Do Your Ovaries Qualify for IVF? Essential Fertility Tests for IVF Success
Once you have decided to do IVF, there are several tests that you need to have to ensure optimal IVF success. Today, we are going to talk about checking the function of the ovaries
IVF utilizes fertility drugs to stimulate the development of multiple eggs in the ovaries at the same time. Women can respond differently to these medications. It is important to measure the function of the ovaries before starting stimulation in order to allow the doctor to estimate your prognosis for a successful IVF and to choose the correct IVF stimulation protocol.
Ovarian reserve testing
In 2020, the optimal evaluation of the ovaries which is also called ovarian reserve testing, is done with a combination of blood tests and ultrasound. If you are a woman who ovulates and gets her periods on her own, these tests should be done on the second or third day of your period.
Day one is considered the first day of full flow bleeding - spotting does not count. If you are a woman who does not get periods or gets them infrequently because you don't ovulate then you can do these tests any time.
Ultrasound - Antral follicle count
First, let's talk about ultrasound. This is an ultrasound image of an ovary.
Those black spots are small cysts called follicles. Each follicle contains fluid, follicle cells and an egg.
At the beginning of your cycle, when the follicles are small, the eggs inside are immature. It's important for your doctor to count how many follicles are visible in each ovary.
Women who have a lot of follicles are typically going to respond better to fertility medication and get more eggs than women who have fewer follicles. In fact, the dose of fertility medications in women who have a very high number of follicles should be reduced to prevent the complication called ovarian hyperstimulation syndrome.
Ovarian Hyperstimulation Syndrome (OHSS)
Women who have few follicles will likely need a more aggressive medication protocol with higher doses of medication but may still get fewer eggs during IVF.
There are three blood tests that IVF experts recommend before starting IVF two are absolutely mandatory, the third one is newer but may become more important in the future. The first mandatory blood test is called AMH.
AMH levels for IVF
AMH is a hormone that is produced from the follicles in the ovary. Similar to the follicle count on ultrasound, a higher AMH level indicates a better response to fertility medication; more eggs retrieved and the need to lower the dose of medication to help reduce the risk of hyper-stimulation.
Younger women, who generally have ovaries that are more likely to produce more eggs, tend to have higher AMH levels.
AMH levels and PCOS
Another group of women with high AMH levels are women with an ovulation problem called polycystic ovary syndrome or PCOS.
FSH levels in IVF
The second mandatory hormone blood test you need to have before starting IVF is called FSH. FSH comes from the pituitary gland not the ovaries. I like to think of FSH as the opposite of AMH.
This means that you would like to have low FSH levels as opposed to high AMH levels. Women with high FSH levels have a number of problems when they do IVF. They have a higher chance for not responding to fertility medications and not making it to the point of an egg retrieval.
When they do get to an egg retrieval, they produce less eggs and therefore get less embryos. There is some evidence that even in younger women, a high FSH level may predict a higher chance for chromosomally abnormal embryos though this is still somewhat uncertain.
One word of caution about FSH levels: The levels can vary from month to month so you could have a normal FSH level in one month and it could be abnormal on another month. The older you are, the greater the chance that a normal FSH level on one month could be abnormal on another month.
Effect of estrogen on FSH levels
FSH levels are also affected by the levels of estrogen. Both hormones should always be measured together. If your FSH level is normal your estrogen level is elevated at the same time, you shouldn't put too much faith in that FSH level it could be a lot higher than you think.
IGF-1 levels in IVF
Finally, a new study has found that in women who don't respond well to fertility medications, measuring a hormone called IGF-1, could be helpful. This study found that poor responders were more likely to have high IGF-1 levels and that suppressing IGF-1 levels with a medication may result in a stimulation with more eggs.
This is still preliminary evidence though.
Our bottom line is this:
Before starting IVF, your doctor should do a thorough assessment of the function of your ovaries with blood tests and ultrasounds and adjust your IVF medication protocol based on the results.