hormones

Anti-Mullerian hormone (AMH) is a hormone produced by the follicles in the ovaries (the fluid filled sacs that contain eggs). It requires a simple blood draw and is most often used as a marker of ovarian reserve. Ovarian reserve is the term for the number of healthy eggs left in your ovaries. Since people with ovaries are born with a fixed number of eggs, this number naturally declines over time. 

A low AMH level is usually related to natural aging, but it can also have other causes. In this article, we’ll explore what a low AMH result means and answer some common questions that can come up.

AMH and its role in fertility

So what exactly can AMH tell you about your fertility? As mentioned, your AMH level is positively correlated with the number of follicles you have in your ovaries. Simply put, the more follicles you have, the higher your AMH level typically is. As a result, AMH levels have been shown to be a good predictor of ovarian reserve and someone’s expected response to fertility treatments. 

In fact, several studies have shown that there is a strong correlation between what your AMH level is and the number of mature eggs retrieved during an egg freezing or in vitro fertilization (IVF) cycle. To learn more about those studies, check out AMH and Egg Retrieval Outcomes. 

What your AMH level can’t tell you is the exact number of eggs you have left in your ovaries or what your chances of pregnancy are. There are a number of other factors like your age, overall health, and genetics that also affect the number and quality of eggs and your overall fertility. So while AMH can be a useful tool in assessing your fertility, it shouldn’t be the only factor when making decisions about fertility treatments.

What is a low AMH result?

As with most things in medicine, there’s no absolute answer here. What is considered a low, normal, or high AMH level depends on your age and the lab where you take the test. Since there is no international standard, it’s best to use the reference ranges that come with your test results.

In general, an AMH between 1.0 and 3.5 ng/mL is considered to be in the “normal” range, which means you’re likely to have a good response to fertility treatments. Anything below 1.0 ng/mL is considered low and a sign of a declining ovarian reserve.

What does a low AMH mean?

Having a low AMH level can be a sign that your ovaries are making less of the preantral follicles. The lower the number of follicles, the lower your ovarian reserve is. 

So what does this mean in terms of fertility?

First, having a lower AMH does not automatically mean you aren’t ovulating regularly or that you won’t be able to get pregnant naturally or with assisted reproductive technologies. However, research has found that what AMH is good at predicting is the response to ovarian stimulation and the number of eggs retrieved, regardless of a person’s age. So, someone with a higher AMH is generally expected to be able to get more eggs in one cycle than someone with a lower AMH. Because of this, fertility doctors typically use AMH levels (along with other information) to figure out the drugs and dosages you’ll need to maximize your response to ovarian stimulation medications. 

If you’re trying to conceive naturally, you’ll be glad to hear that multiple studies have shown that AMH does not correlate with how likely you are to actually get pregnant. In fact, one study looked at levels of AMH, FSH, and another ovarian hormone, inhibin B and tracked people for a year. They found that there was no correlation between someone’s ovarian reserve and their ability to conceive and that a low ovarian reserve was not associated with lower fertility. As a result, they did not recommend the use of FSH or AMH levels to “assess natural fertility.”

Reasons AMH would be low

There are a few reasons that could explain a low AMH. Let’s explore them.

Natural decline with aging

By far, the most common reason for a low AMH is age. People with ovaries are born with all the eggs that they’re going to have in their lifetime. These eggs are then slowly used up over time as you ovulate during each menstrual cycle until menopause is reached. As a result, ovarian reserve naturally decreases over time, meaning the AMH level also decreases. 

Hormonal birth control

Research suggests that hormonal birth control may affect AMH levels but it depends on the type of birth control. Specifically, birth control use is associated with a lower average AMH level than for people who are not on birth control, with the exact effect depending on the type of birth control. 

The amount of time you’re on birth control may also be a factor. Multiple studies have shown that AMH doesn't change if you use combined oral contraceptive pills for less than six months. However, you may have a lower AMH if you’ve been a long-term user of the pill (or other hormonal methods). Thankfully, this is temporary – AMH levels typically rebound after a person stops using birth control.

You can learn more about birth control and AMH here.

Tobacco use

Studies have shown that tobacco use, usually cigarette smoking, decreases AMH levels. This effect appears to be reversible though–it was only seen in people who were active smokers, not people who had previously smoked. 

Less common causes 

There are several other, less common causes for a low AMH level. These include:

• Genetic disorders that affect the X chromosome.
• Medical treatments like radiation or chemotherapy.
• Having surgery on your ovaries.
• Losing one or both of your ovaries.
• Autoimmune conditions.

Can I still donate my eggs with a low AMH?

If you are looking to donate your eggs, minimum AMH requirements are usually 2.0 or above. With Cofertility’s Split program, we require a minimum AMH of 2.0, though clinics may have their own unique requirements. This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.

What to do if you have a low AMH result

Finding out you have a low AMH can be disheartening, especially if you had future fertility plans that you’re worried may be affected. While there’s unfortunately not much that can be done to reverse a low AMH, there is still hope for starting a family someday even with a low AMH. With the exception of birth control or cigarette smoking, most studies have shown that lifestyle changes like diet or supplements have an insignificant effect on AMH levels but despite this, I promise it’s not all gloom and doom. 

Let’s go through a few things you can do as you move forward with this new information. 

Lean on your village

The first thing to do is take a deeeeeep breath… There are a lot of nuances involved here which can make it hard not to get lost in the weeds. Fertility is impacted by so many different things that you can drive yourself crazy trying to manage all of them. 

Having friends, family, and mental health specialists available to support you when you need it is going to be crucial. Navigating fertility is hard no matter what, so having people around you who you can lean on on bad days and celebrate with on good days will help immensely. 

Consult a fertility specialist

Speaking of your village, it should definitely include a fertility specialist. Consulting with a fertility doctor can help you better understand your reproductive health and provide guidance on any concerns or questions you may have. They’ll be able to review your specific options and work with you on a plan that helps you reach your family-building goals. This treatment plan will depend on a lot of things including how soon you want to have a child, how many children you want to have, your finances, and your desire to have a child who is genetically related to you. 

So does this mean I have to freeze my eggs ASAP?

This is typically the first question people ask and the answer is not necessarily. As mentioned before, there are many other factors involved in assessing your fertility and modern technology has allowed for advances that make family building a possibility for virtually everyone. Your fertility specialist will be able to discuss all the options for starting a family based on your unique family-building goals. This could certainly include freezing your eggs for later use but it could also mean trying to conceive unassisted, undergoing IVF with your own eggs or with donor eggs, using a gestational carrier, or even options beyond these. Again, this is something that will require you to examine your personal goals and work with your provider to figure out the best way to reach them. 

You are not a number

Repeat after me: you are more than one number! Your AMH level provides valuable insights into your ovarian reserve, but it’s just one piece of the puzzle when it comes to your fertility. AMH is always used as part of a full fertility evaluation, which often includes information about your medical history and age, a partner semen analysis, an ultrasound of the pelvis, an x-ray of the uterus and fallopian tubes, and/or additional lab work.

If that sounds like a lot, it is. This process can be overwhelming but focusing on the things that you can control can help you feel more grounded during your fertility journey, whatever that may look like.

How Cofertility can help

Cofertility is here to help you every step of the way on that journey. Our Split program offers women a chance to freeze their eggs for free when donating half the eggs retrieved to a family who cannot conceive otherwise. If you qualify for the program and decide to donate half of your retrieved eggs, every expense associated with the egg freezing procedure —  medications, supplements, travel if necessary, insurance, and 10 years of storage — are completely free of charge. We don’t even need a payment or credit card up front, as the family you match with covers all the expenses.

In our Keep program, you can freeze and store your eggs for your own future use, with lower prices on things like storage and medication. as well as our team’s support and access to our community.In addition, you’ll have access to our team’s support and access to our community where you can engage with other people freezing their eggs at the same time! 

Your journey is uniquely yours and our team is here to help you through it in whatever way you need.

If you are considering starting a family or have concerns about your fertility, understanding the concept of ovarian reserve is essential. Ovarian reserve refers to the quantity of eggs (oocytes) available for fertilization. It serves as a key indicator of your reproductive potential and can play a crucial role in fertility treatment decisions. 

In this guide, we will delve into the topic of ovarian reserve, exploring its significance, how it is assessed, factors that affect it, available options for optimizing fertility, and emotional considerations related to fertility journey.

First off, what does your ovarian reserve mean?

Simply put, your ovarian reserve is your fertility potential, which is influenced by a variety of factors, including age, genetics, and certain medical conditions.

As we age, our fertility naturally declines. This is totally normal, and due to fewer eggs in the ovaries, a decrease in egg quality, and an increase in chromosomal abnormalities of the remaining eggs. These collective factors contribute to lower pregnancy rates and higher miscarriage rates as we approach age 40.

While the decline in fertility happens to ALL of us, the specific age when we can no longer conceive varies from individual to individual. And in some cases, it may be earlier than we expected.

To assess your fertility potential, including your ovarian reserve, several tests are available that can give us clues to our reproductive capabilities. These tests can also help fertility doctors, like myself, evaluate the likelihood of successful pregnancy, and guide you in making informed decisions regarding family planning and fertility treatments.

How do I know my ovarian reserve?

If you want to know your ovarian reserve, it’s best to set up time for a fertility assessment with a fertility doctor (reach out – we can help with this!). 

There are two ways a doctor can help assess your ovarian reserve, including:

Blood hormone tests

Hormone tests, including follicle-stimulating hormone (FSH), estradiol, luteinizing hormone (LH), anti-Müllerian hormone (AMH), and estradiol, provide valuable information about ovarian function and egg supply. While AMH can be taken any time, FSH and LH are typically performed on specific days of the menstrual cycle to obtain accurate results.

Antral follicle count

Transvaginal ultrasound is used to visualize the ovaries and count the number of antral follicles present. Antral follicles are small, fluid-filled sacs that contain immature eggs. The count of antral follicles serves as an indirect indicator of ovarian reserve.

By combining the results of hormone tests and ultrasound assessments, we can estimate your ovarian reserve and provide insights into fertility potential.

What is a normal ovarian reserve?

Determining what constitutes a “normal” ovarian reserve involves comparing your results to established reference ranges for your age. Age-specific reference ranges serve as benchmarks to evaluate your ovarian reserve relative to peers of the same age group. Keep in mind that ovarian reserve will gradually decline for everyone – it’s the timing and pace of change that differs. 

For example, in younger women, a higher number of antral follicles (small fluid-filled sacs containing immature eggs) and lower levels of certain hormones like FSH may be considered within the normal range. However, as a woman ages, it is expected that the number of antral follicles will decrease and hormone levels, such as FSH, may increase.

While age is a significant factor, other individual factors should also be taken into account when interpreting ovarian reserve results. Factors such as medical history, previous fertility experiences, underlying medical conditions, and fertility goals play a role in assessing the overall fertility potential. These additional factors can influence the interpretation of ovarian reserve results and help guide fertility treatment decisions tailored to the specific needs of the individual.

What causes decreased ovarian reserve?

Decreased ovarian reserve can result from various factors, including:

• Age: As we age, the quantity and quality of eggs naturally decline. The aging process gradually reduces the quality of eggs and ovarian reserve, making it more challenging to conceive.
• Smoking: Cigarette smoking has been linked to a higher rate of diminished ovarian reserve. Chemicals in tobacco smoke can accelerate the depletion of eggs and negatively impact ovarian function.
• Cancer treatment: Some cancer treatments, such as chemotherapy and radiation therapy, can have damaging effects on the ovaries. These treatments may cause a decrease in ovarian reserve and compromise fertility.
• Pelvic Surgery: Surgical procedures involving the ovaries or other pelvic organs can inadvertently damage or remove ovarian tissue. This can lead to a decrease in ovarian reserve and potentially affect fertility.
• Autoimmune diseases: Certain autoimmune conditions, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis, can impact ovarian function and diminish ovarian reserve.
• Genetic conditions: Certain genetic disorders, such Fragile X syndrome, and other chromosomal abnormalities, can be associated with decreased ovarian reserve. These conditions may affect the development and function of the ovaries.

While these factors are known to contribute to diminished ovarian reserve, individual experiences vary. You may have none of the above conditions, and still face premature ovarian failure (POF). Or you may have one of the above factors, and have no problems at all getting pregnant. Sometimes, it just comes down to luck.

What does it mean if I have a high ovarian reserve?

A high ovarian reserve refers to a situation where there is an abundant number of eggs in the ovaries. While ovarian reserve naturally declines with age, certain factors can contribute to a higher ovarian reserve in some people.

One factor associated with a high ovarian reserve is younger age. Those in their 20s and early 30s generally have a higher number of eggs compared to those in their 40s, resulting in a larger ovarian reserve. Additionally, genetic factors can influence ovarian reserve, and some may have a naturally higher number of follicles and eggs in their ovaries.

Another factor that can contribute to a higher ovarian reserve is polycystic ovary syndrome (PCOS). PCOS is a hormonal disorder that can lead to the development of multiple small follicles on the ovaries. Those diagnosed with PCOS often have a higher number of immature follicles in their ovaries, which can translate into a higher ovarian reserve.

While a high ovarian reserve can be advantageous for fertility, it does not guarantee successful conception or a higher chance of pregnancy. Other factors, such as egg quality and hormonal balance, also play significant roles in achieving pregnancy.

At-home ovarian reserve tests

There are at-home options for ovarian reserve testing. However, keep in mind that most fertility doctors will want to re-do these tests. So taking a test at home, may mean paying for a test twice.

