hormones

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 test

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. 

Understanding reproductive health is crucial, especially when it comes to fertility. Anti-Müllerian hormone (AMH) is one of the key markers used to assess ovarian reserve, which refers to the quantity of eggs. Many factors can impact AMH levels, including age, genetics, and certain medical conditions.

One common question that arises is whether birth control, a widely used contraceptive method, can affect AMH levels. In this article, we will explore the relationship between birth control and AMH levels to shed light on this topic and provide valuable insights for those concerned about their fertility.

What is AMH?

Before delving into the impact of birth control on AMH levels, let's first understand what AMH is and its significance in assessing ovarian reserve. AMH is a protein produced by the small follicles in the ovaries. These follicles contain immature eggs, and the level of AMH in the blood provides an estimate of the remaining egg supply. Ovarian reserve tests can help you make decisions about egg freezing. In general, higher AMH levels indicate a larger number of follicles and potentially better ovarian reserve, while lower levels may suggest a diminished egg supply.

Can birth control affect your AMH levels?

One common concern among women is whether taking birth control can influence AMH levels. Birth control methods, such as oral contraceptive pills (aka “the pill”), patches, injections, and intrauterine devices (IUDs), work by regulating hormones and preventing ovulation. So it is reasonable to question whether these hormonal interventions can impact AMH levels.

Research suggests that hormonal birth control may affect AMH levels. But it depends on the type of birth control.

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 than for women who are not on contraceptives, with variation depending on the type of birth control

Learn more: Egg Freezing and Birth Control: An Overview

The amount of time you are on birth control may also be a factor. A systematic review of 15 studies concluded that AMH is unchanged in women using combined oral contraceptive pills if they were using it under six months. 

However, they found a lower AMH in long-term users of the pill. But it’s just temporary – AMH levels rebounded after they stopped using birth control.

Is AMH accurate if on birth control pills?

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.  

Do I need to get off birth control to get AMH tested?

In general, it is not necessary to discontinue birth control before getting an AMH test. However, it's important to be aware that hormonal contraceptives, such as oral contraceptive pills, can potentially lower AMH levels temporarily while being used. This means that if you are currently using birth control, the AMH results may be lower than they would be if you were not on contraceptives.

If you are concerned about the accuracy of your AMH test or have specific fertility-related questions, it’s best to consult with a fertility doctor. They can provide personalized guidance based on your individual circumstances and help you understand how birth control may impact your AMH results. They will take into consideration factors such as the type of birth control you are using, your reproductive goals, and any underlying medical conditions. This will help ensure that you receive the most accurate and relevant information regarding AMH testing and its interpretation.

Will my AMH change if I get off birth control?

AMH can and will change throughout your life. And, it is generally believed that AMH levels should return to their baseline after stopping hormonal contraceptives. 

Birth control methods, such as oral contraceptive pills, work by suppressing ovulation and altering hormone levels. Once you discontinue birth control, your body will naturally resume its normal hormonal patterns, and AMH levels should stabilize accordingly.

Individual responses to stopping birth control may vary. Some may experience a temporary fluctuation in their hormone levels as their body adjusts, which could potentially affect AMH measurements. However, these fluctuations are typically short-lived, and AMH levels should gradually return to their baseline within a few menstrual cycles.

If you are planning to assess your ovarian reserve through an AMH test, you may want to wait for a few weeks or consult with your fertility doctor to determine the most appropriate timing after discontinuing birth control. This will help ensure a more accurate assessment of your current ovarian reserve without the influence of hormonal contraceptives.

Remember, AMH levels provide valuable insights into ovarian reserve but are just one piece of the puzzle when it comes to fertility. 

Does birth control help egg reserve?

Although birth control does not directly affect AMH levels or egg reserve, it can provide some indirect benefits related to reproductive health. By preventing ovulation and regulating menstrual cycles, birth control can help manage various gynecological conditions such as polycystic ovary syndrome (PCOS), endometriosis, and irregular periods. By providing symptom relief and controlling hormone levels, birth control can potentially improve overall reproductive health (thanks birth control!).

