I’m curious about my fertility... where do I start?

I get this question a lot. I’m Eileen McMahon, a Nurse Practitioner at Hannam Fertility Centre, so I frequently have friends and family, and friends of friends, asking about fertility. It’s a common question but there isn’t a single answer. Everybody has their own story and their own family plan. How you approach your fertility will be different if, for example, you want a big family soon versus if you want one child at some point in the distant future. One thing that I can tell you is that if you know you want children, or want to keep your fertility options open, you should consider assessing your ovarian reserve (the store of eggs in your ovaries) to help you understand more about your personal fertility. 

It’s going to be different for everyone... 

Though there’s been a lot of research into how fertility changes over the lifecycle, the fertile window is going to be different for every individual. In the reproductive years, ovarian reserve is highest around age 25 and gradually decreases over time, dropping most significantly from age 35 to age 40, with a lot of individual variation. Some people have low ovarian reserve for their age, but would not know this without testing. I don’t bring this up to frighten you, but to let you know why ovarian reserve testing, which includes a blood test of a biomarker called Anti-Mullerian Hormone (AMH), can be helpful in proactively determining your ovarian reserve. What we really want to avoid is age-related infertility due to a lack of information.

Okay, what is this AMH test? 

The AMH test measures the level of Anti-Mullerian hormone in your blood. This hormone is produced in the ovarian follicles which are tiny sacs of fluid in the ovary that hold immature eggs. Typically, people have 200,000 and 300,000 immature eggs and follicles. Ovarian reserve goes down over time because of ovulation but also because there is continuous loss of eggs all the time. Follicles stop producing AMH as they mature and form eggs, so AMH is a good proxy for how many immature follicles and eggs are left.  

It is crucial to note that while AMH levels can provide a good estimate of ovarian reserve, this is only predictive of fertility treatment success, where the goal is to produce many eggs at once for egg freezing or in-vitro fertilization. Your AMH level is not a good predictor of your ability to conceive without medical assistance (your ‘natural’ pregnancy rate).

So... Should I get my AMH tested?  

It depends on what your family plans are. There are a couple of questions for you to consider. 

• Are you already trying? If you’ve been actively trying to conceive but have yet to get pregnant, a comprehensive fertility assessment may be helpful to see if you need fertility treatment to support your family goals. There are many reasons you could be struggling to conceive beyond just your ovarian reserve, so meeting with a fertility specialist can help you understand what tests will help you learn more. 

• Do you have a clear family plan? Knowing the number of children you want to have, and when you want to start trying can help determine whether fertility treatment may be required to achieve your family goals. For example, if you want more than one child and plan to start trying when you are 35 years of age, it is probably a good idea to get tested in your early 30’s, so you can understand whether your natural window aligns with your goals or if fertility treatment may be necessary or helpful. 

What happens after completing the AMH test? 

Whatever your plan is, if you decide to do an AMH test, you should be ready to act on the results. You may not be fully sure about whether you want a family, but you can take action to keep your options open. If you discover that you have a low ovarian reserve, you may have a small window where you can freeze your eggs and prolong your fertile window. Similarly, if you have a high reserve, freezing eggs can give you peace of mind that you’ll have help to have the family you want when you’re ready. 

Connecting with a fertility specialist can help you decide by getting the information as early as possible. Click here to book an appointment with Eileen McMahon. 

Author: Eileen McMahon, Nurse Practitioner and Egg Freezing Specialist at Hannam Fertility Centre