Here are some options:

• Natalist Women’s Fertility Test ($149) measures 5 hormones: estradiol, LH, FSH, TSH, and total testosterone. You can save 20% with code COFERTILITY20
• LetsGetChecked Ovarian Reserve Test ($139) measures 1 hormone, AMH. You can save 25% with code COFERTILITY25

Ovarian reserve and egg freezing

Ovarian reserve plays a significant role in the process of egg freezing, also known as oocyte cryopreservation. Egg freezing involves the retrieval and freezing of your eggs for future use, preserving your fertility potential at a younger age. 

Assessing ovarian reserve before undergoing egg freezing is crucial for determining the quantity of eggs available for freezing. Those with a higher ovarian reserve generally have a greater number of eggs suitable for freezing, increasing their chances of successful future pregnancy. 

On the other hand, those with diminished ovarian reserve may have fewer eggs available for freezing, necessitating careful consideration of the potential outcomes and options. Understanding your ovarian reserve provides valuable information to help guide the egg freezing process and optimize the chances of achieving successful future pregnancies when the frozen eggs are thawed and used in assisted reproductive techniques.

Freeze your eggs with Cofertility

We’d love the opportunity to support you on your egg freezing journey.

Cofertility is a human-first, tech-enabled fertility ecosystem that provides people agency over if, how, and when they have babies — today or someday. We have two programs for egg freezers:

1. The Split program, which offers women a chance to both freeze their own eggs and donate half the eggs to a family who cannot conceive otherwise. If you qualify for the program and decide to donate half of your retrieved eggs, every expense associated with the egg freezing procedure —  medications, supplements, travel if necessary, insurance, and 10 years of storage — are completely free of charge. We don’t even need a payment or credit card up front, as the family you match with covers all the expenses.
2. Our self-pay Keep program allows women to freeze their eggs and keep them all for their future use. Through Keep, we offer our members partnerships and discounts to lighten the financial load of egg freezing, as well as access to our member community.

The benefits for of working with Cofertility include:

• Power of choice: Freeze your eggs more affordably or, if you qualify, freeze for free when you give half to a family who can’t otherwise conceive.
• Community: Our inclusive online spaces allow you to connect with others going through the process in our private online community.
• Compassion: We’ll always treat you with care, and our Split program gives you the opportunity to make someone’s family building dreams a reality.
• Data-driven: We provide you with trustworthy guidance and evidence-based research so you can make informed decisions about your fertility.
• Free egg freezing: Freeze and store your eggs for 10 years, entirely for free if you qualify for our Split program.

Ready to learn about more affordable (even free!) egg freezing with Cofertility? Fill out this quick quiz to learn about our accessible egg freezing options and see if you qualify for our programs — it only takes one minute.

Our goal at Cofertility is to match intended parents with Split members who can help them achieve their goal of parenthood.  Because of that, we want to make sure we’re upfront about what might disqualify someone from our Split program. 

Through this program, you can freeze your eggs for free if you donate half to a family who can’t otherwise conceive. But, importantly, several factors may limit your eligibility.  Some of these are official disqualifiers based on regulations by the Food and Drug Administration (FDA). Others are discretionary disqualifications based on recommendations by governing bodies like the American Society for Reproductive Medicine (ASRM). 

While it’s not possible to create an exhaustive list of every reason someone may not qualify for our Split program, this guide outlines some of the most common reasons for disqualification.

Age

To apply to be a part of the Split Program, you must be between the ages of 21-33. This is because you’ll need to complete your retrieval before you turn 35, so because the process can take some time, we don’t accept applicants who are 34 or older. 

The reason for this age limitation is because data shows that, on average, those over 35 tend not to respond to fertility medication as well and therefore may not produce as many eggs. Also, research shows that, unfortunately, egg quality declines with age. Various factors may affect your cycle timing (application paperwork, time to match with a family, and more) and you will need to cycle before you turn 35. We’d hate for someone to apply, get accepted, and then when the time comes for the cycle itself, potentially age out.

If you are 34-39, you are still eligible to participate in our Keep program. With this program, you can freeze your eggs and keep 100% of them for yourself. 

If you are under 21 and you’d like to participate, please reach out and we’ll get back in touch after you turn 21. 

Health-related factors 

As a preliminary step in the process, we’ll review several health-related factors. 

For starters, you’ll need to have two ovaries and you cannot have taken a Depo Provera shot, which can interfere with hormonal medications, within the past 6 months. 

Due to these hormonal medications you’ll need to take during egg freezing, you also cannot be currently pregnant or breastfeeding. However, if you plan to stop breastfeeding within the next six months, you can still go through with your Split application. You’d just need to hold off on your actual freezing cycle until then, and this situation would be communicated to potential match families. 

Additionally, you’ll need to have a BMI of 18-29. Those outside of this range are at increased risk of complications, negative outcomes, and negative side effects from hormonal medications or an egg retrieval. 

You will not qualify if you’ve had a sexually transmitted disease within the past 12 months (but can apply after 12 months of treatment). You also will be disqualified if you’ve been refused as a blood donor due to other infectious disease or medical conditions. Same goes if you’ve ever had a blood transfusion. 

Medical and family history

We will also review your and your family’s medical history. Unfortunately, this means that if you are adopted and cannot confirm your biological family’s medical history, you will not qualify. 

Though not an exhaustive list of every condition that may disqualify a member, when reviewing your personal and family medical history, we look for personal and/or family history of:

• Cancer
• Heart/blood disease
• Neurological diseases
• Mental health disorders
• Thyroid disorders
• Genetic disease
• Fertility issues
• Reproductive disease
• Autoimmune disease
• Respiratory disease
• Metabolic disease
• Gastrointestinal disease
• Kidney disease
• Birth defects

We review your personal and family medical history as a whole with our medical advisors. When reviewing, we consider the severity of the disease/conditions, number of relatives with the disease/condition, age of diagnosis, as well as that relative’s relation to you.

Psychological screening

There are also some psychological questions you’ll have to answer. We don’t expect you to be perfect. But note that certain psychological factors may be more likely to disqualify you than others. 

For example, a history of physical, sexual or substance abuse or having family members with psychiatric disorders that could be passed down may make it more difficult to be approved than, for example, having had some mild depression or anxiety. Per ASRM guidance, we will exclude those with a personal or first-degree (parents, siblings, offspring) family history of: 

• Bipolar disorder
• Schizophrenia
• Schizoaffective disorder
• Severe depression
• History of alcoholism or drug abuse

Genetic screening

As part of the process, you’ll also be required to do genetic testing via blood test or saliva sample. This helps ensure that embryos resulting from your eggs will lead to a viable pregnancy and that a child won't be born with severe disease. 

But even for serious diseases, not all disease-related genes are deal breakers. For example, if we find that you have a copy of a gene that can lead to cystic fibrosis, spinal muscular atrophy, or thalassemia, this may or may not disqualify you; it can depend on the clinic and genes of the intended parents. 

In line with ASRM guidance, in most conditions where carrying one copy of a particular gene won't impact the child themselves, you can still qualify for the Split program. 

Physical screening

In addition to genetic screening, you will have to undergo a physical screening to ensure you are physically healthy and producing a good number of eggs.  

Some disqualifications here are set in stone by the Food and Drug Administration (FDA). If evidence of any of these conditions arises, you will be considered ineligible for the program. These are considered to be non-negotiable.

• HIV
• Hepatitis B
• Hepatitis C
• Human transmissible spongiform encephalopathy
• Treponema pallidum

The following could also be deal breakers: 

• Issues with your ovaries, such as having only one ovary
• Hormone levels outside of recommended limits with concerns about your ability to produce sufficient eggs
• Any issues that would make the egg freezing and donation process risky for your health
• Evidence that you are at high risk of getting a sexually transmitted disease or could already have one. Doctors will look for discharge or ulcerative lesions for this purpose
• Indicators of possible drug use (needle tracks, for example) or exposure to needles in non-sterile conditions—including recent piercings or tattoos within the past 12 months

Anti-Mullerian hormone (ovarian reserve) levels

As you likely know, women have a set egg quantity present at birth. Your eggs mature in ovarian follicles, and each of these follicles produces the anti-Mullerian hormone (AMH). Over time, this hormone level drops; eventually, it drops so low that women naturally develop what's known as a diminished ovarian reserve (DOR).

Your AMH level can help predict how well medication may work to stimulate your ovaries to produce eggs. It also tells doctors what dosage of drugs may be needed to do so. The higher the AMH level, the more eggs generally produced. 

At Cofertility, if your AMH < 2, you are ineligible for our Split program. We only accept Split Members with these higher AMH levels as it helps mitigate the possibility of a second cycle to obtain enough eggs that could result in a live birth down the line (for yourself and for intended parents). Nevertheless, it’s important to note that, even with a high AMH level, there is always a chance that you need to do another cycle to improve the odds of a live birth. In the Split Program, you will receive AMH-reading bloodwork prior to being activated on our platform. 

If it turns out that your AMH levels are below the required minimum threshold, you would unfortunately be ineligible to move forward with egg donation. However, we can still help you freeze your eggs for your own future use through our Keep program.

State-specific qualifications

Some states do maintain their own requirements for women who are donating eggs. These requirements will extend to those in our Split program and would be determined by the location of the clinic at which you would be conducting the retrieval. 

Any state-specific egg donation qualifications will be evaluated at the time of your physical examination. 

Additional disqualifying factors

Lastly, there are a few additional factors that, unfortunately, would disqualify you from our Split program. These include if you:

• Have served jail time for more than two days within the previous 12 months
• Have undergone body piercing and/or tattooing within the past twelve months in which sterile procedures may not have been used
• Have the highest education level of GED
• Have Indigenous American ancestry and are associated with a tribe — this is due to the Indian Welfare Act 
• Currently use any nicotine products regularly, since the ASRM has confirmed an association between smoking and decreased fertility — if you engage in vaping, you will need to quit for 2-3 months before re-applying for Split, but if you only vape occasionally/socially, you will need to quit for one month prior to your retrieval date

If one or more of the above applies to you and you’d still like to participate in our Split program, reach out to us. We’d be happy to chat with you about your fertility options, including your ability to re-apply in the future. 

The net net

We know this sounds like a lot, but these disqualifiers are in place to respect the health and wellbeing of our Split members and intended parents. If you have any questions about Split—including the factors outlined here—don’t hesitate to connect with us. 

You have tons to offer, and whether you qualify for the Split program is in no way reflective of your value. The most important thing is that you feel one hundred percent comfortable in any decision you make. This is a big one, and we’re with you every step of the way.

Polycystic ovarian syndrome isn’t just a single issue, but a constellation of symptoms that many women have. And if you have a messed-up menstrual cycle, significant weight gain, or infertility, there’s a chance you may have it. You can thank an imbalance in your male and female hormones (androgen and progesterone) for getting you on this crazy train.

Even if you don’t have PCOS, it’s likely you know plenty of people who do—one in 10 women of childbearing age have the syndrome. And while any woman can develop PCOS, you’re more likely to have it if your mother or sisters had it, or if you’re overweight or obese. For some women, the symptoms start as soon as they get their first period, while others develop the syndrome later on—after significant weight gain, for instance.

Your body on PCOS

PCOS is one of those issues that may require some detective work (and some testing) before you get a diagnosis. Some of the most common PCOS symptoms include:

• Irregular periods: Your period may not follow a set schedule, may not occur often, or it may extend long beyond the typical five to seven days (lucky you). Women may also experience painful periods or pain during ovulation, says Dr. Janelle Luk, medical director and founder of Generation Next Fertility in New York City. 
• Hormonal imbalances: The increased levels of androgen can cause male-like hair patterns—including male pattern baldness, facial hair, and excess body hair—along with severe acne. You may also have a lower than normal level of progesterone, a key female hormone associated with fertility.
• Blood sugar fluctuations: We all get hangry from time to time, but if you have PCOS, this goes one step further. “Sometimes, women may also experience sugar cravings and blood sugar fluctuations that physically manifest themselves in a lack of energy or feeling light-headed,” Dr. Luk says. These blood sugar issues can sometimes lead to weight gain that’s hard to lose. PCOS can also boost your chances of developing prediabetes or type 2 diabetes. 
• Polycystic ovaries: Normally, ovary follicles release eggs during ovulation. But if you have PCOS, the excessive androgen could be working against ovulation. Your ovaries may appear swollen, and may contain several follicles that are holding on to eggs and not releasing them. That said, this isn’t a dead giveaway that you have PCOS. Having cysts alone isn’t enough for a PCOS diagnosis, and your doctor should assess your menstrual cycle (or lack thereof), hormone levels, and weight fluctuation. 

And just because you don’t check the box for every symptom, doesn’t mean you don’t have PCOS or PCOS infertility. You don’t have to have all the symptoms to be diagnosed with PCOS, and sometimes PCOS actually flies a bit under the radar. Your best bet is to head to a doctor who can specifically check for PCOS. 

How PCOS could impact your fertility

If the PCOS symptoms—like that insane menstrual cycle—don’t suck enough, they can also do a number on your ability to become pregnant. According to Dr. Luk, PCOS often creates infertility issues due to its impact on periods and ovulation; if you aren’t ovulating, you aren’t releasing an egg.

PCOS can make getting pregnant challenging, but it’s hardly impossible. While it’s super common, it’s actually one of the most treatable causes of infertility in women. If you know you have PCOS, Dr. Douglas suggests talking to your doctor about proactive steps you can take to balance your hormones and create a plan if and when you decide to try to get pregnant. 

So can I freeze my eggs if I have PCOS?

Absolutely. Like others, women with PCOS may want to freeze their eggs to proactively increase their chances of having children down the road. It’s best to freeze when you are younger, in order to get the most high quality eggs possible. 

