All it takes is one good egg…but how do you know if your eggs are good?
What is a good egg, anyways?
A good egg is one that is able to go through the all the steps needed to take that egg from the primordial pool into a healthy embryo and ultimately a healthy baby.
What’s the primordial pool?
A woman’s eggs are formed while she herself is in utero. Eggs will lay dormant in the ovaries, aka the primordial pool, until they undergo the process of maturation. This phase of ripening, known as folliculogenesis, takes 3 – 4 months. The final stage occurs when the eggs are recruited for ovulation. In any given cycle somewhere between 5 – 20 eggs will be recruited.
One egg will become the dominant follicle, reach maturity first and be released into the fallopian tube via ovulation. The other developing follicles will be re-absorbed. Once the egg is released, it will be fertilized by a sperm at the top of the fallopian tube, thus becoming an embryo, and within a few days it will implant in the uterus.
This process of an egg turning into a baby requires:
1) enough eggs,
2) eggs that are responsive to the hormonal signals that govern maturation, and
3) healthy DNA inside the eggs.
In other words, quantity and quality. We can assess both of these factors via hormones. Evaluating the quantity and quality of the eggs is not an exact science. At best we are able to assess the probability of getting pregnant – is it more or less likely to happen? With this information one can make decisions about pursuing different treatment options.
Anti-Mullerian Hormone (AMH) measures egg quantity.
This hormone is secreted by the eggs as they are going through the 3 – 4 month phase of folliculogenesis, so AMH gives us an idea of how many eggs are in the pipeline. For AMH the desirable range is between 1.0 – 5.0. If AMH is below 1.0 it indicates fewer eggs are available to be recruited in any given cycle. This information is most useful in determining what type of fertility treatments might be appropriate.
Something like In Vitro Fertilization (IVF) is a more cost-effective option with more eggs. With fewer eggs, intrauterine insemination (IUI) or natural conception (where you only need one egg!) might be a better option. AMH levels over 5.0 suggest the possibility of PCOS (polycystic ovarian syndrome), and further diagnostic testing is recommended.
Follicle Stimulating Hormone (FSH) is the primary hormone we look at to determine egg quality.
FSH does exactly what the name implies, it stimulates the eggs to mature. A healthy egg should be responsive, needing less FSH to get the job done. An FSH below 10 suggests a high probability of getting pregnant, with an FSH below 8.0 being ideal. As eggs get older they become more sluggish, requiring more FSH to reach maturity. FSH levels between 10 – 15 indicate eggs that are slowing down and might benefit from some additional help via fertility treatments. FSH levels above 15 need to be evaluated on a case by case basis.
FSH needs to be evaluated along with estradiol (E2), the main estrogen involved in women’s reproductive health. High levels of estradiol can artificially suppress the FSH levels, giving a false reading. Estradiol levels should be between 20 -60. If the estradiol levels are above this range, the tests should be repeated in a different cycle.
When to test: AMH can be measured at any time in the cycle. FSH and estradiol must be measured on cycle day 2 or 3, with cycle day 1 being the first day of full flow.
Understanding the many nuances of these test results requires a fertility expert.
Make sure you are getting the help you need from a qualified provider. AMH, FSH, and estradiol are just part of an overall fertility work-up. The most important thing when it comes to family building is to make the best use of your time. Thorough testing is essential for making informed decisions about your path forward.
If you are in the San Francisco East Bay we invite you to book an appointment with us.