Additionally, certain forms of birth control, such as combined oral contraceptive pills, may help reduce the risk of ovarian cysts and decrease the incidence of ovarian and endometrial cancers. These benefits contribute to the overall well-being of your reproductive system, indirectly supporting egg reserve.

AMH and egg sharing

If you are looking to donate your eggs through Cofertility’s Split program, where you freeze for free in exchange for donating half to a family that could not otherwise conceive, 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.

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. 

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.

Or, 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.

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.

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

Summing it up

Understanding reproductive health is crucial, especially when it comes to fertility. AMH is a key marker used to assess ovarian reserve, which refers to the quantity eggs. While birth control does not directly impact AMH levels or egg reserve, it can have temporary effects on AMH measurements while being used. The type and duration of birth control can influence the degree of impact on AMH levels. 

If you are currently using birth control, it is not necessary to discontinue it before getting an AMH test. However, it's important to be aware that hormonal contraceptives can potentially lower AMH levels temporarily. This means that the AMH results may be lower than they would be if you were not on contraceptives. Consulting with a fertility doctor can provide you with specific guidance on timing and interpretation of AMH results.

If you decide to discontinue birth control, AMH levels should return to their baseline over time as your body adjusts to its natural hormonal patterns. Temporary fluctuations in hormone levels may occur, but these are typically short-lived, and AMH levels should stabilize within a few menstrual cycles. (And if you do discontinue birth control, definitely use backup contraception during that period if you’re trying to avoid pregnancy). 

Remember, AMH levels provide valuable insights into ovarian reserve, but they are just one piece of the puzzle when it comes to fertility. Consulting with a fertility doctor can help you understand the broader context of your reproductive health and provide guidance on any concerns or questions you may have.

Read more:

• What AMH Level Do I Need to Freeze My Eggs?
• Which Matters More for Fertility: AMH or Age?
• I’m Going Off Birth Control. Now What?

Anti-Mullerian hormone (AMH) is a hormone produced by ovarian follicles. It is commonly used as a marker of ovarian reserve and can be measured in the blood. A high AMH level is often associated with polycystic ovary syndrome (PCOS), but it can also have other causes. In this article, we will explore what a high AMH result means and answer some common questions about AMH testing.

First off, what is AMH?

AMH is a hormone that is produced by the granulosa cells in the ovarian follicles. It plays a role in the growth and maturation of ovarian follicles in females. AMH levels are relatively stable throughout the menstrual cycle and can be measured in the blood.

AMH is commonly used as a marker of ovarian reserve, which is a rough number of eggs that a female has remaining in her ovaries. Since females are born with a fixed number of eggs, this number naturally declines over time. 

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.

If you are looking to donate your eggs, however, 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.

What AMH level is considered high?

In healthy females of reproductive age, higher levels of AMH mean that the ovaries have a larger supply of eggs. This means one would be expected to have better than average outcomes for egg freezing. 

Remember, there is no universal standard for AMH, so it can vary depending on the lab where the test is run. Your test results will include if your range is “normal”, “low”, or “high” and the cut-off can differ. For example, Atlanta Fertility considers over 4.5 ng/mL high. Advanced Fertility considers anything over 4.0 ng/ml high. While RMA would consider an AMH over  3.0 ng/ml as “very high”.

With high levels of AMH, you may be at higher risk for ovarian hyperstimulation syndrome (OHSS). This means your doctor may choose a specific protocol and/or do extra monitoring to decrease the risk of complications during egg freezing.

What AMH level is considered too high?

Again, this question depends on the lab. Your test results will come with a reference range, and will indicate if your number is high for your age. If your doctor considers your levels abnormally high and has concerns, they will discuss the results with you. 

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 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. 

Does high AMH always mean PCOS?

While an increase in AMH levels has been reported to be associated with PCOS, high AMH alone is not enough to diagnose PCOS. 

