothyroidism or underactive thyroid. 

Testosterone

While testosterone is often associated with male reproductive health, females also produce small amounts of testosterone from the ovaries. It helps preserve muscle mass and supports an overall sense of wellbeing. It also helps the development of those follicles and even plays a role in boosting our libido.

Testosterone does fluctuate throughout your cycle, so if you notice that your libido surges at certain times of your cycle (usually around ovulation), you can thank testosterone.

Normal testosterone levels

15 to 70 ng/dL or 0.5 to 2.4 nmol/L

What testosterone can tell you

Abnormal testosterone levels can negatively affect fertility. 

Too little testosterone could mean you are nearing menopause or have premature ovarian failure. It could also be lower due to certain medications, malnutrition, chemotherapy/radiation, 

Too much testosterone could be a sign of PCOS.

At-home fertility hormone testing

If you’re curious to test your hormones, you'll be glad to know that there are convenient at-home options available. These tests allow you to assess your hormone levels from the comfort of your own home, providing valuable insights into your reproductive health. 

Let's take a closer look at some of the top at-home fertility hormone testing options for you to consider:

• LetsGetChecked Ovarian Reserve Test: For $139, this test specifically focuses on measuring anti-Müllerian hormone (AMH), a critical marker for ovarian reserve. By understanding your ovarian reserve, you can make informed decisions about family planning and fertility preservation.

These at-home fertility hormone testing options give you the opportunity to better understand your reproductive health. But keep in mind that if you are planning to freeze your eggs, your doctor may want you to test again. 

Summing it up

These fertility hormones - AMH, Estrogen, FSH, LH, Progesterone, Prolactin, and Testosterone– work in harmony to regulate the menstrual cycle, facilitate ovulation, prepare the uterus for pregnancy, and support early gestation. 

Imbalances or abnormalities in these hormone levels can affect fertility and reproductive health. Unfortunately for many of us, we don’t find out there’s a problem until we start trying. 

Evaluating the levels of these hormones through diagnostic tests can provide insights into your fertility health and empower you with knowledge to make informed decisions about your reproductive journey.

By understanding your hormone levels, you can identify potential issues that may hinder reproductive health, now or in the future. 

Sources:

• Estradiol (Blood). Health Encyclopedia. University of Rochester Medical Center. URL
• Follicle-stimulating hormone (FSH) blood test. Mount Sinai. URL
• Shufelt CL, Torbati T, Dutra E. Hypothalamic Amenorrhea and the Long-Term Health Consequences. Semin Reprod Med. 2017;35(3):256-262. doi:10.1055/s-0037-1603581. URL
• Hyperprolactinemia (High Prolactin Levels). ReproductiveFacts.org. URL
• Testosterone. Mount Sinai. URL
• Soman M, Huang LC, Cai WH, et al. Serum androgen profiles in women with premature ovarian insufficiency: a systematic review and meta-analysis. Menopause. 2019;26(1):78-93. doi:10.1097/GME.0000000000001161. URL

More and more people in the US (and the rest of the world) are taking control of their reproductive health and fertility by choosing to freeze their eggs. Whether this is so they can focus on a career, get an insurance policy with coverage for treatments, or because of medical reasons, this has allowed people to delay having children until whenever they’re ready to start a family.

If you’re thinking about freezing your eggs, you probably have tons of questions. In this article, we’re going to focus on a very common question: “How can I increase my chances of success when I freeze my eggs?”

Factors that can affect egg freezing success rates

Before an egg freezing cycle

Let’s start by going through what specific things make a difference in your chances of success before you even freeze your eggs.

Age

Age has been proven by countless research studies to be one of the biggest determinants of egg quality. As a person ages, their eggs are more likely to become aneuploid, meaning they’re genetically “abnormal.” This can lead to issues with both getting and staying pregnant (i.e, higher risk of miscarriages). On top of that, as a person ages, the number of eggs their ovaries contain continues to decrease naturally. Once a person reaches their mid to late thirties, the quality and quantity of eggs starts to go down more quickly. While there is no “perfect” age at which to freeze your eggs, freezing them before you reach your late 30s is considered ideal. 