You’ll want to make sure you work with the best doctors, because women with PCOS are more susceptible to developing ovarian hyperstimulation syndrome (OHSS) during egg freezing. This is because they are likely to have more follicles, and the more follicles an ovary has the more likely it is to be overstimulated by HCG, one of the drugs used during egg freezing. One study of 2,699 women with PCOS undergoing IVF found that 75.2% had a normal response to controlled ovarian hyperstimulation (COH), while 24.8% developed OHSS.

Interested in freezing your eggs? We can help! Freeze by Co is a better approach to egg freezing, where you can freeze for free when you give half to a family who can't otherwise conceive.

What your doctor might recommend for managing PCOS

Medication is generally the first step to try to get everything moving. If you’re trying to conceive soon, progestin therapy might be used to level out your hormones. Metformin, a medication that is used to treat type 2 diabetes, can also help treat PCOS. Although metformin isn’t FDA approved for the treatment of PCOS, decreasing insulin resistance in women with PCOS has been shown to give spontaneous ovulation rates a boost, says Dr. Marra Francis, MD, FACOG, an OB/GYN in The Woodlands, Texas. 

Some women may need to move on to ovulation-inducing medications, like Clomid, but women with PCOS need to be carefully monitored if they do. If you have PCOS and take Clomid, you may be at increased risk of releasing more eggs than the one or two typically released with each Clomid cycle, which could result in twins. 

If these treatments still can’t help you conceive, your doctor may move onto other protocols. Get ready—here come the injections, like Follitism or Menopur. If the injections alone still don’t get you pregnant, IVF may be your best bet, according to Daniel Kort, associate medical director and practice director at Neway Fertility in New York City.

Summing it up

PCOS can lead to some really crappy symptoms. But fortunately, there are plenty of tools and treatments you can use to combat your PCOS and boost your chances of getting pregnant.

The AMH (anti-mullerian hormone) test is just one of many tests you may get when seeking answers about your fertility. But we know you’re not about to head to the doctor’s office for a blood draw without understanding what you’re getting yourself into. So here’s the full scoop on what to expect.

The lowdown on the AMH test

Think of the AMH blood test as a peek into a woman’s ovarian reserve. Here’s how it works: The AMH hormone is secreted by follicles in the ovaries. As you may know, follicles are the beginnings of human eggs, and a woman only has a finite number of eggs—the number of eggs decreases with age. This test measures the level of AMH in your blood.

“A higher level of AMH correlates to a higher ovarian reserve, or as we say, ‘the more gas left in the tank,’ says Dr. Joshua Hurwitz, MD, senior physician and partner at Reproductive Medicine Associates of Connecticut (RMACT).

About those eggs...

Unfortunately, women with a lower ovarian reserve may retrieve fewer eggs during egg freezing, so understanding your ovarian reserves is an important step in informing yourself and your doctors about what’s going on in your body. That way, you can make the right plans for you, depending on your goals.

Probably the most common reason to have an AMH blood test is as part of a fertility evaluation for any female patient interested in egg freezing or IVF, says Dr. Hurwitz. Any woman who’s trying to understand her future fertility potential could decide to have her AMH levels tested as well. In other words, you also might want to get the AMH blood test if you fall into any of these categories:

• You’re considering becoming an egg donor
• You might be freezing your eggs
• You’re thinking about getting pregnant and want to know if there’s a reason to act quickly

This isn’t like looking into a crystal ball. While having a normal ovarian reserve gives you a snapshot of what your fertility looks like now, it’s not a guarantee for what will happen in the future. Still, the results could help a woman more confidently decide to wait to try to become pregnant, or to freeze her eggs for potential use in the future, says Dr. Hurwitz.

What AMH do I need to freeze my eggs?

Research has found that AMH is a good predictor of the number of eggs retrieved during egg freezing, independent of age. Because of this, a fertility doctor will use your AMH levels (amongst other biomarkers) to determine the drugs and dosages during the procedure. 

In general, says Hurtwitz, patients can interpret their AMH level this way:

• Above 1.0 ng/ml (nanograms per deciliter): Normal
• Below 1.0 ng/ml: Showing weakness in the ovarian reserve
• Below 0.5 ng/ml: Showing severe weakness in the ovarian reserve

But know that a very high level of AMH could be a sign of polycystic ovary syndrome (PCOS), which may require specific fertility treatment and/or medications. When AMH is over 5.0 nanograms per deciliter, for example, Dr. Hurwitz says it’s worth addressing if there are other potential signs of PCOS. Also, FYI: younger women tend to have higher AMH levels, and older women tend to have lower AMH levels.

What AMH do I need to donate my eggs?

If you are looking to donate your eggs, minimum AMH requirements may be slightly higher. For example, with Cofertility’s Split program, we require a minimum AMH of 2.0, though clinics may have their own unique requirements. This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.

AMH as part of a full work-up

It’s important to know that the AMH really isn’t a one-and-done test. It’s often done as part a full fertility evaluation, which may also include:

• Hysterogram (a.k.a. Sonohystogram or SHG), an ultrasound in which saline is added to the uterus (sort of a weird sensation but not so bad), so doctors can see inside and identify any problems with the uterus or fallopian tubes.
• Semen analysis, a test of a male partner’s sperm that gauges sperm count, as well as motility (the way they move) and morphology (size, shape and structure). Guys are so lucky this is their only major test.
• Hysterosalpingogram (HSG), an X-ray of the uterus and fallopian tubes (with a liquid dye in your bod!), which also can help identify or rule out certain problems.

In fact, the AMH probably isn’t the only ovarian reserve test you’ll get. It’s often done alongside:

• FSH blood test, another blood test. This is used to measure a different hormone called the Follicle Stimulating Hormone. FSH is released at the beginning of the menstrual cycle, so you’ve got to have your blood drawn at day 2, 3, or 4 of your period. A high level of FSH is associated with low ovarian reserve, and a low level of FSH is associated with a normal ovarian reserve.
• Basal Antral Follicle Count, an ultrasound in which the doctors will count the number of follicles they can see. The more follicles, the greater the ovarian reserve.

A woman’s age is also a huge factor in ovarian reserve and is really the most accurate way of gauging the quality of the remaining eggs, says Dr. Hurwitz.

It’s painless (mostly)

Since this is just a low-key blood test, there’s really not much to worry about. It can be done at any time during your menstrual cycle, and you don’t need to prep for it by fasting or in any other way. Think of it like getting a blood draw at your annual physical. You’ll have blood taken as usual through a needle into a syringe, and a Band-Aid will be placed on the site. Then, you’ll be able to go about your day as normal.

Dr. Hurwitz says his patients usually receive their AMH test results within a few days up to about a week, and they’re given over the phone by a nurse who can answer any questions they may have about their AMH levels. Then, after all their initial testing is done, the doctor sits down with his patients and discusses the results of all their tests to give a 360-degree picture of their fertility status. 

Plotting your next steps

AMH level alone won’t tell you what your next steps will be. If you’ve had all the ovarian reserve testing done, there isn’t anything further that needs to be measured in that regard.

Remember, AMH level should never be the sole measure of a woman’s fertility. In fact, one recent Journal of the American Medical Association study found that AMH levels didn’t predict which women would get pregnant over the course of a year. This is a reassuring sign for women who have low AMH levels, but Dr. Hurwitz notes that it doesn’t mean that the AMH test results aren’t important. They can help your doctor understand what’s going on in your body.

Taking your AMH results into consideration with all your other test results and health history,  you and your doctor will come up with a course of action. There’s no one answer for what this will be based on AMH level, but a low ovarian reserve might prompt a woman to begin egg freezing sooner. 

Interested in freezing your eggs? We can help! Our Freeze by Co is a better approach to egg freezing, and free when you give half to a family who can't otherwise conceive

OHSS, or Ovarian Hyperstimulation Syndrome, is a rare but potentially serious complication of egg freezing and egg donation. OHSS occurs when the ovaries become swollen and painful as a result of the hormonal medications used to stimulate egg production during fertility treatment. If you are considering egg freezing or donation, you may be wondering if you are at risk for OHSS. In this article, we will discuss everything you need to know.

What is OHSS?

OHSS is a condition that can occur as a result of fertility treatment, particularly after egg freezing. During this treatment, patients receive hormonal medications to stimulate the ovaries to produce multiple eggs for retrieval. In some cases, the ovaries may become overstimulated and produce too many eggs, causing them to become swollen and painful.

OHSS is a rare complication of egg freezing, but it can be serious if left untreated. In some cases, OHSS can lead to hospitalization and require medical intervention. Severe OHSS can cause complications such as blood clots, kidney failure, and fluid buildup in the lungs.

Ultrasound image of severe OHSS (Source)

How common is OHSS?

Data suggest the incidence of mild OHSS is 20%–33%, moderate OHSS is 3%–6%, and severe OHSS occurs in 0.1%–2% of cycles. In rare cases, OHSS can be life-threatening, so it's important to be aware of the potential risks and to inform your doctor of any symptoms (severe abdominal pain, bloating, and nausea). 

The incidence of OHSS has decreased over the years due to a better understanding of the risk factors and evidence-backed data on how to prevent OHSS. 

How do you know if you are at risk for OHSS?

The risk of developing OHSS depends on several factors, including: 

• Previous history of OHSS in past cycles
• High number of follicles during treatment puts you at an increased risk of developing OHSS
• Medications: The dosage and duration of hormonal medications can impact the chances of developing OHSS
• Age: Patients under the age of 30 are at a higher risk of developing OHSS 
• Low body weight puts you at a higher risk of developing OHSS
• Polycystic ovary syndrome (PCOS) increases your risk of developing OHSS due to the increased sensitivity to fertility medications
• Elevated hormone levels, including elevated serum estradiol (E2) concentrations and increased anti-Mullerian hormone (AMH) levels are risk factors for OHSS

Ask your doctor if they think you might be at higher-than-average risk for OHSS. If you are at high risk of OHSS, they may choose a specific protocol which utilizes the leuprolide trigger instead of hCG, which can prevent OHSS. Another medicine called cabergoline also can help reduce the fluid accumulation, or they may give you extra IV fluids at the time of egg retrieval. Most clinics will do extra monitoring of patients at risk of OHSS to decrease the risk of complications.

How many follicles put you at risk of OHSS?

Follicles are small sacs in the ovaries that contain eggs. During fertility treatment, patients are given medications to stimulate the ovaries to produce multiple follicles, which can increase the chances of achieving pregnancy down the line. However, when too many follicles develop, the risk of OHSS increases.

Ultrasound scans and blood tests are used to monitor the number and size of follicles, as well as hormone levels. There is no set number of follicles that puts you at risk of developing OHSS, as the risk varies depending on other factors such as age, body weight, and response to medications. However, as a general guideline, having more than 20 follicles on an ultrasound scan is considered a high risk for OHSS. If you are deemed to be at high risk of developing OHSS, your doctor may adjust your medication dosages or cancel the cycle to prevent OHSS from developing.

There is no set number of follicles that puts you at risk of developing OHSS. However, as a general guideline, having more than 20 follicles on an ultrasound scan is considered a high risk for OHSS.

Symptoms of OHSS after egg retrieval

Most people who undergo egg freezing do not develop OHSS. For those who do, the severity of the symptoms can vary from mild to severe and may include:

• Abdominal pain or discomfort: Patients with OHSS may experience abdominal pain or discomfort, which can range from mild to severe. This pain may feel like bloating, cramping, or a fullness in the abdomen.
• Bloating and fluid retention: OHSS can cause fluid to accumulate in the abdomen, leading to bloating and a feeling of fullness. Patients with OHSS may also experience swelling in the hands and feet due to fluid retention.
• Nausea and vomiting: Some patients with OHSS may experience nausea and vomiting, which can be caused by the swelling of the ovaries and the accumulation of fluid in the abdomen.
• Difficulty breathing: In severe cases of OHSS, the accumulation of fluid in the abdomen can cause pressure on the diaphragm, making it difficult to breathe.
• Rapid weight gain: People with OHSS may experience rapid weight gain due to the accumulation of fluid in the abdomen and other parts of the body.
• Decreased urine output: OHSS can cause a decrease in urine output, which can be a sign of dehydration and electrolyte imbalances.
• Fatigue: Patients with OHSS may experience fatigue, which can be caused by the body's response to the hormonal medications and the strain on the body's systems.

If you are undergoing egg freezing and experience any of these symptoms, it is important to contact your clinic immediately. Early recognition and management of OHSS can help to prevent the condition from worsening and ensure the best possible outcome.

How long after the egg retrieval are you at risk for OHSS?

The risk of OHSS typically peaks around five to ten days after egg retrieval. During this time, the hormones that were used to stimulate your ovaries to produce multiple eggs are still in your system, and your ovaries may continue to produce hormones even after the eggs have been retrieved. This can lead to excessive fluid accumulation and swelling in the body.

If you have undergone egg retrieval, it is important to be aware of the signs and symptoms listed above and report any concerns to your clinic right away.

Can you prevent OHSS after an egg retrieval?