Not all patients with PCOS have high AMH levels, and not all patients with high AMH levels have PCOS. Diagnosis of PCOS requires a combination of symptoms, hormone levels, and imaging studies, such as ultrasound.

Does high AMH mean good egg quality?

Not necessarily. While a high AMH level is often associated with a larger number of ovarian follicles and eggs, 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.

Am I ovulating if my AMH is high?

AMH levels do not indicate if you’re ovulating or not. Ovulation is the release of a mature egg from the ovary and can be confirmed by monitoring the menstrual cycle and/or performing ultrasound studies.

Will I get a lot of eggs if I have a high AMH?

The success of egg freezing outcomes 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 doctor performing the procedure.

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. 

Freeze your eggs with Cofertility

One option to make egg freezing better is working with Cofertility. 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. It also enables access to exclusive guidance, free expertise, and community events. 

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.

Summing it up

A high AMH level is generally a good sign for your ability to successfully freeze your eggs. But for some, it can also be one indicator of PCOS. While a high AMH level is often associated with a larger number of ovarian follicles and eggs, it does not necessarily mean that the eggs are of good quality (egg quality is more dependent on age). 

AMH levels are commonly used as a marker of ovarian reserve and can be helpful, in conjunction with other measures, in predicting the number of eggs that can be retrieved during an egg freezing cycle. However, it is important to keep in mind that egg quality is determined by several factors and cannot be measured directly by AMH levels. If you have concerns about your fertility or AMH levels, it is important to speak with a fertility doctor for personalized advice and treatment options.

‍

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

OHSS, or Ovarian Hyperstimulation Syndrome, is a rare but potentially serious complication of egg freezing and egg donation. OHSS occurs when the ovaries become swollen and painful as a result of the hormonal medications used to stimulate egg production during fertility treatment. If you are considering egg freezing or donation, you may be wondering if you are at risk for OHSS. In this article, we will discuss everything you need to know.

What is OHSS?

OHSS is a condition that can occur as a result of fertility treatment, particularly after egg freezing. During this treatment, patients receive hormonal medications to stimulate the ovaries to produce multiple eggs for retrieval. In some cases, the ovaries may become overstimulated and produce too many eggs, causing them to become swollen and painful.

OHSS is a rare complication of egg freezing, but it can be serious if left untreated. In some cases, OHSS can lead to hospitalization and require medical intervention. Severe OHSS can cause complications such as blood clots, kidney failure, and fluid buildup in the lungs.

Ultrasound image of severe OHSS (Source)

How common is OHSS?

Data suggest the incidence of mild OHSS is 20%–33%, moderate OHSS is 3%–6%, and severe OHSS occurs in 0.1%–2% of cycles. In rare cases, OHSS can be life-threatening, so it's important to be aware of the potential risks and to inform your doctor of any symptoms (severe abdominal pain, bloating, and nausea). 

The incidence of OHSS has decreased over the years due to a better understanding of the risk factors and evidence-backed data on how to prevent OHSS. 

How do you know if you are at risk for OHSS?

The risk of developing OHSS depends on several factors, including: 

• Previous history of OHSS in past cycles
• High number of follicles during treatment puts you at an increased risk of developing OHSS
• Medications: The dosage and duration of hormonal medications can impact the chances of developing OHSS
• Age: Patients under the age of 30 are at a higher risk of developing OHSS 
• Low body weight puts you at a higher risk of developing OHSS
• Polycystic ovary syndrome (PCOS) increases your risk of developing OHSS due to the increased sensitivity to fertility medications
• Elevated hormone levels, including elevated serum estradiol (E2) concentrations and increased anti-Mullerian hormone (AMH) levels are risk factors for OHSS

Ask your doctor if they think you might be at higher-than-average risk for OHSS. If you are at high risk of OHSS, they may choose a specific protocol which utilizes the leuprolide trigger instead of hCG, which can prevent OHSS. Another medicine called cabergoline also can help reduce the fluid accumulation, or they may give you extra IV fluids at the time of egg retrieval. Most clinics will do extra monitoring of patients at risk of OHSS to decrease the risk of complications.

