Mirror, mirror on the wall, who is the most fertile of us all? And while we wish it would be as simple as “My Queen, you are,” it is nowhere near this clear. Although the mirror is there (in the form of hormone levels and ultrasounds), the glass is blurry. Nothing from FSH to AMH to AFC (antral follicle count) can reliably predict with certainty who will have success with IVF and who won’t. Much of what holds the answer to this age-old question is not defined by lab tests or imaging but by the most basic of numbers—age and how long you have been trying.
When interpreting the results, either with or without your doctor, you should be careful in how you let the information make you feel. Everything must be analyzed in context and assessed carefully. A high or low value can lead to instant joy or despair. And while some of this is warranted, and some of it is not—the truth usually lies somewhere in the middle. To understand how close you are to each goal post, you need to have your results reviewed rather than just Googled.
But if you are going to take to the Internet, here are a few pointers from your favorite fertility MDs:
- FSH must be checked on day 2 or 3 (latest day 4) of the cycle. After that, the data are nothing more than a bunch of numbers printed on a page (exception: women with very, very long cycles). If you think you might be that exception, talk to the person who sent the blood in the first place!
- FSH must be checked with Estradiol. An FSH in isolation is like an alto without a soprano; it may sound good but can’t really be appreciated in isolation. The brain makes FSH. The ovaries make estrogen. Although the two are produced in opposite ends of the body, they work very closely together. In terms of ovarian reserve testing, estrogen suppresses FSH levels (an elevated estrogen results in a low FSH). Therefore, a normal FSH level is only as normal as your estrogen level. Simply stated, an elevated estrogen can mask an elevated FSH. As a result of their tight relationship (#BFFs!), to have an accurate assessment of your FSH you need to know what your estrogen level was on the day the FSH was sent!
- AMH can be checked at any time, on any day, in any month. It is usually not impacted by the period, the pill, or pregnancy. It is a hormone made by the resting follicles, which rest, no matter what your body is doing!
Bottom line… be careful when looking into and listening to that mirror. While the words may be what you want to hear (or not—cue Snow White!), you must make sure the person speaking to you is telling you the truth. You may not want to hear it, but it will help you figure out your best next steps.