Is There a Test for Fertility?

This video explains the concept of ovarian reserve and the limitations of fertility tests, emphasizing that ovarian reserve does not equal fertility.

I often get asked the question by couples, am I fertile? And what I want to talk about today is to really show that there is not a single test that can prove whether or not an individual is fertile or infertile. When we evaluate a couple who has infertility, I often say that there are four components that are needed in order to have a baby. We have to have sperm.

We have to have ovaries that contain eggs. We have to have a uterus and fallopian tubes that are open. When we see a couple who has not yet tried to conceive, short of seeing a semen analysis that has no sperm or ovaries that contain very few eggs within them, there's really no test that predicts whether a couple is fertile or infertile.

Now, there are a whole bunch of tests that are marketed towards fertility. And what those tests are really looking at is the concept of ovarian reserve. Ovarian reserve is really the question of how many eggs are remaining in a woman's ovary.

And while we can't answer that exact question of how many eggs we have, we can measure relative to what we expect that somebody will have for a given age. And that concept is something called ovarian reserve. Ovarian reserve is a series of tests that quantify the number of eggs that are within a woman's ovary.

And they try to put it into context relative to that woman's age. When we talk about measuring ovarian reserve, we talk about measuring really three things. The first is a hormone called AMH, or anti-Mullerian hormone.

The second is a hormone called follicle-stimulating hormone, or FSH. And that hormone has to be tested in conjunction with the hormone estrogen. And the third way that we assess ovarian reserve is through an enteral follicle count.

And that's an ultrasound that's performed to look at the number of eggs within a woman's ovary. So the question then becomes, is what does ovarian reserve tell me? And again, ovarian reserve does not tell me that a woman is fertile or that she's infertile. Ovarian reserve very specifically answers the question of if a woman was going through ovarian stimulation with injectable hormones called gonadotropins, it gives us a very good idea of how many follicles will be recruited, or quite simply, how many eggs can be retrieved.

And when we look at the question of whether or not somebody is fertile or infertile, studies have shown that there's not a linear relationship between the number of eggs a woman has in her ovary and whether or not she will conceive. And so oftentimes, people confuse this idea and think that low ovarian reserve equals infertility, but really it doesn't. When we look at ovarian reserve testing and we're looking at that AMH level, the FSH and the estradiol, as well as the antral follicle count, we want to see a good number of eggs within a woman's ovary or a good number of follicles that we can visualize on ultrasound.

And that just provides us with reassurance that when that woman goes through fertility treatment or when that person goes through fertility treatment, that they're going to have a robust response to stimulation. Part of the success of fertility treatment, and not all of it, but part of the success really hinges upon the idea that we want to obtain eggs and then we want to be able to select for the best embryo that that woman can produce if she's going through in vitro fertilization. When we talk about less aggressive fertility treatments, we also want a good egg supply so that we're able to recruit one follicle or one egg to be ovulated each month or maybe two or three in different types of settings.

But I think the most important take-home point is that ovarian reserve does not equal fertility. And there really is no such test as a fertility test, even though it may be marketed as such.