How many follicles put you at risk of OHSS?

Follicles are small sacs in the ovaries that contain eggs. During fertility treatment, patients are given medications to stimulate the ovaries to produce multiple follicles, which can increase the chances of achieving pregnancy down the line. However, when too many follicles develop, the risk of OHSS increases.

Ultrasound scans and blood tests are used to monitor the number and size of follicles, as well as hormone levels. There is no set number of follicles that puts you at risk of developing OHSS, as the risk varies depending on other factors such as age, body weight, and response to medications. However, as a general guideline, having more than 20 follicles on an ultrasound scan is considered a high risk for OHSS. If you are deemed to be at high risk of developing OHSS, your doctor may adjust your medication dosages or cancel the cycle to prevent OHSS from developing.

There is no set number of follicles that puts you at risk of developing OHSS. However, as a general guideline, having more than 20 follicles on an ultrasound scan is considered a high risk for OHSS.

Symptoms of OHSS after egg retrieval

Most people who undergo egg freezing do not develop OHSS. For those who do, the severity of the symptoms can vary from mild to severe and may include:

• Abdominal pain or discomfort: Patients with OHSS may experience abdominal pain or discomfort, which can range from mild to severe. This pain may feel like bloating, cramping, or a fullness in the abdomen.
• Bloating and fluid retention: OHSS can cause fluid to accumulate in the abdomen, leading to bloating and a feeling of fullness. Patients with OHSS may also experience swelling in the hands and feet due to fluid retention.
• Nausea and vomiting: Some patients with OHSS may experience nausea and vomiting, which can be caused by the swelling of the ovaries and the accumulation of fluid in the abdomen.
• Difficulty breathing: In severe cases of OHSS, the accumulation of fluid in the abdomen can cause pressure on the diaphragm, making it difficult to breathe.
• Rapid weight gain: People with OHSS may experience rapid weight gain due to the accumulation of fluid in the abdomen and other parts of the body.
• Decreased urine output: OHSS can cause a decrease in urine output, which can be a sign of dehydration and electrolyte imbalances.
• Fatigue: Patients with OHSS may experience fatigue, which can be caused by the body's response to the hormonal medications and the strain on the body's systems.

If you are undergoing egg freezing and experience any of these symptoms, it is important to contact your clinic immediately. Early recognition and management of OHSS can help to prevent the condition from worsening and ensure the best possible outcome.

How long after the egg retrieval are you at risk for OHSS?

The risk of OHSS typically peaks around five to ten days after egg retrieval. During this time, the hormones that were used to stimulate your ovaries to produce multiple eggs are still in your system, and your ovaries may continue to produce hormones even after the eggs have been retrieved. This can lead to excessive fluid accumulation and swelling in the body.

If you have undergone egg retrieval, it is important to be aware of the signs and symptoms listed above and report any concerns to your clinic right away.

Can you prevent OHSS after an egg retrieval?

Fertility doctors can identify your risk factors and take action to reduce your chances of getting OHSS in the first place. But there are also steps you can take to help prevent OHSS after egg retrieval. Here are some tips:

• Stay hydrated: Drinking plenty of fluids, especially electrolyte-rich fluids like coconut water or gatorade, can help flush out excess hormones and prevent dehydration, which can contribute to the development of OHSS. Aim for at least eight to ten glasses per day, or as directed by your doctor.
• Eat a high protein diet: A healthy, high protein diet is an important component of preparing for egg freezing.
• Rest and avoid strenuous activity: After the egg retrieval, it is important to take it easy and avoid activities that could increase your risk of developing OHSS. This includes exercise, lifting heavy objects, and sexual activity. Your doctor will likely recommend that you rest for at least 24 to 48 hours after the procedure.
• Monitor your symptoms: Be aware of the signs and symptoms of OHSS, such as those listed above. If you experience any of these symptoms, contact your clinic right away.
• Take prescribed medications as directed: Your doctor may prescribe medications, such as pain relievers or hormone supplements, to help prevent OHSS after egg retrieval. It is important to take these medications as directed and not to skip any doses.
• Attend follow-up appointments: Your doctor may schedule follow-up appointments to monitor your progress and check for signs of OHSS. Attend these appointments as scheduled and report any symptoms or concerns you may have.

