Most women have no knowledge at all about the status of their remaining fertility potential. Many women put off trying to get pregnant until a convenient time in their lives, and by the time the “right time” comes, their fertility potential might be reduced – or already gone forever.
Female age is often used by gynaecologists to counsel women regarding the question of when they should try to get pregnant. But, chronological age is not the same as “reproductive age”. Some women are still fertile at 40 (few), while others could be in menopause – and completely out of eggs – at age 30.
We have some screening tests that are can help us determine the “reproductive age” of a woman, although these are not perfect.
By measuring a baseline FSH on day 2 of the cycle (day 1 is the start of the period), we can get an indication that the woman is closer to menopause and has relatively less “ovarian reserve”. In other words, if the day 3 FSH is elevated the egg quantity is reduced.
AMH, or anti-mullerian hormone is a substance produced by granulosa cells in ovarian follicles. It is first made in primary follicles and hence these levels reflect the amount of “eggs” that are still in reserve in an ovary. AMH levels can be done on any day of the cycle. Low AMH levels reflect few “eggs” in reserve, hence a lower fertility potential. High levels could indicate too many small follicles as seen in PCOS.