Fertility doctors can identify your risk factors and take action to reduce your chances of getting OHSS in the first place. But there are also steps you can take to help prevent OHSS after egg retrieval. Here are some tips:

• Stay hydrated: Drinking plenty of fluids, especially electrolyte-rich fluids like coconut water or gatorade, can help flush out excess hormones and prevent dehydration, which can contribute to the development of OHSS. Aim for at least eight to ten glasses per day, or as directed by your doctor.
• Eat a high protein diet: A healthy, high protein diet is an important component of preparing for egg freezing.
• Rest and avoid strenuous activity: After the egg retrieval, it is important to take it easy and avoid activities that could increase your risk of developing OHSS. This includes exercise, lifting heavy objects, and sexual activity. Your doctor will likely recommend that you rest for at least 24 to 48 hours after the procedure.
• Monitor your symptoms: Be aware of the signs and symptoms of OHSS, such as those listed above. If you experience any of these symptoms, contact your clinic right away.
• Take prescribed medications as directed: Your doctor may prescribe medications, such as pain relievers or hormone supplements, to help prevent OHSS after egg retrieval. It is important to take these medications as directed and not to skip any doses.
• Attend follow-up appointments: Your doctor may schedule follow-up appointments to monitor your progress and check for signs of OHSS. Attend these appointments as scheduled and report any symptoms or concerns you may have.

While OHSS can be a serious complication, taking these steps can help reduce your risk and ensure the best possible outcome after egg retrieval. Be sure to discuss any concerns or questions you may have with your doctor, as they can provide personalized recommendations based on your individual needs and medical history.

How is OHSS treated?

Mild cases of OHSS can usually be treated with rest, increased fluid intake, and pain medication. More severe cases may require hospitalization and treatment with intravenous fluids, electrolyte replacement, and other supportive measures.

If you develop mild to moderate OHSS, your clinic may recommend close monitoring to ensure that your symptoms do not worsen. This may involve regular check-ins, blood tests, and ultrasounds to track your progress and check for signs of complications.

One of the most important treatments for OHSS is rest and hydration. This can help relieve symptoms such as bloating, abdominal pain, and nausea, and prevent complications such as dehydration and blood clots. Your doctor may recommend bed rest and increased fluid intake, and may also prescribe medications to manage your symptoms.

Your doctor may also prescribe medications such as pain relievers, anti-nausea medications, and diuretics (medications that help remove excess fluid from the body) to manage your symptoms and prevent complications. In some cases, medications such as cabergoline or GnRH agonists may be used to reduce the production of hormones that contribute to OHSS.

If you do develop severe OHSS, you may need to be hospitalized for close monitoring and treatment. In the hospital, you may receive intravenous fluids and medications, and may undergo procedures such as paracentesis (the removal of excess fluid from the abdomen) to relieve symptoms and prevent complications.

Does OHSS affect egg quality?

OHSS is caused by an overstimulation of the ovaries with fertility medications, which can lead to a higher number of eggs being produced than normal. However, the quality of those eggs is usually not affected by the presence of OHSS. In fact, one small study of 42 patients who developed severe OHSS during IVF found that while the fertilization rate was lower, the quality of embryos and the pregnancy rate were the same. 

The quality of the eggs retrieved during egg freezing is more dependent on your age and other factors, such as hormonal imbalances or underlying medical conditions. 

Does OHSS mean more eggs?

OHSS may mean more eggs, but only because having more eggs means a higher chance of OHSS. One of the main causes of OHSS is the use of medications called gonadotropins, which stimulate the ovaries to produce multiple eggs. Patients who produce a large number of eggs, usually more than 20, are at a higher risk of developing OHSS. 

In some cases, OHSS may indicate that a patient has produced a larger number of eggs than average. However, this is not always the case. Mild to moderate cases of OHSS can occur even when fewer than 10 eggs are retrieved.

Keep in mind that the number of eggs retrieved is not always an indicator of success. Other factors, such as the quality of the eggs, your age, and your overall health can all have an impact on the success of the treatment.

The goal of egg freezing is to produce a sufficient number of high-quality eggs for fertilization down the line, while minimizing the risk of complications such as OHSS. If you are undergoing egg freezing and have concerns about the number of eggs or the risk of developing OHSS, it is important to discuss your options with your doctor. They can provide guidance on the best course of action based on your individual circumstances and can help you make informed decisions about your fertility journey.

Summing it up

Egg freezing is becoming an increasingly popular option for those who want to preserve their fertility for future use. This process involves harvesting and freezing your eggs, which can then be thawed and used down the line when you are ready to start a family. However, like any medical procedure, egg freezing is not without its risks. One potential complication that can occur during the process of egg retrieval is OHSS.

While OHSS is a potential risk of egg freezing, the good news is that it is a relatively rare complication. Plus, the risk of OHSS can be reduced by carefully monitoring your response to the fertility medications and adjusting the dosage as needed. If you are worried about OHSS, we recommend talking to your doctor to discuss what can be done to reduce the risk.

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References:

1. Aboulghar M. Prediction of ovarian hyperstimulation syndrome (OHSS). Estradiol level has an important role in the prediction of OHSS. Hum Reprod. 2003 Jun;18(6):1140-1. doi: 10.1093/humrep/deg208. PMID: 12773437.
2. Fiedler K, Ezcurra D. Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment. Reprod Biol Endocrinol. 2012 Apr 24;10:32. doi: 10.1186/1477-7827-10-32. PMID: 22531097; PMCID: PMC3403873.
3. Kol S, Itskovitz-Eldor J. Severe OHSS: yes, there is a strategy to prevent it! Hum Reprod. 2000 Nov;15(11):2266-7. doi: 10.1093/humrep/15.11.2266. PMID: 11056117.
4. Namavar Jahromi B MD, Parsanezhad ME MD, Shomali Z MD, Bakhshai P MD, Alborzi M MD, Moin Vaziri N MD PhD, Anvar Z PhD. Ovarian Hyperstimulation Syndrome: A Narrative Review of Its Pathophysiology, Risk Factors, Prevention, Classification, and Management. Iran J Med Sci. 2018 May;43(3):248-260. PMID: 29892142; PMCID: PMC5993897.
5. Nelson SM. Prevention and management of ovarian hyperstimulation syndrome. Thromb Res. 2017 Mar;151 Suppl 1:S61-S64. doi: 10.1016/S0049-3848(17)30070-1. PMID: 28262238.
6. Sansone P, Aurilio C, Pace MC, Esposito R, Passavanti MB, Pota V, Pace L, Pezzullo MG, Bulletti C, Palagiano A. Intensive care treatment of ovarian hyperstimulation syndrome (OHSS). Ann N Y Acad Sci. 2011 Mar;1221:109-18. doi: 10.1111/j.1749-6632.2011.05983.x. PMID: 21401638.
7. Soave I, Marci R. Ovarian stimulation in patients in risk of OHSS. Minerva Ginecol. 2014 Apr;66(2):165-78. PMID: 24848075.
8. Sun B, Ma Y, Li L, Hu L, Wang F, Zhang Y, Dai S, Sun Y. Factors Associated with Ovarian Hyperstimulation Syndrome (OHSS) Severity in Women With Polycystic Ovary Syndrome Undergoing IVF/ICSI. Front Endocrinol (Lausanne). 2021 Jan 19;11:615957. doi: 10.3389/fendo.2020.615957. PMID: 33542709; PMCID: PMC7851086.

Anti-Mullerian hormone (AMH) is a hormone produced by ovarian follicles. It is commonly used as a marker of ovarian reserve and can be measured in the blood. A high AMH level is often associated with polycystic ovary syndrome (PCOS), but it can also have other causes. In this article, we will explore what a high AMH result means and answer some common questions about AMH testing.

First off, what is AMH?

AMH is a hormone that is produced by the granulosa cells in the ovarian follicles. It plays a role in the growth and maturation of ovarian follicles in females. AMH levels are relatively stable throughout the menstrual cycle and can be measured in the blood.

AMH is commonly used as a marker of ovarian reserve, which is a rough number of eggs that a female has remaining in her ovaries. Since females are born with a fixed number of eggs, this number naturally declines over time. 

What are normal AMH numbers?

What is considered a “normal” AMH level depends on your age, as well as the lab where you take the test. Since there is no international standard, it’s best to use the reference ranges included on the test results (your doctor can share those with you if you did a test through a clinic). 

In general, however, an AMH between 1.0 and 3.5 ng/mL suggests a “normal” range that is likely to have a good response to egg freezing.

If you are looking to donate your eggs, however, minimum AMH requirements may be slightly higher. For example, with Cofertility’s Split program, we require a minimum AMH of 2.0, though clinics may have their own unique requirements. This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.

What AMH level is considered high?

In healthy females of reproductive age, higher levels of AMH mean that the ovaries have a larger supply of eggs. This means one would be expected to have better than average outcomes for egg freezing. 

Remember, there is no universal standard for AMH, so it can vary depending on the lab where the test is run. Your test results will include if your range is “normal”, “low”, or “high” and the cut-off can differ. For example, Atlanta Fertility considers over 4.5 ng/mL high. Advanced Fertility considers anything over 4.0 ng/ml high. While RMA would consider an AMH over  3.0 ng/ml as “very high”.

With high levels of AMH, you may be at higher risk for ovarian hyperstimulation syndrome (OHSS). This means your doctor may choose a specific protocol and/or do extra monitoring to decrease the risk of complications during egg freezing.

What AMH level is considered too high?

Again, this question depends on the lab. Your test results will come with a reference range, and will indicate if your number is high for your age. If your doctor considers your levels abnormally high and has concerns, they will discuss the results with you. 

Common reasons for high AMH

The most common reason for high AMH is that you are very fertile and likely to retrieve more eggs in an egg freezing cycle.  

But a high AMH level may also indicate PCOS, which is a hormonal disorder that affects 8–13% of females of reproductive age. Those with PCOS typically have high levels of androgens (male hormones) and may have irregular periods, acne, and excess hair growth. Patients with an average AMH level ≥ 4.45 ng/ml have a 9.35 times higher likelihood of developing PCOS, but not all patients with a high AMH have PCOS.

In rare cases, abnormally high AMH could be a sign of an ovarian tumor. Certain types of ovarian tumors, such as granulosa cell tumors, can produce high levels of AMH. 

Does high AMH always mean PCOS?

While an increase in AMH levels has been reported to be associated with PCOS, high AMH alone is not enough to diagnose PCOS. 

Not all patients with PCOS have high AMH levels, and not all patients with high AMH levels have PCOS. Diagnosis of PCOS requires a combination of symptoms, hormone levels, and imaging studies, such as ultrasound.

Does high AMH mean good egg quality?

Not necessarily. While a high AMH level is often associated with a larger number of ovarian follicles and eggs, it does not necessarily mean that the eggs are of good quality. Egg quality is determined by factors such as your age, genetics, and environmental factors, and cannot be measured directly by AMH levels.

Am I ovulating if my AMH is high?

AMH levels do not indicate if you’re ovulating or not. Ovulation is the release of a mature egg from the ovary and can be confirmed by monitoring the menstrual cycle and/or performing ultrasound studies.

Will I get a lot of eggs if I have a high AMH?

The success of egg freezing outcomes largely depends on the number and quality of eggs retrieved. Studies have shown that AMH levels can be used as a predictor of egg quantity, and can thus help to predict the potential success of egg freezing. Those with higher AMH levels tend to have better outcomes with egg freezing, as they are likely to have more eggs retrieved and a higher chance of success in future fertility treatments. 

But by no means does a high AMH level guarantee a lot of eggs during an egg retrieval procedure for fertility treatments. The number of eggs retrieved during an egg freezing cycle depends on several factors, including your age, ovarian response to stimulation medications, any other underlying medication conditions, and the skill of the doctor performing the procedure.

What is a good AMH level for egg freezing?

Research has found that AMH is a good predictor of the response to ovarian stimulation and the number of eggs retrieved. Because of this, fertility doctors typically use your AMH levels (along with other biomarkers) to determine the drugs and dosages you will need to maximize your response to ovarian stimulation. 

Now, what about a correlation between AMH and actual babies born (live birth rate)? Well, while AMH does seem to have some association with live birth rates after IVF, its ability to actually predict a live birth is not that great. This is especially true for younger people. A 2021 study found that AMH is a good predictor of live birth in older (>39 years old), but not younger, people. They found that younger participants (≤38 years old) could get pregnant even with low AMH levels as long as they had frequent egg retrievals. 

Freeze your eggs with Cofertility

One option to make egg freezing better is working with Cofertility. Through our Split program, qualified freezers can freeze their eggs for free when donating half of the eggs retrieved to a family who can’t otherwise conceive. 

Through our Keep program — where you keep 100% of eggs retrieved for your own future use — we offer exclusive discounts on expenses, such as frozen egg storage. Keep members also still gain free access to our Freeze by Co Community, a safe space for those engaging in the egg freezing process (or gearing up for it) to connect and lean on each other. It also enables access to exclusive guidance, free expertise, and community events. 

By making egg freezing easier and more accessible, our programs further strengthen the American Society of Reproductive Medicine (ASRM)’s Committee Opinion that egg freezing can help promote social justice and strengthen gender equality.

Summing it up

A high AMH level is generally a good sign for your ability to successfully freeze your eggs. But for some, it can also be one indicator of PCOS. While a high AMH level is often associated with a larger number of ovarian follicles and eggs, it does not necessarily mean that the eggs are of good quality (egg quality is more dependent on age). 

AMH levels are commonly used as a marker of ovarian reserve and can be helpful, in conjunction with other measures, in predicting the number of eggs that can be retrieved during an egg freezing cycle. However, it is important to keep in mind that egg quality is determined by several factors and cannot be measured directly by AMH levels. If you have concerns about your fertility or AMH levels, it is important to speak with a fertility doctor for personalized advice and treatment options.

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Read more:

• Which Matters More for Fertility: AMH or Age?
• What AMH Level Do I Need to Freeze My Eggs?
• Do’s and Don’ts During Egg Freezing: Alcohol, Baths, Exercise, and More

More and more people are freezing their eggs; in fact, in 2021 we saw a 46% increase in egg freezing cycles in the United States. If you’re exploring egg freezing, you may have a lot of questions, including if you can stay on birth control or not. In this article, we will discuss how birth control works and answer common questions about egg freezing while on various types of birth control.