AMH level

Another important factor is your Anti-Müllerian hormone (AMH) level. This is a simple blood test that is commonly used to tell us a person’s reproductive potential based on the number and the quality of eggs they have left in their ovaries. AMH is released by antral follicles, which are small, fluid-filled sacs in the ovaries that each contain a single oocyte (immature egg). Your AMH level is positively correlated with the number of antral follicles you have in your ovaries. Simply stated, the more follicles you have, the higher your AMH level typically is. AMH naturally goes down as a person gets older until it reaches close to zero during perimenopause. While there is no international standard for what a normal AMH level is, some studies have tried to create models for what’s considered normal for specific ages. Check out this article to find out more about AMH levels at different ages.

Antral follicle count

Antral follicle count (AFC) is another number to be aware of before egg freezing. AFC is used in fertility assessments to estimate the number of developing follicles in someone’s ovaries at a specific point in the menstrual cycle using ultrasound. As mentioned before, the more follicles you have (the higher your AFC is), the higher your AMH level. And just like your AMH, your AFC will also naturally go down as you age. 

How these values affect your egg freezing success 

Unfortunately, there isn’t a lot that can be done about aging or about the decline in AMH and AFC that goes with it but there are a few things to know about how they affect your egg freezing changes. 

• Ovarian reserve assessment. Age, AMH and AFC all provide valuable information about a person’s ovarian reserve. In general, younger age, higher AMH levels, and a higher AFC are good indicators that you have a larger pool of potential eggs in the ovaries. This means that you’re more likely to produce more eggs during an egg retrieval cycle, which increases the chances of a successful egg freezing cycle.
• Response to ovarian stimulation. Part of the egg freezing cycle includes taking medications to stimulate the ovaries to develop multiple eggs at once (as opposed to just one during a natural, unmedicated menstrual cycle). The response to these medications can vary based on age, AMH, and AFC. People who are younger and those who have a higher AFC/AMH tend to have a better response and produce more mature eggs during the stimulation. This increases the chances of retrieving a larger number of high-quality eggs for freezing.
• Number of cycles. In some cases, people with a lower AFC and/or AMH may have to go through more than one egg freezing cycle in order to get an adequate number of eggs. This can get costly and time-consuming pretty quickly.
• Future fertility potential. The number and quality of frozen eggs affects the chances of having a successful pregnancy when the frozen eggs are later thawed, fertilized, and transferred during an in vitro fertilization (IVF) treatment. A higher AFC and AMH can mean a higher number of frozen eggs, which increases a person’s chances of success in the future. However, neither of these numbers is the end-all-be-all here. In fact, while AMH does seem to have some association with live birth rates after IVF, its ability to actually predict a live birth is not that great, especially for younger people.

Again, all three of these factors aren’t necessarily things you can change so it can be easy to get discouraged if your values aren’t where you want them to be. Remember that each of these is just one value your provider looks at to assess your overall reproductive potential. No value by itself can completely predict your chances of conceiving naturally or define your fertility. A comprehensive assessment of a person’s fertility potential has to be done by a fertility specialist before jumping to any conclusions and making decisions about fertility preservation.

During an egg freezing cycle

Now, let’s go through the factors during an egg freezing cycle that can affect your chances of success.

Quantity and quality of eggs retrieved

The success rates of egg freezing cycles are significantly influenced by both the number and quality of eggs retrieved. The number of eggs retrieved is important because it directly correlates with the chances of developing viable embryos after thawing. This is definitely a case of “more is more”--the more eggs that are successfully frozen, the higher the probability of having viable embryos when the time comes. 

However, the quality of the retrieved eggs is just as important. High-quality eggs have a better chance of surviving the freezing and thawing process than low-quality ones. So, as you can imagine, a cycle with lots of eggs that are all low-quality isn’t necessarily more successful than another cycle that produced less eggs but they’re all high-quality. 

