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What Do You Know About Your Fertility?

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a blog by David Kreiner, M.D., F.A.C.O.G. and Pamela Madsen

Part II: What Do You Know About Fertility Screening?

Statistics and general truths aside, every woman is unique. Given just how complicated it is to make a baby in the first place, understanding your own body’s reproductive capability and the changes it might undergo from year to year is an invaluable planning tool.

Consider an annual fertility evaluation or screening.
Simply put, the screening involves a few simple blood tests and an ultrasound to assess your ovarian function. These tests have been around for years and are tried and true tools in the assessment of fertility.

We propose using these tests as a screen to prevent future infertility. We recommend that annual screening begin at 30 years of age or earlier if you have irregular menses, hot flashes, difficulty conceiving after 6 months or a family history of early menopause or infertility.

Taken together with your individual and your family’s medical histories, fertility screening helps establish where you are on your personal fertility curve. The first screening establishes your baseline, subsequent annual evaluations will flag changes in key hormone levels and mature follicle and egg production that could signal potential trouble. Mind you, any warning flares are just that and may mean nothing. But they could indicate that follow-up with your doctor, gynecologist or a reproductive specialist is warranted. And if there’s a problem, you’re ahead of the game with the opportunity for early intervention and, where possible, corrective action.

Fertility screening can help identify women whose ovarian function is diminishing so they can get timely treatment. The fact is, some women in their 30’s prematurely age from a reproductive perspective and their fertility may look more like that of a woman in her 40’s.

What Does the Screen Involve?

The screening itself is fairly low-tech.

Part one consists of a blood test to check the levels of FSH (follicle stimulating hormone), estradiol and AMH (antimullerian hormone). The FSH and estradiol must be measured on the second or third day of your period. The granulosa cells of the ovarian follicles produce estradiol and AMH. The fewer the follicles there are in the ovaries the lower the AMH level. It will also mean that less estradiol is produced as well as a protein called inhibin. Both inhibin and estradiol decrease FSH production. The lower the inhibin and estradiol the higher the FSH as is seen in diminished ovarian reserve. The higher the estradiol or inhibin levels are then the lower the FSH. Estradiol may be elevated especially in the presence of an ovarian cyst even with failing ovaries that are only able to produce minimal inhibin. However, the high estradiol reduces the FSH to deceptively normal appearing levels. If not for the cyst generating excess estradiol, the FSH would be high in failing ovaries due to low inhibin production. This is why it is important to get an estradiol level at the same time as the FSH and early in the cycle when it is likely that the estradiol level is low in order to get an accurate reading of FSH.

Part two is a vaginal ultrasound to count the number of antral follicles in both ovaries. Antral follicles are a good indicator of the reserve of eggs remaining in the ovary. In general, fertility specialists like to see at least a total of eight antral follicles for the two ovaries. Between nine and twelve might be considered a borderline antral follicle count.
As you start to screen annually for your fertility, what you and your doctor are looking for is a dramatic shift in values from one year to the next.

What Does the Screen Indicate?

A positive screen showing evidence of potentially diminishing fertility is an alarm that should produce a call to action. When a woman is aware that she may be running out of time to reproduce she can take the family-planning reins and make informed decisions. The goal of fertility screening is to help you and every woman of childbearing years make the choices that can help protect and optimize your fertility.

Although none of these tests is in of and of themselves an absolute predictor of your ability to get pregnant, when one or more come back in the abnormal range, it is highly suggestive of ovarian compromise. It deserves further scrutiny. That’s when it makes sense to have a discussion with your gynecologist or fertility specialist. Bear in mind, the “normal” range is quite broad. But when an “abnormal” flare goes off, you want to check it out.

It’s important to remember that fertility is more than your ovaries. If you have risk factors for blocked fallopian tubes such as a history of previous pelvic infection, or if your partner has potentially abnormal sperm, then other tests are in order. And if, for example you do have blocked tubes, it’s better to have them corrected sooner rather than later when the becoming pregnant is an urgent matter.

Learn More About Your Fertility

This article is part of a three-part series. Make sure you read its other two parts:

Part I: What Do You Know About Your Biological Clock?
Part III: What Do You Know About Egg Freezing?

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