How birth control works

Birth control methods work in various ways to prevent pregnancy. Hormonal methods, such as the pill, patch, ring, and injection, regulate hormones in the body to prevent ovulation. Without ovulation, there is no egg available for fertilization.

Non-hormonal methods, such as condoms, diaphragms, and intrauterine devices (IUDs), physically prevent sperm from reaching the egg or alter the environment in the uterus to prevent implantation. IUDs can be either hormonal or non-hormonal, depending on the type.

If you are freezing your eggs, do not start or stop your current birth control regimen without talking to your fertility doctor. 

Can I freeze my eggs while on the pill?

You will need to stop taking the pill before the actual egg freezing cycle. That’s because hormonal birth control is intended to prevent ovulation, but during freezing you want to do exactly the opposite. Some doctors will have you stop during your egg freezing cycle, and some may have you stop for the month leading up to the retrieval. 

The irony is that in preparation for an egg freezing cycle, the birth control pill is commonly prescribed for two to three weeks to sync your cycle and reduce the chance of inducing a cyst from the ovulation follicle. It can also help synchronize the cohort of follicles for a more optimal response. So if you’re not on the pill, you may be prescribed birth control pills with the start of the menstrual cycle in which you plan to undergo the egg freezing cycle.

Can I freeze my eggs while on Depo-Provera?

Depo-Provera (medroxyprogesterone acetate) is an injection that contains a synthetic form of the hormone progesterone. Since this shot can interfere with hormonal medications, you You may have to wait up to three to six months after the last shot until your ovaries are in an optimal state to be stimulated.

While Depo-Provera can affect the timing of ovulation, it does not impact the number or quality of eggs that are retrieved during the egg freezing process.

Can I freeze my eggs with an IUD?

Yes! Unlike other forms of birth control, IUDs do not prevent ovulation and therefore will not get in the way of stimulating egg production during your freezing cycle. If you have an IUD, there’s no need to remove it before your cycle. Although if you’ve been meaning to take it out, ask the doctor if they can do it during your procedure. 

Studies show that egg and embryo freezing results are the same for patients with or without IUDs.

Can I freeze my eggs with Nexplanon (birth control implant)?

Nexplanon is a small rod that is inserted under the skin of the upper arm and contains a synthetic form of the hormone progesterone. It can remain in place and does not appear to impact the number or quality of eggs that are retrieved during the egg freezing process.

Can I freeze my eggs with the patch?

Like the pill, the patch contains synthetic hormones that regulate the body's natural hormone levels and prevent ovulation. In order to begin an egg freezing cycle, you will need to remove the patch. 

Can I freeze my eggs with NuvaRing?

The NuvaRing is a vaginal hormonal birth control ring. Because it’s using hormones to prevent ovulation, like the pill and the patch, you will need to remove the NuvaRing before your cycle. However, your fertility doctor will give you instructions and there’s no need to remove it until they tell you to. 

Why is my doctor prescribing birth control to freeze my eggs?!

While it may seem counterintuitive, many fertility doctors recommend or prescribe birth control at the beginning of the egg freezing process. There are several reasons why:

• To coordinate the timing of stimulation start. Hormonal birth control pills can be used to offset the menstrual cycle to help facilitate the best timing for your cycle with your clinic/lab.
• To reduce the likelihood of ovarian cysts. Birth control pills may help to suppress the growth of ovarian cysts, which can interfere with the egg retrieval process. 

So while it may seem counterintuitive, using birth control pills before egg freezing is pretty typical. 

Summing it up

Hormonal birth control methods work by regulating hormones in the body to prevent ovulation, while non-hormonal methods physically prevent sperm from reaching the egg or alter the environment in the uterus to prevent implantation. While it is possible to freeze your eggs while on various types of birth control, it depends on which one. 

• Definitely okay: condoms, diaphragms
• Generally okay: IUD, birth control implant
• Need to stop: the pill, the patch, NuvaRing
• Potential wait of three-six months: Depo-Provera

Of course, do not start or stop your current birth control regimen without talking to your fertility doctor first.  

Freeze your eggs with Cofertility

Cofertility is in the “family” business, striving to make egg freezing and third-party reproduction more human-centered and accessible for all. Our Freeze by Co program allows you to freeze your eggs for free when you give half of the eggs retrieved to a family who can't otherwise conceive.

Understanding reproductive health is crucial, especially when it comes to fertility. Anti-Müllerian hormone (AMH) is one of the key markers used to assess ovarian reserve, which refers to the quantity of eggs. Many factors can impact AMH levels, including age, genetics, and certain medical conditions.

One common question that arises is whether birth control, a widely used contraceptive method, can affect AMH levels. In this article, we will explore the relationship between birth control and AMH levels to shed light on this topic and provide valuable insights for those concerned about their fertility.

What is AMH?

Before delving into the impact of birth control on AMH levels, let's first understand what AMH is and its significance in assessing ovarian reserve. AMH is a protein produced by the small follicles in the ovaries. These follicles contain immature eggs, and the level of AMH in the blood provides an estimate of the remaining egg supply. Ovarian reserve tests can help you make decisions about egg freezing. In general, higher AMH levels indicate a larger number of follicles and potentially better ovarian reserve, while lower levels may suggest a diminished egg supply.

Can birth control affect your AMH levels?

One common concern among women is whether taking birth control can influence AMH levels. Birth control methods, such as oral contraceptive pills (aka “the pill”), patches, injections, and intrauterine devices (IUDs), work by regulating hormones and preventing ovulation. So it is reasonable to question whether these hormonal interventions can impact AMH levels.

Research suggests that hormonal birth control may affect AMH levels. But it depends on the type of birth control.

One study looked at data from women on various types of birth control and found: 

• Combined oral contraceptive pill led to 23.7% lower AMH
• Progestin-only pill led to 14.8% lower AMH
• Vaginal ring led to 22.1% lower AMH
• IUD led to 6.7% lower AMH
• Implant led to 23.4% lower AMH
• Copper intrauterine device led to 1.6% lower AMH

The authors concluded that birth control use is associated with a lower mean AMH level than for women who are not on contraceptives, with variation depending on the type of birth control

Learn more: Egg Freezing and Birth Control: An Overview

The amount of time you are on birth control may also be a factor. A systematic review of 15 studies concluded that AMH is unchanged in women using combined oral contraceptive pills if they were using it under six months. 

However, they found a lower AMH in long-term users of the pill. But it’s just temporary – AMH levels rebounded after they stopped using birth control.

Is AMH accurate if on birth control pills?

One study compared the AMH levels of 228 hormonal contraception users and 504 non-users. They found that users of birth control had 29.8% lower AMH concentrations. Because of this, the authors concluded that AMH may not be an accurate predictor for women using hormonal contraception.

You may want to consider the timing of the AMH test when using hormonal contraceptives. Estrogen can suppress the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are necessary for the development and maturation of follicles. 

As AMH levels are influenced by FSH and LH, you could wait for a few weeks after discontinuing birth control before measuring AMH levels for a more accurate assessment of ovarian reserve. Or, you could take the test knowing the results may be lower due to birth control. It’s best to discuss this with your doctor.  

Do I need to get off birth control to get AMH tested?

In general, it is not necessary to discontinue birth control before getting an AMH test. However, it's important to be aware that hormonal contraceptives, such as oral contraceptive pills, can potentially lower AMH levels temporarily while being used. This means that if you are currently using birth control, the AMH results may be lower than they would be if you were not on contraceptives.

If you are concerned about the accuracy of your AMH test or have specific fertility-related questions, it’s best to consult with a fertility doctor. They can provide personalized guidance based on your individual circumstances and help you understand how birth control may impact your AMH results. They will take into consideration factors such as the type of birth control you are using, your reproductive goals, and any underlying medical conditions. This will help ensure that you receive the most accurate and relevant information regarding AMH testing and its interpretation.

Will my AMH change if I get off birth control?

AMH can and will change throughout your life. And, it is generally believed that AMH levels should return to their baseline after stopping hormonal contraceptives. 

Birth control methods, such as oral contraceptive pills, work by suppressing ovulation and altering hormone levels. Once you discontinue birth control, your body will naturally resume its normal hormonal patterns, and AMH levels should stabilize accordingly.

Individual responses to stopping birth control may vary. Some may experience a temporary fluctuation in their hormone levels as their body adjusts, which could potentially affect AMH measurements. However, these fluctuations are typically short-lived, and AMH levels should gradually return to their baseline within a few menstrual cycles.

If you are planning to assess your ovarian reserve through an AMH test, you may want to wait for a few weeks or consult with your fertility doctor to determine the most appropriate timing after discontinuing birth control. This will help ensure a more accurate assessment of your current ovarian reserve without the influence of hormonal contraceptives.

Remember, AMH levels provide valuable insights into ovarian reserve but are just one piece of the puzzle when it comes to fertility. 

Does birth control help egg reserve?

Although birth control does not directly affect AMH levels or egg reserve, it can provide some indirect benefits related to reproductive health. By preventing ovulation and regulating menstrual cycles, birth control can help manage various gynecological conditions such as polycystic ovary syndrome (PCOS), endometriosis, and irregular periods. By providing symptom relief and controlling hormone levels, birth control can potentially improve overall reproductive health (thanks birth control!).

Additionally, certain forms of birth control, such as combined oral contraceptive pills, may help reduce the risk of ovarian cysts and decrease the incidence of ovarian and endometrial cancers. These benefits contribute to the overall well-being of your reproductive system, indirectly supporting egg reserve.

AMH and egg sharing

If you are looking to donate your eggs through Cofertility’s Split program, where you freeze for free in exchange for donating half to a family that could not otherwise conceive, we require a minimum AMH of 2.0 (though clinics may have their own unique requirements). This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.

You are not a number

With all the nuances involved here, it’s important not to get lost in the weeds. Fertility is impacted by so many factors that you can drive yourself crazy trying to manage all of them. 

Remember, you are more than any number. This process can be overwhelming, but focusing on the things that you can control can help you feel more grounded during your fertility journey, whatever it may look like. 

Cofertility is here to help you every step of the way on that journey. 

Our Split program offers women a chance to freeze their eggs for free when donating half the eggs retrieved to a family who cannot conceive otherwise. If you qualify for the program and decide to donate half of your retrieved eggs, every expense associated with the egg freezing procedure —  medications, supplements, travel if necessary, insurance, and 10 years of storage — are completely free of charge. We don’t even need a payment or credit card up front, as the family you match with covers all the expenses.

Or, in our Keep program, you can freeze and store your eggs for your own future use, with lower prices on things like storage and medication – as well as our team’s support and access to our community.

The benefits for of working with Cofertility include:

• Power of choice: Freeze your eggs more affordably or, if you qualify, freeze for free when you give half to a family who can’t otherwise conceive.
• Community: Our inclusive online spaces allow you to connect with others going through the process in our private online community.
• Compassion: We’ll always treat you with care, and our Split program gives you the opportunity to make someone’s family building dreams a reality.
• Data-driven: We provide you with trustworthy guidance and evidence-based research so you can make informed decisions about your fertility.
• Free egg freezing: Freeze and store your eggs for 10 years, entirely for free if you qualify for our Split program.

Ready to learn about more affordable (even free!) egg freezing with Cofertility? Fill out this quick quiz to learn about our accessible egg freezing options and see if you qualify for our programs — it only takes one minute.

Whatever your journey looks like, our team is here to guide you through it and keep your family-building options open.

Summing it up

Understanding reproductive health is crucial, especially when it comes to fertility. AMH is a key marker used to assess ovarian reserve, which refers to the quantity eggs. While birth control does not directly impact AMH levels or egg reserve, it can have temporary effects on AMH measurements while being used. The type and duration of birth control can influence the degree of impact on AMH levels. 

If you are currently using birth control, it is not necessary to discontinue it before getting an AMH test. However, it's important to be aware that hormonal contraceptives can potentially lower AMH levels temporarily. This means that the AMH results may be lower than they would be if you were not on contraceptives. Consulting with a fertility doctor can provide you with specific guidance on timing and interpretation of AMH results.

If you decide to discontinue birth control, AMH levels should return to their baseline over time as your body adjusts to its natural hormonal patterns. Temporary fluctuations in hormone levels may occur, but these are typically short-lived, and AMH levels should stabilize within a few menstrual cycles. (And if you do discontinue birth control, definitely use backup contraception during that period if you’re trying to avoid pregnancy). 

Remember, AMH levels provide valuable insights into ovarian reserve, but they are just one piece of the puzzle when it comes to fertility. Consulting with a fertility doctor can help you understand the broader context of your reproductive health and provide guidance on any concerns or questions you may have.

Read more:

• What AMH Level Do I Need to Freeze My Eggs?
• Which Matters More for Fertility: AMH or Age?
• I’m Going Off Birth Control. Now What?

I was 28 when I first started trying to conceive. I vividly remember taking my last birth control pill, throwing out my pack, and texting my friend to tell her we were no longer “not trying,” excited but nervous. Sounds pretty standard, right? Unfortunately, what I didn’t know at the time was that I was about to embark on a two-and-a-half-year journey to get pregnant with my son. This included several pregnancy losses, a few rounds of IVF, and lots of questions, including, “should I have tested my fertility sooner?”. 

I don’t share this to scare anyone. But my story is not all that uncommon. In fact, 1 in 6 individuals experience some form of fertility challenge. 

I was woefully unprepared. And because of this lack of preparedness by Sex Ed as well as limited time with my OBGYN, it probably took a good six months before I started to understand what actually goes into conceiving a healthy pregnancy: timing, lifestyle, genetics, and more. So much of my time, stress, and probably money could have been saved by proactive fertility testing.