As a result, fertility providers will always aim to maximize both the quantity and quality of the eggs retrieved. This is essential for improving  the success rates of egg freezing cycles so that, ultimately, we end up with healthier embryos and better chances of a successful pregnancy.

Type of freezing method used 

There are two main techniques used for freezing eggs: slow freezing and vitrification. The slow freezing method involves gradually lowering the temperature of the eggs, which allows ice crystals to form within the cells. This process can damage the delicate internal structure of the eggs, which can lead to lower viability and success rates once the eggs are thawed. In contrast, vitrification is a freezing process that solidifies the eggs quickly without forming ice crystals. This method protects the cell’s internal structures better and has been shown to increase post-thaw survival rates. This in turn, means higher success rates during IVF treatments. It makes complete sense, then, that vitrification has become the preferred way to freeze eggs.

Tips to increase egg freezing success rates

Alright, so now that we’ve established what’s important when it comes to egg freezing, what exactly can you do to maximize these factors for yourself? 

• Consider freezing your eggs at a younger age. There may not be much we can do about the fact that we’re all getting older but in terms of egg freezing, the general rule is that the younger you can do it, the better. According to the American Society for Reproductive Medicine (ASRM), the ideal time to freeze your eggs is in your 20s and early 30s, while you have more eggs and those eggs are healthier. So, whether you’re 25 or 35, your eggs today are still probably healthier than your eggs in one, five or 10 years!
• Optimize your fertility health before beginning the egg freezing process. This step will look a little different from person to person since everyone has their own unique medical history and concerns. Generally speaking though, optimizing your health will include following a balanced diet and making other healthy lifestyle choices. In some cases, you may want to consider adding certain vitamins and supplements to your regimen too. Make sure to talk to your fertility specialist if you’re not sure!
• Consider using a different type of freezing method. Ask your fertility provider which method they plan to use when freezing your eggs. Vitrification is the more common method now given its improved outcomes when compared to slow freezing but it doesn’t hurt to confirm that this is the method your particular clinic uses.   
• Consider doing multiple egg retrieval cycles. If you have the resources and time to do multiple cycles, this can vastly improve the pool of eggs to choose from in the future. This is an especially helpful option for people who are older or have a low AMH level or AFC. If your fertility provider thinks more cycles will improve your chances, they’ll discuss those recommendations with you.
• Be particular about the clinic you choose. There are a ton of fertility clinics to choose from nowadays, so take the time to do some detective work and find one that works for your needs. If you know people who’ve used a fertility clinic, ask them for their honest opinions. Read reviews. Look up the providers’ credentials (usually listed on the clinic’s website). You can also find out the clinic’s success rates in terms of live births and other important statistics through their website. Schedule a couple consultations to compare your options. Make sure to come with questions and to actually ask them all. If you’re not sure what to ask, check out some suggestions here. 

Emotional considerations

It’s important that we take a second to talk about the emotional side of this experience. For many people, the decision to freeze their eggs is tied to hopes of preserving future fertility. When a lab test or a cycle doesn't yield the desired results, there can be feelings of hopelessness, frustration, sadness, anxiety, and uncertainty about future family planning options. On top of that, this isn’t a cheap or simple process! So there can be disappointment stemming from both the financial and physical investments that have been made. 

Because of all of this, seeking support and guidance throughout this process has to be a priority. Support from both loved ones and through professional counseling can make a huge difference when it comes to coping with the emotions you might be dealing with. 

Establishing clear and open communication with your fertility providers also plays a key part in helping people cope with the challenges that might come up. Your providers know the ins and outs of your particular situation so they’re the most qualified to tell you what you need to prioritize (and what you can ignore) to improve the success of your egg freezing cycle(s).

With all the nuances involved here, it’s important not to get lost in the weeds. Fertility is impacted by so many factors that you can drive yourself crazy trying to manage all of them. Remember, you are more than any number. 

