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Predicting Fertility

More women are waiting until their 30s and 40s to have children. In fact, about 20% of women in the United States now have their first child after age 35. However, about one-third of couples in which the woman is older than 35 years have fertility problems.

Aging can affect fertility in the following ways:

  • Decreased number of healthy eggs
  • Decreased chances of having a baby
  • Increased chances of having a miscarriage and a child with a genetic abnormality

Although the ability to have a baby decreases in all women as they get older, the exact age when a woman can no longer conceive varies from woman to woman. Tests to check a woman’s egg count, or ovarian reserve, include:

  • Hormone blood levels. Commonly used hormone blood testing are anti-müllerian hormone (AMH), follicle-stimulating hormone (FSH) and estradiol.
    • AMH is made in the follicle and is related to the number of eggs. AMH levels can be drawn at any time during the menstrual cycle.
    • FSH and estradiol can show important information about how the ovaries and pituitary gland are working together. These blood levels should be drawn on cycle day 2 or 3.
  • Transvaginal ultrasound. The transvaginal ultrasound can be done to count the number of small (2mm-10mm) follicles in the ovary, which are called antral follicles, and are where eggs develop. The ultrasound should be done on cycle day 2 or 3. 

Unfortunately, no tests can predict a woman’s ability to get pregnant. Abnormal ovarian reserve test results suggest that fertility potential has declined but they do not tell who will or who will not conceive.

A woman with abnormal ovarian reserve tests many consider egg (oocyte) banking to improve her chances of having a biologically related child in the future. Success with banked oocytes depends on a woman’s age at the time of banking, the number of oocytes banked and how well the oocytes freeze and thaw. An online calculator can help women understand their chance of success with oocytes banking. Unfortunately, there are no guarantees that oocyte banking will be successful in the future and some women experience regret after oocyte banking.

Many obstetricians/gynecologists can order and interpret ovarian reserve tests. A reproductive endocrinologist and infertility specialists could help you decide if oocyte banking is a good option for you.