In this article, we’ll discuss when to test your fertility, the importance of early fertility awareness, and proactive measures you can take to understand it. If you take one thing away from this article, though — the best time to test your fertility is right now. Let’s talk about why. 

So what is fertility testing, anyway?

Before we dive into when to test your fertility, it’s important to understand what fertility testing even is. 

Ovarian reserve testing

A fundamental concept of assessing one’s fertility is to understand their ovarian reserve. This involves evaluating the quantity of a woman's remaining egg supply (oocytes) in her ovaries. One of the most widely used tests for ovarian reserve (though not without its limitations — more on that below) is the measurement of Anti-Mullerian Hormone (AMH) levels, which can be done with a simple blood test. 

Understanding AMH

AMH is a protein produced by cells in the ovarian follicles, with levels of AMH in your blood providing an indication of the number of eggs remaining in your ovaries. If you’re considering egg freezing, AMH testing is especially valuable, as it helps assess your starting point and may indicate a timeline of how urgently you may want to move forward with freezing your eggs. 

Your AMH may also give a sense of how your ovaries might respond to the actual egg freezing process. Lower AMH levels typically suggest a diminished ovarian reserve, which may impact fertility potential. In general, an AMH between 1.0 - 3.5 ng/mL is considered a “normal” range. 

Individuals with a higher AMH level — which varies by lab, but could be anywhere over 3.0 ng/ml — usually have a better response to ovarian stimulation, leading to a higher number of eggs likely to be retrieved during the procedure. That said, a higher AMH also carries a greater risk of ovarian hyperstimulation syndrome (OHSS), so your doctor will need to be careful with your medication protocol and monitoring.

Should I test my fertility at home or in a clinic?

At-home fertility tests have gained popularity in recent years due to their convenience and privacy. These tests typically involve collecting blood or urine samples and mailing them to a laboratory for analysis. On the other hand, in-clinic fertility tests are conducted at a medical facility, where specialized equipment and healthcare professionals are available.

The pros of at-home fertility tests

• Convenience and privacy: Samples can be collected in the comfort of your home.
• Cost-effective: At-home tests are often more affordable than in-clinic procedures.
• Early assessment: At-home tests allow you to gain insights into your fertility potential before actively trying to conceive. Plus, you won’t have to wait to get squeezed in for an appointment at the clinic!

The pros of testing your fertility at a clinic

• A broader scope: At-home tests may not provide a comprehensive evaluation of fertility health, while testing your fertility at a clinic provides a more comprehensive picture of your fertility. An important note is, when testing your fertility at a clinic, you’ll also undergo a transvaginal ultrasound, where the technician or doctor will be able to get a view of what’s going on in those ovaries and the number of follicles available this cycle.
• Better accuracy: Some at-home tests may have varying levels of accuracy when compared to in-clinic tests.
• Face time: At a clinic, you’ll have the ability to chat directly with a doctor, before and after your results.

When should I test my fertility? 

So, when is the “right” age for testing your fertility, anyway? 

It depends.

And ultimately, it’s up to you! It’s your body, and your data, and there is no one-size-fits-all answer. We’re firm believers that knowledge is power and you deserve this information. Studies do show that our ovarian reserve declines with age — in other words, it’s a good idea to assess your fertility potential sooner rather than later. That way, if you do want to preventatively freeze your eggs, you can do so while your ovarian reserve is still higher. 

According to the American Society for Reproductive Medicine (ASRM), the optimal time to freeze your eggs is in your 20s and early 30s. And this study indicated that, as we get older, our chances increase of needing to do multiple egg freezing cycles in order to achieve a 70% live birth rate. We know we’re a bit of a broken record here, but: the younger you are, the healthier and more plentiful your eggs are. 

Consider your egg freezing plans

Because the ASRM doesn’t recommend egg freezing for people older than 38 (although this is not a hard and fast rule), it’s a good idea to test your fertility earlier on if possible. That way, should you decide to move forward with egg freezing, you’ll have the time and space to come up with a plan and hopefully see some successful results.

If and when you decide to move forward with egg freezing, you can freeze your eggs more affordably (even for free!) with Cofertility. Fill out this quick quiz to learn about our accessible egg freezing options and see if you qualify for our programs — it only takes one minute.

Should I test my fertility in my 20s?

Testing your fertility in your 20s gives you the most flexibility. Whether your testing looks great and you want to freeze your eggs now, or you uncover potential fertility risks to address, the more time you have, the better. 

Your doctor may even recommend fertility testing if you have past or current reproductive health issues, including sexually transmitted infections (STIs), endometriosis, or PCOS, all of which can contribute to fertility challenges. Even if you’re not yet sure if you want to start a family in the future, testing your fertility in your 20s may help you make informed decisions about family planning options down the line. 

Best at-home fertility tests

If you’re curious to learn more about your ovarian reserve, talk to your doctor about fertility testing. If your doctor won’t order the tests…you might want to find a new one who listens to your concerns and takes them seriously. But in the meantime, there are many great at-home fertility testing options out there. 

LetsGetChecked Ovarian Reserve Test

Cost: $139 

Hormones measured: AMH

Why we like it: While it only tests one hormone, the test is simple and fast. It’s also the least expensive of the three, plus you can get 25% off with code COFERTILITY25.

‍Natalist Women’s Fertility Test 

Cost: $149

Hormones measured: estradiol, LH, FSH, TSH, and total testosterone

Why we like it: Natalist provides comprehensive insights into ovarian reserve, empowering individuals to assess their fertility potential in the comfort of their own homes. Plus, it’s a woman-owned and woman-run company. Use Cofertility20 for 20% off your entire purchase.

Remember: at-home fertility tests aren’t without limitations

Although at-home fertility tests are a great way to get a peek behind the curtain of your fertility, they aren’t without limitations. For starters, according to recent studies, measuring AMH alone may not predict your time to pregnancy. As mentioned above, testing your fertility with a doctor at a clinic will likely provide a more comprehensive picture of your fertility outlook, especially as they consider your medical history, and conduct a physical exam and transvaginal ultrasound. Of course, you’ll also get professional interpretation of the results that you may not receive with an at-home fertility test. 

All of that being said, any fertility testing (whether at home or in a clinic) only measures your fertility at that given point in time. It should not be taken as a guarantee for future outcomes. It also can’t tell you anything about your egg quality, which cannot be truly observed until it comes time to actually fertilize those eggs. 

Consider egg freezing as a proactive measure

After testing your ovarian reserve, it’s worth considering freezing your eggs if you don’t want kids soon. We’ll be the first to say that egg freezing is not a guarantee for a successful pregnancy in the future — those eggs need to be fertilized into embryos, transferred to a uterus, and then carried for 40 weeks to result in a live birth! But because our fertility declines with age, the earlier we preserve it, the more set up for success we may be in the future if we do need to use those eggs down the line. 

How does egg freezing work? 

As a primer, egg freezing allows individuals to preserve their fertility by freezing and storing their eggs for future use (fertilization). Let’s get into some of the specifics. 

Some benefits of egg freezing

There are many reasons why egg freezing can be beneficial, including: 

Delaying parenthood: Egg freezing enables individuals to postpone childbearing to pursue educational, career, or personal goals while increasing their chances of having a healthy pregnancy down the line.

Medical reasons: Some medical treatments, such as chemotherapy or radiation, can impact fertility. Egg freezing offers a proactive option for individuals facing medical conditions that may affect their reproductive health.

Preserve higher quality eggs: As we age, our ovarian reserve diminishes, and the quality of our eggs declines. By freezing eggs at a younger age, individuals can preserve their eggs when they are of higher quality.

The egg freezing process

Overall, the egg freezing process is a 10-14 day period involving ovarian stimulation, the actual egg retrieval, and storing the frozen eggs. Here’s what goes into each.

Ovarian stimulation: Before the egg retrieval, individuals typically take injectable hormone medications for about 10-14 days. This process encourages the ovaries to produce multiple mature eggs. You’ll head to the clinic for monitoring every few days (more frequently as you get closer to your retrieval) so your doctor can check on how things are progressing and make updates to your medication protocol if needed.

The egg retrieval: Once the eggs are mature, a minimally invasive procedure known as transvaginal ultrasound-guided aspiration is performed to retrieve the eggs from the ovaries. The procedure is usually well-tolerated and does not require a surgical incision.

Cryopreservation: After retrieval, the eggs are frozen using a process called vitrification. This method prevents the formation of ice crystals, which could damage the eggs during freezing. You’ll store your eggs in a special storage facility meant for just that. 

For an in-depth overview of the egg freezing process, click here.

Success rates of egg freezing

The success of egg freezing largely depends on the age at which the eggs are frozen. Generally, eggs frozen at a younger age have a higher chance of resulting in a successful pregnancy. Advanced vitrification techniques have significantly improved egg freezing success rates, with some studies reporting comparable pregnancy rates between fresh and frozen-thawed eggs.

One study of 1,241 women found that the average number of eggs retrieved on the first egg freezing round was:

• 21 eggs for women under 35
• 17 eggs for women 35-37
• 14 eggs for women 38-40

But, in addition to egg quantity, we also need to consider egg thaw survival rate, and the rate at which these eggs become embryos and result in a live birth. According to a study in the Journal of Assisted Reproduction and Genetics, a woman under 35 will need 9 eggs to achieve a 70% chance of having at least one live birth. If you’re trying to conceive in your mid to late 30s, you may need double as many eggs to achieve that same 70% success rate. 

Not only will freezing your eggs proactively give you the options of utilizing higher quality eggs in the future, it also helps alleviate the pressure of finding a reproductive partner, and can allow us to feel empowered to make family planning decisions on our own terms without any compromises. Taking a proactive approach to fertility preservation can provide the freedom to pursue opportunities without sacrificing the dream of having a family when the time is right.

Freezing your eggs with Cofertility

With Freeze by Co, you have the opportunity to apply to our Split program, where you can freeze your eggs for free when you donate half of the retrieved eggs to a family that can’t otherwise conceive. The cost of the entire process, including 10 years of cryopreservation, is fully covered. 

Or, if you want to freeze and store your eggs for your own future use without donating, as part of our Keep program, we offer lower prices on things like consultations and storage, along with access to our community of others going through the process at the same time. ‍Plus, you’ll have direct access to our team, which is here to support you throughout the entire journey.

Summing it up

If you’re considering testing your fertility, the best age to do it is now. Whether you test yourself at home, or with a doctor at a fertility clinic, testing your fertility can provide valuable insights into what your family-building future may look like. It might also uncover the need for egg freezing in order to preserve some of your existing fertility as it stands today. But whatever you decide to do with the results, you’ll at least be armed with more information about yourself than you would have had otherwise. 

Are you ready to embark on a journey through the fascinating world of female fertility hormones? We've got all the details on those tiny chemical messengers that hold the key to your reproductive prowess. Whether you're curious about boosting your chances of egg freezing success or simply want to understand the inner workings of your amazing body, this article will dive into a hormonal adventure that will leave you feeling empowered and in control. Let’s go!

Anti-Mullerian Hormone (AMH)

What it is

The most talked about hormone of them all: AMH. AMH is produced by the developing follicles in the ovaries and serves as an biomarker of ovarian reserve. It helps estimate the quantity of eggs remaining in the ovaries and is commonly used in assessing how well your body will respond to IVF or egg freezing. 

Normal AMH levels

You can take an AMH test any time in your cycle. In general, AMH levels can be interpreted by:

• Above 1.0 ng/ml (nanograms per deciliter): Normal
• Below 1.0 ng/ml: Showing weakness in the ovarian reserve
• Below 0.5 ng/ml: Showing severe weakness in the ovarian reserve

Keep in mind that lab numbers can vary. Your blood test results will show the lab’s normal range on the report.

What AMH can tell you

As we age, our AMH levels naturally decrease until we hit menopause and our AMH reaches 0. While the decline in fertility happens to ALL of us, the specific age when we can no longer conceive varies from individual to individual. And in some cases, it may be earlier than expected. AMH can give us insight into where we are on that journey.

While AMH is pretty awesome, there are two things it can’t tell us: (1) it can’t tell us the quality of the eggs remaining and (2) it can’t tell us our chances of getting pregnant unassisted.

Estrogen

What it is

Estrogen hormone is the ultimate multitasker, responsible for so many amazing things. It's the power behind that glowing, radiant skin and full, thick hair. And it also takes charge of thickening the uterine lining each month, which either sets the stage for a growing embryo, or culminates in your period.

Estrogen is actually a collective term used to describe a group of hormones that play a vital role in the female reproductive system. It includes three types of hormones: 

• Estrone (E1) which is the only type of estrogen that our bodies keeps making even after menopause
• Estradiol (E2) causes the maturation and release of the egg as well as the thickening of the uterus lining each month
• Estriol (E3) is really only present during pregnancy, and helps the uterus grow and stay healthy

Estrogen levels fluctuate throughout the menstrual cycle, with estradiol being the dominant form during the follicular phase (leading up to ovulation) and progesterone taking the lead during the luteal phase (after ovulation). Understanding the dynamics and functions of estrogen and estradiol can help shed light on the intricate mechanisms underlying female reproductive health.

Altogether, estrogen plays a key role in regulating the menstrual cycle, supporting the growth and development of the uterus and breasts, and maintaining bone health.

Normal E2 levels

Estrogen levels fluctuate throughout your life, often aligning with other hormones that regulate crucial bodily functions, such as the menstrual cycle. These dynamic changes in estrogen levels are considered a normal part of the body's hormonal rhythm. 