Conclusion

To recap, there are several different factors that can affect the success of an egg freezing cycle including your age, AMH level, AFC, the number and quality of eggs retrieved, and the type of freeing method used. Some of these, you don’t have control over. For the ones you can control, there are a few things you can do. 

Optimizing your fertility health before the egg freezing process, freezing your eggs at a younger age, doing more than one cycle, and using a safer freezing option are all ways that you can improve your chances of a successful freezing cycle. This process can be so overwhelming— focusing on the things that you can control can help you feel more grounded throughout your fertility journey. 

Freeze by Co is here to help you every step of the way on that journey. With our Keep program, you’re able to freeze your eggs and keep them all for yourself, on your timeline. In addition, you’ll have access to our online support community, the Nest. This is a valuable resource that lets you engage with other people freezing their eggs at the same time!

I was 28 when I first started trying to conceive. I vividly remember taking my last birth control pill, throwing out my pack, and texting my friend to tell her we were no longer “not trying,” excited but nervous. Sounds pretty standard, right? Unfortunately, what I didn’t know at the time was that I was about to embark on a two-and-a-half-year journey to get pregnant with my son. This included several pregnancy losses, a few rounds of IVF, and lots of questions, including, “should I have tested my fertility sooner?”. 

I don’t share this to scare anyone. But my story is not all that uncommon. In fact, 1 in 6 individuals experience some form of fertility challenge. 

I was woefully unprepared. And because of this lack of preparedness by Sex Ed as well as limited time with my OBGYN, it probably took a good six months before I started to understand what actually goes into conceiving a healthy pregnancy: timing, lifestyle, genetics, and more. So much of my time, stress, and probably money could have been saved by proactive fertility testing.

In this article, we’ll discuss when to test your fertility, the importance of early fertility awareness, and proactive measures you can take to understand it. If you take one thing away from this article, though — the best time to test your fertility is right now. Let’s talk about why. 

So what is fertility testing, anyway?

Before we dive into when to test your fertility, it’s important to understand what fertility testing even is. 

Ovarian reserve testing

A fundamental concept of assessing one’s fertility is to understand their ovarian reserve. This involves evaluating the quantity of a woman's remaining egg supply (oocytes) in her ovaries. One of the most widely used tests for ovarian reserve (though not without its limitations — more on that below) is the measurement of Anti-Mullerian Hormone (AMH) levels, which can be done with a simple blood test. 

Understanding AMH

AMH is a protein produced by cells in the ovarian follicles, with levels of AMH in your blood providing an indication of the number of eggs remaining in your ovaries. If you’re considering egg freezing, AMH testing is especially valuable, as it helps assess your starting point and may indicate a timeline of how urgently you may want to move forward with freezing your eggs. 

Your AMH may also give a sense of how your ovaries might respond to the actual egg freezing process. Lower AMH levels typically suggest a diminished ovarian reserve, which may impact fertility potential. In general, an AMH between 1.0 - 3.5 ng/mL is considered a “normal” range. 

Individuals with a higher AMH level — which varies by lab, but could be anywhere over 3.0 ng/ml — usually have a better response to ovarian stimulation, leading to a higher number of eggs likely to be retrieved during the procedure. That said, a higher AMH also carries a greater risk of ovarian hyperstimulation syndrome (OHSS), so your doctor will need to be careful with your medication protocol and monitoring.

Should I test my fertility at home or in a clinic?

At-home fertility tests have gained popularity in recent years due to their convenience and privacy. These tests typically involve collecting blood or urine samples and mailing them to a laboratory for analysis. On the other hand, in-clinic fertility tests are conducted at a medical facility, where specialized equipment and healthcare professionals are available.

The pros of at-home fertility tests

• Convenience and privacy: Samples can be collected in the comfort of your home.
• Cost-effective: At-home tests are often more affordable than in-clinic procedures.
• Early assessment: At-home tests allow you to gain insights into your fertility potential before actively trying to conceive. Plus, you won’t have to wait to get squeezed in for an appointment at the clinic!

