Orchid offers advanced genetic testing for couples who want their child to have the best shot of a healthy life. As part of our “Pregnancy and Fertility” series, we distill down your fertility treatment options and help you navigate the complex process.

Fertility Testing 101:

By definition, fertility is your ability to reproduce. However, understanding fertility within your own body isn’t exactly an easy concept to understand. Not to mention, it comes with a whole slew of new vocabulary words for you to learn (you’ll see in just a minute!)

It also suffices to say that no test can actually predict a woman’s ability to get pregnant. We know, it sounds counterintuitive, but that’s only because fertility tests are meant to give you an idea of how easy—or difficult—it will be for you to conceive.

Not whether or not you will conceive.

Additionally, no single test will give you all the answers. Each fertility test for men and women is simply a piece to your reproductive puzzle. This is especially true for women, as a combination of tests will be more accurate at telling you your remaining egg supply.

So, what exactly does fertility testing test for?

Generally speaking, the various fertility tests will give you an idea of where your hormone levels are at, if you have any health issues that can get in the way of getting pregnant, and how many ovarian follicles you have. You’ll also likely have to start tracking your ovulation patterns by checking your cervical mucus and temperature as well as using at-home ovulation tests.

What Fertility Tests Are Available and How Accurate Are They?

You have two main options when it comes to fertility testing: At-home and in-office. Both options involve testing your blood, but the most common tests you’ll hear about are the Anti-Müllerian Hormone (AMH) and the Antral Follicle Count (AFC)—which test your blood and use transvaginal ultrasound to get a closer look at your ovaries.

The Anti-Müllerian Hormone Test

The AMH is a hormone that exists solely in a woman’s ovaries. The hormone is produced by the granulosa cells in a woman’s early ovarian follicles and is used as a marker of oocyte quality and ovarian reserve (basically, your remaining egg supply that can lead to pregnancy).

The AMH is a hormone that exists solely in a woman’s ovaries. The hormone is produced by the granulosa cells in a woman’s early ovarian follicles and is used as a marker of oocyte quality and ovarian reserve (basically, your remaining egg supply that can lead to pregnancy).

These hormones are gonadotropin-independent. That means they’re unaffected by the gonadotropins released from your pituitary gland and therefore remain relatively consistent during and between cycles in both regularly ovulating women and in women with infertility caused by medical conditions.

The Anti-mullerian hormone is created during the primordial follicle stage, which means it decreases with age. The concentration of this hormone is directly related to the number of eggs you have left. OB GYNs and fertility doctors use AMH testing specifically to assess your egg count, and it can be done on any day of a woman’s cycle.

The higher your AMH levels, the better your ovarian response (as in a higher egg count). Keep in mind though that in some cases, very high levels of AMH may indicate polycystic ovarian syndrome (PCOS) and can cause irregular periods.

Generally speaking, an AMH value of (1 ng/mL) or lower is considered low; (1-2.5 ng/mL) is medium, and above (2.5 ng/mL) is good. However, it’s important to note that your AMH values also depend on the lab used to analyze the test because each lab utilizes a different values scale. Therefore, AMH value results vary from lab to lab.

For most women who ovulate regularly, the AMH fertility blood test is fairly reliable. As we mentioned earlier, each test is just one piece to the puzzle and there are other factors that contribute to a woman’s ability to get pregnant including age, PCOS diagnosis, or medications taken.

For example, women taking oral contraceptives can suppress your AMH level by up to 17%. However, your AMH value doesn’t determine whether or not you will be able to get pregnant—it’s simply to take a headcount to see what you’re working with.

The Antral Follicle Count Test

The antral follicles are the fluid-filled sacs that contain immature eggs, also referred to as oocytes. The AFC count test is conducted via transvaginal ultrasound during the early follicular phase for both ovaries.

This test also gives OB GYNs and fertility doctors an idea of how many eggs are available for development as well as what the potential response would be of a woman’s body to gonadotropin fertility medicines.

In terms of antral follicle detection, a normal ovary typically consists of 8-10 follicles ranging from 2mm to 28mm in size. The follicles that are smaller than 18mm are the antral follicles while the larger follicles are the dominant follicles.

Much like the AMH test, the higher the number of antral follicles a woman has on her ovaries, the greater her egg count will be. Once again, a woman’s egg count won’t determine her ability to get pregnant. However, a low antral follicle count does mean there may be a poor response to fertility drugs due to diminished ovarian reserve.

Why You Need Both Tests

Bottomline: AMH and Antral Follicle Count are the simple way to measure the ovarian reserve. They can predict egg count, but not necessarily overall reproductive potential or outcome.

By doing both the AMH test and AFC test, you’ll be able to get a much better idea of not just your egg count, but how your ovaries will respond to treatments. These tests are used to develop a treatment plan for couples with infertility, determining the protocol for fertility medication dosage and whether or not a donor egg is needed.

Of course, your OB GYN or fertility doctor will also test for other hormones such as progesterone, estradiol, FSH, LH, TSH, prolactin, etc. They may also conduct a saline infusion sonogram, hysterosalpingogram, or hysteroscopy to check for uterine cavity abnormalities such as polyps, scarring, fibroids or congenital differences that can interfere with pregnancy, especially if the couple is having trouble conceiving.

Remember, it doesn’t matter whether you use an at-home fertility test or have the tests performed by a doctor—no single test will give you a definitive diagnosis in terms of fertility and the reasons you may or may not be infertile. Fertility is a journey, therefore you’ll need to take all the necessary tests and work with your OB GYN or fertility doctor to come up with a plan.

Fertility treatment and reproductive medicine have come a long way since IVF was first introduced over 40 years ago. Today, advanced embryo testing is now available to couples who want their child to have the best shot of a healthy life. Explore how Orchid helps you conceive with confidence.