Estradiol (E2) is the hormone most often tested for fertility. E2 levels vary widely through the menstrual cycle, and are expected to fluctuate from test to test. A normal range is considered:

• Premenopausal: 30 to 400 pg/mL (110 to 1468.4 pmol/L)
• Postmenopausal: 0 to 30 pg/mL (0 to 110 pmol/L)

There can be variations in the normal value ranges for laboratory tests, as different laboratories may use different measurement methods (e.g. saliva, blood prick, or venipuncture) or test different samples. Your doctor will be able to provide you with accurate interpretation and insights based on your individual circumstances.

What E2 can tell you

If you consistently test on the lower range, it may indicate the onset of menopause, premature ovarian failure, or low estrogen from rapid weight loss or anorexia. If your results are higher, it may suggest a tumor of the ovary.

Follicle-Stimulating Hormone (FSH)

What it is

‍FSH is the ultimate fertility cheerleader. Like the squad captain, FSH leads the charge in the growth and development of those ovarian follicles, which contain the eggs. It's the one shouting, "Let's grow those eggs, ladies!" 

Our FSH levels change throughout the menstrual cycle, with the highest levels happening just before ovulation (when an egg is released by the ovary).

Normal FSH levels

For fertility testing, you need to have the FSH blood test on day 3 of your menstrual cycle (day 1 is the day your period begins). In general, normal FSH levels are:

• Premenopausal: 4.7 to 21.5 mIU/mL
• Postmenopausal: 25.8 to 134.8 mIU/mL

Keep in mind that lab numbers can vary. Your blood test results will show the lab’s normal range on the report.  

What FSH can tell you

‍Higher-than-normal levels of FSH can be a sign of infertility due to premature ovarian failure or menopause. It could also be due to certain types of tumors in the pituitary gland, or due to Turner syndrome.

Lower levels could mean pregnancy, being very underweight or having had recent rapid weight loss, not ovulating, or that parts of the brain are not producing normal amounts of hormones. If you have abnormal results, your doctor will discuss your situation and next steps. 

Luteinizing Hormone (LH)

What it is

This hormone takes center stage and demands attention as it triggers the grand finale of the menstrual cycle: the release of a mature egg. LH sends that egg on its way, ready for its moment in the spotlight and a chance at fertilization.

While LH has a major job for our reproductive system, it’s actually secreted by a tiny structure in your brain called the pituitary gland.

Normal LH levels

LH fluctuates throughout your cycle, and the ranges are:

Premenopause: 5 to 25 IU/L

Postmenopause: 14.2 to 52.3 IU/L

Remember, lab numbers can vary. Your blood test results will show the lab’s normal range on the report.  

What LH can tell you

Abnormal LH levels can indicate ovulatory disorders, such as polycystic ovary syndrome (PCOS) or hypothalamic amenorrhea. 

LH testing (via urine test strips) can also help to predict ovulation. By detecting the LH surge each cycle, these test strips give us a glimpse into our fertile windows, or when we’re most likely to get pregnant. 

Progesterone

What it is

Progesterone swoops in after ovulation (which, remember, was ushered in by LH) to prepare the uterine lining, transforming it into a cozy, welcoming haven for a potential embryo. Progesterone is crucial for early pregnancy, helping maintain the thickened endometrium. But if an egg isn’t fertilized during that cycle, progesterone levels decrease, your uterine lining thins, and your period begins. 

Normal progesterone levels

• Pre-ovulation: less than 1 nanogram per milliliter (ng/mL) or 3.18 nanomoles per liter (nmol/L)
• Mid-cycle: 5 to 20 ng/mL or 15.90 to 63.60 nmol/L
• Postmenopausal: less than 1 ng/mL or 3.18 nmol/L
• Pregnancy 1st trimester: 11.2 to 90.0 ng/mL or 35.62 to 286.20 nmol/L
• Pregnancy 2nd trimester: 25.6 to 89.4 ng/mL or 81.41 to 284.29 nmol/L
• Pregnancy 3rd trimester: 48 to 150 to 300 or more ng/mL or 152.64 to 477 to 954 or more nmol/L

What progesterone can tell you

While LH tests can help us predict when we’re about to ovulate, progesterone tests can help confirm if we actually did ovulate. 

If you have low progesterone and aren’t pregnant, you may have symptoms like irregular periods, infertility, mood changes, trouble sleeping, or hot flashes.

If you have low progesterone and are pregnant, it could mean a higher risk of miscarriage or an ectopic pregnancy.

Prolactin

What it is

Prolactin is the hormone that orchestrates the magic of breastfeeding. It causes the breasts to grow and make milk during pregnancy and after birth. While its primary role lies in the breastfeeding realm, elevated levels of prolactin when not pregnant or postpartum can sometimes interfere with ovulation and menstrual regularity.

Normal prolactin levels

Made in the the pituitary gland, normal levels of prolactin are:

• Nonpregnant: less than 25 ng/mL (25 µg/L)
• Pregnant: 80 to 400 ng/mL (80 to 400 µg/L)

Keep in mind that lab numbers can vary. Your blood test results will show the lab’s normal range on the report. Talk to your doctor about your specific results.

What prolactin can tell you

Abnormally high levels of prolactin when you are not pregnant could mean a condition called hyperprolactinemia, which is actually quite common. Believe it or not, about a third of women in their childbearing years with irregular periods (but perfectly normal ovaries) have hyperprolactinemia. Hyperprolactinemia could mean trouble getting pregnant. Not to mention, your boobs might start producing milk when you're not even expecting it (hello, galactorrhea!).

High prolactin levels can also throw a wrench in the normal hormone production, messing with the likes of estrogen and progesterone. And when that happens, it can disrupt ovulation or lead to irregular or missed periods. 

Thyroid-Stimulating Hormone (TSH)

What it is

This hormone ensures that our thyroid gland, that tiny powerhouse in our neck, is working harmoniously. Thyroid health is crucial for maintaining menstrual regularity and fertility, so when TSH steps onto the scene, you know it's time to keep that thyroid in check!

Normal TSH levels

Another hormone produced by the pituitary gland, TSH can give us insight into thyroid disorders, such as hypothyroidism or hyperthyroidism.

• Nonpregnant: 0.27 – 4.2 uIU/mL.
• First trimester (9 to 12 weeks): 0.18 – 2.99 (uIU/mL).
• Second trimester: 0.11 – 3.98 uIU/mL.
• Third trimester: 0.48 – 4.71 uIU/mL.

What TSH can tell you

Low levels of TSH typically indicate hyperthyroidism, or overactive thyroid, when your thyroid gland is making excess thyroid hormone. On the other hand, high levels of TSH may suggest an inadequate production of thyroid hormone, leading to a condition called hypothyroidism or underactive thyroid. 

Testosterone

While testosterone is often associated with male reproductive health, females also produce small amounts of testosterone from the ovaries. It helps preserve muscle mass and supports an overall sense of wellbeing. It also helps the development of those follicles and even plays a role in boosting our libido.

Testosterone does fluctuate throughout your cycle, so if you notice that your libido surges at certain times of your cycle (usually around ovulation), you can thank testosterone.

Normal testosterone levels

15 to 70 ng/dL or 0.5 to 2.4 nmol/L

What testosterone can tell you

Abnormal testosterone levels can negatively affect fertility. 

Too little testosterone could mean you are nearing menopause or have premature ovarian failure. It could also be lower due to certain medications, malnutrition, chemotherapy/radiation, 

Too much testosterone could be a sign of PCOS.

At-home fertility hormone testing

If you’re curious to test your hormones, you'll be glad to know that there are convenient at-home options available. These tests allow you to assess your hormone levels from the comfort of your own home, providing valuable insights into your reproductive health. 

Let's take a closer look at some of the top at-home fertility hormone testing options for you to consider:

• Natalist Women’s Fertility Test: Priced at $149, this comprehensive test covers a range of essential hormones. It measures five key hormones: estradiol, LH, FSH, TSH, and total testosterone. By examining these hormone levels, you can gain a better understanding of your reproductive health. And here's a bonus for our readers: use the code COFERTILITY20 to get 20% off!
• LetsGetChecked Ovarian Reserve Test: For $139, this test specifically focuses on measuring anti-Müllerian hormone (AMH), a critical marker for ovarian reserve. By understanding your ovarian reserve, you can make informed decisions about family planning and fertility preservation. And guess what? You can save 25% on this test by using code COFERTILITY25.

These at-home fertility hormone testing options give you the opportunity to better understand your reproductive health. But keep in mind that if you are planning to freeze your eggs, your doctor may want you to test again. 

Summing it up

These fertility hormones - AMH, Estrogen, FSH, LH, Progesterone, Prolactin, and Testosterone– work in harmony to regulate the menstrual cycle, facilitate ovulation, prepare the uterus for pregnancy, and support early gestation. 

Imbalances or abnormalities in these hormone levels can affect fertility and reproductive health. Unfortunately for many of us, we don’t find out there’s a problem until we start trying. 

Evaluating the levels of these hormones through diagnostic tests can provide insights into your fertility health and empower you with knowledge to make informed decisions about your reproductive journey.

By understanding your hormone levels, you can identify potential issues that may hinder reproductive health, now or in the future. 

Sources:

• Estradiol (Blood). Health Encyclopedia. University of Rochester Medical Center. URL
• Follicle-stimulating hormone (FSH) blood test. Mount Sinai. URL
• Shufelt CL, Torbati T, Dutra E. Hypothalamic Amenorrhea and the Long-Term Health Consequences. Semin Reprod Med. 2017;35(3):256-262. doi:10.1055/s-0037-1603581. URL
• Hyperprolactinemia (High Prolactin Levels). ReproductiveFacts.org. URL
• Testosterone. Mount Sinai. URL
• Soman M, Huang LC, Cai WH, et al. Serum androgen profiles in women with premature ovarian insufficiency: a systematic review and meta-analysis. Menopause. 2019;26(1):78-93. doi:10.1097/GME.0000000000001161. URL

If you are part of Cofertility’s Split Program, or even donating your eggs elsewhere, this is a helpful guide to share with your partner.

At Cofertility, we are on a mission to support individuals and families across different phases of the fertility journey. Our work transcends the boundaries of traditional fertility care, forging connections that breathe life into the dreams of thousands of families, both today and the future. 

Through our unique Split Program, we've had the privilege of working with many egg freezers and donors, and know the experience varies widely. We've witnessed joy, apprehension, hope, and triumph, and we've come to recognize that the process of egg sharing is multifaceted and profound. Our journey with these remarkable individuals has not only exposed us to the wide spectrum of emotions and decisions, but has also underscored the indispensable role of a robust support system throughout the journey. 

Becoming an egg donor presents a multitude of emotional, physical, and ethical considerations. How, then, can friends, family, or significant others support a Split member during this journey? 

In the following guide, we hope to share the insights we've gathered, offering a pathway for those seeking to support a loved one through this journey.

Understand the process

It’s helpful for you to understand the logistical and medical process your partner or loved one is going through. Here are a few guides to get up to speed:

• What's the Egg Retrieval Process Like?
• Everything You Need To Know About Egg Freezing Medication
• The Ultimate Guide to the Split Program
• Disclosed vs. Undisclosed Egg Donation: How Should I Choose?
• What are the Side Effects and Risks of Egg Freezing?

Offer assistance

The Split members' journey with egg freezing will require numerous medical appointments for ultrasounds and bloodwork. Your presence at these appointments can provide a reassuring sense of companionship. 

But the most important task is being their reliable ride home from the egg retrieval procedure (in fact, it’s required that they do not drive after this procedure). This might be a clinic near home or you may be asked to travel with your partner to a clinic near the intended parents (if this is the case, travel expenses for both of you will be covered).

Once they get home, ensuring they have the things they need to be comfortable—whether it's a favorite blanket, soothing tea, or just your comforting presence—can make a significant difference in their experience. These thoughtful actions underscore the human connection at the heart of this medical process, turning what could be a solitary journey into a shared experience of empathy and care.

Egg freezing is considered a safe procedure, and complications are rare. But you should know the red flags. If you notice any of the symptoms below, report them to the healthcare provider asap:

• Temperature above 101 F
• Severe abdominal pain or swelling
• Severe nausea or vomiting that doesn’t go away
• Heavy vaginal bleeding (soaking through a pad in an hour; some light bleeding is normal)
• Difficulty urinating, or painful urination
• Fainting or dizziness

Help with the shots

The first step in the egg freezing process is to stimulate the ovaries to produce multiple eggs to be retrieved. This is done with the use of fertility medication, administered in the form of injectable hormones over 10-12 days. 

Helping your loved one with these required injections is huge. This is not a task for everyone, and it's completely understandable if it falls outside your comfort zone. If you do have the capacity and willingness to assist with administering the shots, your help would undoubtedly be appreciated. 

However, even if you prefer not to take a hands-on role, your presence while they give themselves the shot can still make a meaningful difference. 

Simply keeping them company, offering words of encouragement, or offering a little treat (chocolate?) or surprise after each shot can transform an intimidating necessity into a shared moment of support and connection. 

Respect the decision

Friends, family, and partners should respect the donor's autonomy in this deeply personal decision. Recognize that this choice belongs solely to the person making it, and it may reflect a multitude of considerations, both practical and emotional.

Respecting this decision requires acknowledging your partner's autonomy and avoiding any attempts to influence or question her choice. Supporting her means listening without judgment, asking thoughtful questions to understand her perspective, and reassuring her of your support.

Research shows that egg donors are generally happy with their decision and the vast majority do not regret it (in one study of an egg sharing program, only 2.1% regretted their decision to participate). And anecdotally speaking, donors we work with at Cofertility are grateful for the opportunity to donate their eggs and keep half of the eggs retrieved for their own future use, for free. 

