Fertility is not just about numbers and tests alone do not define one’s reproductive capabilities. The prospect of having a baby lies not in how many eggs a woman has but rather how good they are. The ovarian reserve is not necessarily associated with fertility levels.

Yet, for the woman who is desperately trying to conceive, the results of her follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH) blood tests may be pivotal to her anticipated pregnancy.

Dr. Aimee Eyvazzadeh, a San Francisco-based reproductive endocrinologist, says these tests make women tearful and fearful while some lose hope.

The tests are used to gauge fertility and how many eggs a woman has, and when the scores are failing, it can drive some helpless women to a dead end. Reality hits them hard that they can never have children of their own.

But, there is more to fertility than these test scores for, according to Eyvazzadeh, "a hormone level can never tell you that you can or cannot get pregnant." She adds that higher FSH, as well as lower AMH levels, are associated with reduced fertility.

The World Health Organisation (WHO) estimated that about one in every four couples in developing countries could be affected by infertility. It has called infertility a "global public health issue" and has calculated that more than 10% of women worldwide are impacted.

According to World Health Organisation (WHO), infertility is a global public health issue and more than 10% of women worldwide are affected
According to World Health Organisation (WHO), infertility is a global public health issue and more than 10% of women worldwide are affected

"No significant differences" among those with high and normal test levels, study reveals

A new study funded by National Institutes of Health (NIH) suggests that having high FSH and low AMH levels might not predict short-term chances of conception.

The research, published in the medical journal JAMA, covered 750 women aged 30 to 44 years of age, from the area around Raleigh and Durham, North Carolina, who were trying to conceive for up to three months between April 2008 and March 2016. These women didn't have a history of infertility.

Chances for conception also did not differ significantly according to high versus normal levels of FSH. After six cycles of attempting to conceive, results did not differ significantly between women with low levels and normal levels of anti-Müllerian hormone – a 65% chance of conception, compared to a 62% chance.

Similarly, results were not statistically different after 12 cycles: the figures stood at 82% versus 75%.

“Women are born with a set number of eggs that gradually declines through the reproductive years,” said Esther Eisenberg of the Fertility and Infertility Branch of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

“This study suggests that testing for biomarkers of ovarian reserve does not predict the chances for conception in older women still of reproductive age.”

Dr Anne Steiner, a professor at the University of North Carolina School of Medicine (UNC). Photo credit: UNC Fertility
Dr Anne Steiner, a professor at the University of North Carolina School of Medicine (UNC). Photo credit: UNC Fertility

"Our findings challenge the clinical assumption that diminished ovarian reserve is a cause of infertility, but these findings are important for women," said the study's lead author Dr Anne Steiner, a professor at the University of North Carolina School of Medicine (UNC).

Age remains the best predictor of a woman’s potential, said Dr Steiner. "Women are partnering and getting married later in life. They are aware of age-related decline in fertility. Women are seeking tests, outside of their age, that inform them about their fertility. Some women may also use such tests to guide their decision-making about freezing eggs."

Though surprised by the research findings, Steiner said that she thinks AMH and FSH blood tests could still predict the number of eggs that could be retrieved for in vitro fertilisation (IVF).

"Whether or not they predict pregnancy following IVF independent of age is less certain," she said. "Some studies have shown that they do predict live birth following IVF, others haven't."

Quality vs. egg count

When it comes to reduced fertility among women 40 and older, Steiner believed that the quality, not the quantity, of their eggs is the deciding factor.

"As a woman ages, the quality of her eggs also decline," she said. "When the egg is fertilised, the resulting embryo is more likely to be aneuploid, or not have the normal number of chromosomes. This is why women are less likely to get pregnant ... more likely to miscarry, and more likely to have a baby with Down syndrome, as a woman gets older."

"You are not a number ... is really what I love that this study will tell women," she said.

In a separate 2012 study, Dr Jennifer Kawwass, assistant professor at Emory University School of Medicine said, "Ovarian reserve in and of itself does not predict chance of conception particularly in a woman without a known history of infertility.”

Ovarian reserve parameters, she added, are helpful in predicting dose of medication and ovarian response to fertility treatment.

“Fertility decreases with age in all women independent of ovarian reserve testing. I often tell patients, 'age trumps all when it comes to fertility treatment’,” shared Dr Kawwass. MIMS

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