Testing Ovarian Reserve: FSH vs. AMH vs. AFC
Ovarian Reserve is the quality and quantity of a woman’s eggs. Infertility can be caused by a variety of factors, but luckily there are various screenings that can help your doctor diagnose issues. Testing ovarian reserve can help you decide whether you should consider pregnancy sooner rather than later, if you should freeze your eggs, or whether fertility treatment may be successful.
There are three tests that doctors use to predict ovarian reserve: FSH, AMH, and AFC.
FSH (follicle stimulating hormone) is a hormone that stimulates the ovary to release an egg (ovulate). In women who face diminished ovarian reserve, there is signal from the ovary to the brain to produce higher quantities of FSH. Therefore, a high FSH likely indicates a low ovarian reserve.
FSH can fluctuate during the menstrual cycle, and therefore is usually tested on Day 3 with the onset of the period. A Day 3 FSH level of 10 or less is generally considered normal.
AMH (anti-Müllerian hormone) is thought to be a more reliable predictor of ovarian reserve, because the levels stay mainly consistent throughout the menstrual cycle and can be tested on any day. AMH is produced by granulosa cells, the supporting cells that are attached to each egg. Simply, the higher the AMH, in theory the higher the number the eggs. The lower the AMH, the lower the number of eggs.
There are age specific averages for AMH levels, so we know what to expect based on female age. It is important to know that AMH does not predict pregnancy success. It does predict response at the time of an egg freezing cycle or an in-vitro fertilization (IVF) cycle. In general, women who have higher AMH levels, require less medication for stimulation and often generate a larger quantity of eggs. AMH levels continue to drop as a woman ages, and trend toward “0” at the time of menopause.
AFC (antral follicle count), is a measurement of antral follicles (also known as resting follicles) in the ovaries. Follicles are the structures that contain eggs. The AFC is measured at the time of a transvaginal ultrasound. The total number of antral follicles observed can predict your response during an egg freezing or IVF cycle. It is best to have an AFC performed at the beginning of your menstrual cycle.
All three of these tests are important predictors of ovarian reserve, and are completed at the time of an initial consultation with an infertility doctor. If a patient is contemplating egg freezing or having difficulty conceiving, it is best to seek care sooner rather than later.
Dr. Beth McAvey is board certified in Reproductive Endocrinology and Infertility as well as Obstetrics and Gynecology. Dr. McAvey received her medical degree from the State University of New York Downstate Medical Center, completed her residency in Obstetrics and Gynecology at New York Presbyterian Hospital, Weill Cornell Medical Center, and graduated from Montefiore Medical Center’s fellowship program in Reproductive Endocrinology and Infertility. Dr. McAvey is an Assistant Clinical Professor of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai. Dr. McAvey treats patients for infertility, providing assisted reproductive technologies and minimally invasive gynecological surgery, and performs egg freezing for both medical and elective indications.