Concerns and curiosity are natural, but they must be handled with delicacy and empathy. Being there for her doesn't mean agreeing with her on every point but rather offering a safe space where she can express her feelings and thoughts freely.

Empirical studies on autonomy and healthcare decisions reinforce the importance of respecting individual choices, particularly those concerning one's body and reproductive rights. In the context of egg donation, this principle becomes paramount, reflecting the ethical, emotional, and personal dimensions of the choice at hand.

Celebrate the achievement

Egg freezing and donation can be an expression of personal values, a decision that encapsulates a woman's beliefs, or simply an achievement that deserves acknowledgment and celebration.

Celebrating this achievement can take many forms, from simple words of congratulations and admiration to more elaborate expressions of support. It might mean throwing a small celebration, writing a heartfelt letter, or finding another personal way to convey pride and gratitude.

Celebration does not necessarily mean a public declaration but rather an authentic and personal acknowledgment of the strength, courage, and compassion embodied in the decision itself. The act of recognizing and honoring this choice can create a shared moment of joy and connection, strengthening the bonds between the donor and those closest to her.

In summary

Through our work with hundreds of donors, we've learned that the path is never solitary, nor should it be. The role of friends, family, partners, and significant others in this process cannot be overstated.

From understanding the technical aspects of the process to being a comforting presence during medical appointments, offering assistance with injections, respecting personal choices, and celebrating the decision, the support system surrounding a donor becomes an integral part of the experience. These connections not only ease the logistical and emotional challenges but transform the process into a shared journey that's imbued with empathy, respect, and love.

Our commitment to supporting individuals and families remains unwavering. By fostering a robust network of support and sharing our insights, we hope to make the journey not only more approachable but also more meaningful. The dreams of creating and nurturing life are collective ones, and we at Cofertility are honored to be part of these intimate and extraordinary stories.

Follicle-stimulating hormone, or FSH, is a hormone that plays an important role in your reproductive health. As a woman, understanding your FSH levels can provide insights into your fertility potential and help you make informed decisions about family planning, including egg freezing. But what exactly is FSH, and what do your levels mean? Let's dive in and explore this essential hormone.

What is FSH and why should you care?

FSH, short for follicle-stimulating hormone, is a hormone produced by your pituitary gland, a small but mighty gland nestled in your brain. Its job is to stimulate your ovaries to grow follicles, the tiny sacs that house your eggs. As these follicles mature, they release estrogen, which triggers ovulation – the release of an egg that's ready for fertilization.

Your FSH levels aren't static; they naturally fluctuate throughout your menstrual cycle, peaking right before ovulation. However, consistently high FSH levels, especially at the beginning of your cycle, can be a red flag for diminished ovarian reserve.  This means your ovarian reserve may be decreasing, either in quantity or quality. While it doesn't mean you can't get pregnant, it does signal that your fertility might be declining.

Average FSH levels by age

FSH levels naturally creep up as you age. And results also depend on where you are in your menstrual cycle. For females, here are normal FSH test results by life stage:

• Before puberty: 0 to 4.0 mIU/mL (0 to 4.0 IU/L)
• During puberty: 0.3 to 10.0 mIU/mL (0.3 to 10.0 IU/L)
• Females who are still menstruating: 4.7 to 21.5 mIU/mL (4.5 to 21.5 IU/L)
• After menopause: 25.8 to 134.8 mIU/mL (25.8 to 134.8 IU/L)

What is a good FSH level for egg freezing?

Most clinics consider an FSH under 9 as a good number for egg freezing. Above that threshold, the response to egg freezing medication tends to decline.  

Here's a general idea of what's considered normal FSH for females on cycle day 3:

• <9: Normal FSH level, expect a good response to egg freezing medication
• 9-11: Fair FSH level, the response to medication is reduced 
• 11-20: Reduced ovarian reserve and lower changes of live birth rate
• 20+: Very poor chances of response to stimulation, egg donation is generally recommended

Remember, these are just guidelines, and results vary by lab. Your doctor will interpret your FSH levels in the context of your age, medical history, antral follicle count, and other hormone levels to assess your overall fertility picture.

What abnormal FSH results may mean

Abnormal FSH results can be a sign of various underlying conditions related to fertility and reproductive health. 

High FSH Levels (typically 10 mIU/mL+ in premenopausal people) can suggest:

• Diminished Ovarian Reserve (DOR): This means the number of eggs in your ovaries are declining. 
• Primary Ovarian Insufficiency (POI): Also known as Premature Ovarian Failure (POF), this condition occurs when the ovaries stop working normally before age 40.
• Menopause: Naturally occurring decline in ovarian function leading to the end of menstruation.
• Polycystic Ovary Syndrome (PCOS): FSH levels are often higher in people with PCOS, a metabolic and hormonal disorder caused by high androgen (male sex hormone) levels. It can also cause enlarged ovaries due to an increased number of follicles on the outer edges. 
• Turner Syndrome: A genetic condition that can impact ovarian function, leading to a higher FSH.

If you get an abnormal result, your doctor will talk to you about what it could mean and if they suggest any next steps.

Testing your FSH

Getting your FSH levels checked is simple – it's just a routine blood test, typically done on the third day of your cycle. Your doctor may order additional tests, such as an antral follicle count (AFC) ultrasound or an anti-Mullerian hormone (AMH) test, to get a more comprehensive picture of your ovarian reserve.

Or, if you want to take a test at-home, there are a few convenient options:

• Natalist Women’s Fertility Test ($149) measures 5 hormones: estradiol, LH, FSH, TSH, and total testosterone. Get 20% off with code Cofertility20.  
• Modern Fertility Hormone Test ($179) measures 7 hormones: AMH, TSH, FSH, estradiol, prolactin, fT4, and LH

What you need to know about FSH tests: the fine print

While FSH tests are a valuable tool for understanding your fertility, there are a few important caveats to keep in mind:

• FSH levels fluctuate: Don't panic over a single high result. FSH levels naturally change throughout your menstrual cycle and as you get older. 
• FSH is not a diagnostic tool: An FSH test alone can't diagnose a specific condition like menopause or polycystic ovary syndrome (PCOS). It's just one piece of the puzzle, and your doctor will consider other factors to make a diagnosis.
• FSH is just one indicator of fertility: While an abnormal result (high baseline FSH) tends to be very predictive of low egg quantity, a normal result does not necessarily mean that the egg quantity is good. Some people with normal levels can still experience age-related fertility decline or have low quality eggs.
• Invalid in some cases: If you're taking hormone therapies like birth control pills, FSH tests might not be accurate. Be sure to let your doctor know about any medications you're taking before the test.

The bottom line? FSH tests provide valuable information, but they're not the be-all and end-all of fertility assessment. Talk to your doctor about your results and what they mean for your individual situation.

The bottom line: knowledge is power

While FSH tests are a valuable tool for assessing ovarian reserve and determining if egg freezing could be a fit, it's important to remember that they're just one piece of the puzzle. A single FSH result doesn't define your fertility journey, and your doctor will consider various factors, including your age, medical history, AFC, and other hormone levels, to develop a comprehensive picture of your reproductive health.

If you're considering egg freezing or have concerns about your fertility, don't hesitate to consult with a fertility specialist. They can help you interpret your FSH results, discuss your options, and guide you towards the best path for achieving your family-building goals. Understanding your FSH levels is a crucial step towards taking control of your fertility and shaping your future.

In recent years, egg freezing has become a popular option for those looking to preserve their fertility. The procedure, which involves retrieving and freezing eggs for future use, can offer some flexibility for those who may want the option of having kids down the line. However, like any medical procedure, egg freezing isn’t without risks. One pressing concern among prospective egg freezers is whether the process might increase the risk of cancer. 

This is a fair question, considering that during an egg freezing cycle, patients do take medication for hormonal manipulation, and hormones do play a role in some cancers, like breast cancer. This article explores current research on the topic, focusing on the potential cancer risks associated with fertility medications used in egg freezing. 

Understanding egg freezing medications

Before we dive into associated risks, it’s important to understand the egg freezing process and what medications are used. Egg freezing involves stimulating the ovaries to produce multiple eggs, which are then retrieved and frozen — as opposed to in vitro fertilization (IVF), where eggs are fertilized right away and resulting embryos are either transferred into a uterus or frozen for future use. 

In both IVF and egg freezing, the patient uses several hormonal medications to enhance egg production, including:

Gonadotropins (FSH and LH)

• Follicle-Stimulating Hormone (FSH): Stimulates the ovaries to produce multiple follicles, each containing an egg.
• Luteinizing Hormone (LH): Works in concert with FSH to promote follicle growth and maturation.

Elevated levels of FSH and LH could theoretically increase the exposure of breast and ovarian tissues to hormones, but current research hasn’t established if this influences cancer cell proliferation. 

GnRH agonists and antagonists

• GnRH agonists: These medications initially increase, then suppress the production of FSH and LH by the pituitary gland, preventing premature ovulation.
• GnRH antagonists: Directly block the pituitary gland’s release of FSH and LH, also preventing premature ovulation.

By controlling the release of FSH and LH, GnRH agonists and antagonists help manage the stimulation of the ovaries. These medications have a more regulatory role, which may not have a direct impact on cancer risk.

Human Chorionic Gonadotropin (hCG):

hCG mimics the natural LH surge to trigger the final maturation of eggs before they are retrieved. The hormonal impact of hCG is more short-term compared to the longer-term effects of FSH and LH. Current research considers hCG to carry minimal risk impact, due to its temporary use. 

Current research findings

It’s important to maintain a discerning eye when reviewing research about egg freezing and cancer. Earlier studies may have suggested a possible connection, but were often not very controlled and had small sample sizes. 

Breast cancer

In 2022, a meta-analysis encompassing 25 studies and 617,479 participants alleviated most concerns. The data yielded by the meta-analysis indicated that fertility treatments were not associated with a significant increase in breast cancer risk, even if patients underwent six or more cycles. This is reassuring, considering the huge sample size. What’s more is that this data involved long-term follow-up — even after a decade (more time for potentially latent cancer to manifest), the findings remained consistent. 

Ovarian cancer

The research on ovarian cancer risk related to fertility treatments is less definitive but still reassuring. A review published in Current Opinions in Obstetrics and Gynecology (2017) found that while some earlier studies suggested a potential increase in ovarian cancer risk, there is no overall association between fertility medication use and invasive ovarian cancer. The authors emphasize that earlier studies compared subfertile (aka infertile) groups — already at slightly increased risk of ovarian cancer — to the general population. In other words, previous studies did not compare groups apples-to-apples and should have used a more similar group as a control.

Endometrial and uterine cancer

Studies on risks of developing endometrial cancer — the most common type of uterine cancer — related to fertility medications have also been reassuring. A 2021 Cancer Causes & Control study with 146,104 participants found no substantial evidence linking fertility treatments to an increased risk of endometrial cancer. The review noted that while hormone exposure can be a factor in endometrial cancer risk, current data does not show a significant enough association between egg freezing medication usage and endometrial cancer.

That being said, there are other less common forms of uterine cancer to consider, like uterine sarcomas. However, a 2024 Fertility and Sterility article noted that there is no conclusive evidence that fertility drugs increase the risk of uterine cancer. People with infertility may be at higher risk of uterine cancer, but this is true without the usage of medications and doesn’t apply to those without infertility who are electively freezing their eggs.

Limitations and areas for further research

It’s important to recognize that most studies have focused on people undergoing IVF due to infertility rather than elective egg freezers. Infertility itself, along with other factors, could influence cancer risk, making it challenging to generalize findings from infertile populations to those opting for elective egg freezing.

Long-term data specific to egg freezing and cancer risk is still emerging. While current evidence is reassuring, ongoing research will provide more comprehensive insights into the potential long-term impacts. Findings can also be extended from egg freezing to egg donation, as the same process, medication, and risks apply to both scenarios.

Next steps

While there is still a degree of uncertainty and research is still ongoing, current findings provide a reassuring outlook for those considering egg freezing. Large-scale studies generally find no significant association between fertility medications and an increased risk of cancer, including breast, ovarian, and endometrial cancers. However, as with any medical procedure, it is essential to stay informed and consider emerging research. Ultimately, only you can determine your own comfort zone. 

If you have concerns about egg freezing and associated risks, reaching out to experts can provide clarity and guidance. At Cofertility, we are dedicated to helping you understand your egg freezing options, addressing any questions you may have, and help you freeze your eggs more affordably — even for free for those who donate half of the eggs retrieved to another family who can’t conceive. To learn more and get started, click here. 

Sources

National Cancer Institute. Cancer Causes and Prevention. Published April 2015. Accessed September 2023. URL

Cullinane C, Gillan H, Geraghty J, et al. Fertility treatment and breast-cancer incidence: meta-analysis. BJS Open. 2022;6(1):zrab149. doi:10.1093/bjsopen/zrab149 URL

Kroener L, Dumesic D, Al-Safi Z. Use of fertility medications and cancer risk: a review and update. Curr Opin Obstet Gynecol. 2017 Aug;29(4):195-201. doi: 10.1097/GCO.0000000000000370. PMID: 28538003; PMCID: PMC5551049. URL

Guleria, S., Jensen, A., Albieri, V. et al. Endometrial cancer risk after fertility treatment: a population-based cohort study. Cancer Causes Control. 2021. 32, 181–188. URL

Practice Committee of the American Society for Reproductive Medicine. Fertility drugs and cancer: a guideline. Fertility and Sterility. 2024; 106: 1617-1626. URL