While OHSS can be a serious complication, taking these steps can help reduce your risk and ensure the best possible outcome after egg retrieval. Be sure to discuss any concerns or questions you may have with your doctor, as they can provide personalized recommendations based on your individual needs and medical history.

How is OHSS treated?

Mild cases of OHSS can usually be treated with rest, increased fluid intake, and pain medication. More severe cases may require hospitalization and treatment with intravenous fluids, electrolyte replacement, and other supportive measures.

If you develop mild to moderate OHSS, your clinic may recommend close monitoring to ensure that your symptoms do not worsen. This may involve regular check-ins, blood tests, and ultrasounds to track your progress and check for signs of complications.

One of the most important treatments for OHSS is rest and hydration. This can help relieve symptoms such as bloating, abdominal pain, and nausea, and prevent complications such as dehydration and blood clots. Your doctor may recommend bed rest and increased fluid intake, and may also prescribe medications to manage your symptoms.

Your doctor may also prescribe medications such as pain relievers, anti-nausea medications, and diuretics (medications that help remove excess fluid from the body) to manage your symptoms and prevent complications. In some cases, medications such as cabergoline or GnRH agonists may be used to reduce the production of hormones that contribute to OHSS.

If you do develop severe OHSS, you may need to be hospitalized for close monitoring and treatment. In the hospital, you may receive intravenous fluids and medications, and may undergo procedures such as paracentesis (the removal of excess fluid from the abdomen) to relieve symptoms and prevent complications.

Does OHSS affect egg quality?

OHSS is caused by an overstimulation of the ovaries with fertility medications, which can lead to a higher number of eggs being produced than normal. However, the quality of those eggs is usually not affected by the presence of OHSS. In fact, one small study of 42 patients who developed severe OHSS during IVF found that while the fertilization rate was lower, the quality of embryos and the pregnancy rate were the same. 

The quality of the eggs retrieved during egg freezing is more dependent on your age and other factors, such as hormonal imbalances or underlying medical conditions. 

Does OHSS mean more eggs?

OHSS may mean more eggs, but only because having more eggs means a higher chance of OHSS. One of the main causes of OHSS is the use of medications called gonadotropins, which stimulate the ovaries to produce multiple eggs. Patients who produce a large number of eggs, usually more than 20, are at a higher risk of developing OHSS. 

In some cases, OHSS may indicate that a patient has produced a larger number of eggs than average. However, this is not always the case. Mild to moderate cases of OHSS can occur even when fewer than 10 eggs are retrieved.

Keep in mind that the number of eggs retrieved is not always an indicator of success. Other factors, such as the quality of the eggs, your age, and your overall health can all have an impact on the success of the treatment.

The goal of egg freezing is to produce a sufficient number of high-quality eggs for fertilization down the line, while minimizing the risk of complications such as OHSS. If you are undergoing egg freezing and have concerns about the number of eggs or the risk of developing OHSS, it is important to discuss your options with your doctor. They can provide guidance on the best course of action based on your individual circumstances and can help you make informed decisions about your fertility journey.

Summing it up

Egg freezing is becoming an increasingly popular option for those who want to preserve their fertility for future use. This process involves harvesting and freezing your eggs, which can then be thawed and used down the line when you are ready to start a family. However, like any medical procedure, egg freezing is not without its risks. One potential complication that can occur during the process of egg retrieval is OHSS.

While OHSS is a potential risk of egg freezing, the good news is that it is a relatively rare complication. Plus, the risk of OHSS can be reduced by carefully monitoring your response to the fertility medications and adjusting the dosage as needed. If you are worried about OHSS, we recommend talking to your doctor to discuss what can be done to reduce the risk.

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