The pros of testing your fertility at a clinic

• A broader scope: At-home tests may not provide a comprehensive evaluation of fertility health, while testing your fertility at a clinic provides a more comprehensive picture of your fertility. An important note is, when testing your fertility at a clinic, you’ll also undergo a transvaginal ultrasound, where the technician or doctor will be able to get a view of what’s going on in those ovaries and the number of follicles available this cycle.
• Better accuracy: Some at-home tests may have varying levels of accuracy when compared to in-clinic tests.
• Face time: At a clinic, you’ll have the ability to chat directly with a doctor, before and after your results.

When should I test my fertility? 

So, when is the “right” age for testing your fertility, anyway? 

It depends.

And ultimately, it’s up to you! It’s your body, and your data, and there is no one-size-fits-all answer. We’re firm believers that knowledge is power and you deserve this information. Studies do show that our ovarian reserve declines with age — in other words, it’s a good idea to assess your fertility potential sooner rather than later. That way, if you do want to preventatively freeze your eggs, you can do so while your ovarian reserve is still higher. 

According to the American Society for Reproductive Medicine (ASRM), the optimal time to freeze your eggs is in your 20s and early 30s. And this study indicated that, as we get older, our chances increase of needing to do multiple egg freezing cycles in order to achieve a 70% live birth rate. We know we’re a bit of a broken record here, but: the younger you are, the healthier and more plentiful your eggs are. 

Consider your egg freezing plans

Because the ASRM doesn’t recommend egg freezing for people older than 38 (although this is not a hard and fast rule), it’s a good idea to test your fertility earlier on if possible. That way, should you decide to move forward with egg freezing, you’ll have the time and space to come up with a plan and hopefully see some successful results.

If and when you decide to move forward with egg freezing, you can freeze your eggs more affordably (even for free!) with Cofertility. Fill out this quick quiz to learn about our accessible egg freezing options and see if you qualify for our programs — it only takes one minute.

Should I test my fertility in my 20s?

Testing your fertility in your 20s gives you the most flexibility. Whether your testing looks great and you want to freeze your eggs now, or you uncover potential fertility risks to address, the more time you have, the better. 

Your doctor may even recommend fertility testing if you have past or current reproductive health issues, including sexually transmitted infections (STIs), endometriosis, or PCOS, all of which can contribute to fertility challenges. Even if you’re not yet sure if you want to start a family in the future, testing your fertility in your 20s may help you make informed decisions about family planning options down the line. 

Best at-home fertility tests

If you’re curious to learn more about your ovarian reserve, talk to your doctor about fertility testing. If your doctor won’t order the tests…you might want to find a new one who listens to your concerns and takes them seriously. But in the meantime, there are many great at-home fertility testing options out there. 

LetsGetChecked Ovarian Reserve Test

Cost: $139 

Hormones measured: AMH

Why we like it: While it only tests one hormone, the test is simple and fast.

Remember: at-home fertility tests aren’t without limitations

Although at-home fertility tests are a great way to get a peek behind the curtain of your fertility, they aren’t without limitations. For starters, according to recent studies, measuring AMH alone may not predict your time to pregnancy. As mentioned above, testing your fertility with a doctor at a clinic will likely provide a more comprehensive picture of your fertility outlook, especially as they consider your medical history, and conduct a physical exam and transvaginal ultrasound. Of course, you’ll also get professional interpretation of the results that you may not receive with an at-home fertility test. 

All of that being said, any fertility testing (whether at home or in a clinic) only measures your fertility at that given point in time. It should not be taken as a guarantee for future outcomes. It also can’t tell you anything about your egg quality, which cannot be truly observed until it comes time to actually fertilize those eggs. 

Consider egg freezing as a proactive measure

After testing your ovarian reserve, it’s worth considering freezing your eggs if you don’t want kids soon. We’ll be the first to say that egg freezing is not a guarantee for a successful pregnancy in the future — those eggs need to be fertilized into embryos, transferred to a uterus, and then carried for 40 weeks to result in a live birth! But because our fertility declines with age, the earlier we preserve it, the more set up for success we may be in the future if we do need to use those eggs down the line. 

How does egg freezing work? 

As a primer, egg freezing allows individuals to preserve their fertility by freezing and storing their eggs for future use (fertilization). Let’s get into some of the specifics. 

Some benefits of egg freezing

There are many reasons why egg freezing can be beneficial, including: 

Delaying parenthood: Egg freezing enables individuals to postpone childbearing to pursue educational, career, or personal goals while increasing their chances of having a healthy pregnancy down the line.

Medical reasons: Some medical treatments, such as chemotherapy or radiation, can impact fertility. Egg freezing offers a proactive option for individuals facing medical conditions that may affect their reproductive health.

Preserve higher quality eggs: As we age, our ovarian reserve diminishes, and the quality of our eggs declines. By freezing eggs at a younger age, individuals can preserve their eggs when they are of higher quality.

The egg freezing process

Overall, the egg freezing process is a 10-14 day period involving ovarian stimulation, the actual egg retrieval, and storing the frozen eggs. Here’s what goes into each.

Ovarian stimulation: Before the egg retrieval, individuals typically take injectable hormone medications for about 10-14 days. This process encourages the ovaries to produce multiple mature eggs. You’ll head to the clinic for monitoring every few days (more frequently as you get closer to your retrieval) so your doctor can check on how things are progressing and make updates to your medication protocol if needed.

The egg retrieval: Once the eggs are mature, a minimally invasive procedure known as transvaginal ultrasound-guided aspiration is performed to retrieve the eggs from the ovaries. The procedure is usually well-tolerated and does not require a surgical incision.

Cryopreservation: After retrieval, the eggs are frozen using a process called vitrification. This method prevents the formation of ice crystals, which could damage the eggs during freezing. You’ll store your eggs in a special storage facility meant for just that. 

For an in-depth overview of the egg freezing process, click here.

Success rates of egg freezing

The success of egg freezing largely depends on the age at which the eggs are frozen. Generally, eggs frozen at a younger age have a higher chance of resulting in a successful pregnancy. Advanced vitrification techniques have significantly improved egg freezing success rates, with some studies reporting comparable pregnancy rates between fresh and frozen-thawed eggs.

One study of 1,241 women found that the average number of eggs retrieved on the first egg freezing round was:

• 21 eggs for women under 35
• 17 eggs for women 35-37
• 14 eggs for women 38-40

But, in addition to egg quantity, we also need to consider egg thaw survival rate, and the rate at which these eggs become embryos and result in a live birth. According to a study in the Journal of Assisted Reproduction and Genetics, a woman under 35 will need 9 eggs to achieve a 70% chance of having at least one live birth. If you’re trying to conceive in your mid to late 30s, you may need double as many eggs to achieve that same 70% success rate. 

Not only will freezing your eggs proactively give you the options of utilizing higher quality eggs in the future, it also helps alleviate the pressure of finding a reproductive partner, and can allow us to feel empowered to make family planning decisions on our own terms without any compromises. Taking a proactive approach to fertility preservation can provide the freedom to pursue opportunities without sacrificing the dream of having a family when the time is right.

Freezing your eggs with Cofertility

With Freeze by Co, you have the opportunity to apply to our Split program, where you can freeze your eggs for free when you donate half of the retrieved eggs to a family that can’t otherwise conceive. The cost of the entire process, including 10 years of cryopreservation, is fully covered. 

Or, if you want to freeze and store your eggs for your own future use without donating, as part of our Keep program, we offer lower prices on things like consultations and storage, along with access to our community of others going through the process at the same time. ‍Plus, you’ll have direct access to our team, which is here to support you throughout the entire journey.

Summing it up

If you’re considering testing your fertility, the best age to do it is now. Whether you test yourself at home, or with a doctor at a fertility clinic, testing your fertility can provide valuable insights into what your family-building future may look like. It might also uncover the need for egg freezing in order to preserve some of your existing fertility as it stands today. But whatever you decide to do with the results, you’ll at least be armed with more information about yourself than you would have had otherwise.