Decoding fertility tests: understanding your results

“I have my results, but I don't understand anything...” How many people have said this phrase upon leaving the lab, holding an envelope in their hand containing mysterious numbers? Fertility tests are often the first step in the journey, but they can seem intimidating. However, understanding these tests means taking control of your journey and improving communication with your medical team.

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Anti-Müllerian Hormone (AMH): An Indicator of Ovarian Response

What is AMH?

Anti-Müllerian hormone (AMH) is a hormone produced by the granulosa cells of the small antral follicles (follicles visible on ultrasound, measuring between 2 and 10 mm) and pre-antral follicles in your ovaries. Its level in the blood is used as a marker to assess the ovaries' ability to respond to ovarian stimulation, particularly in the context of In Vitro Fertilization (IVF).

Imagine your ovaries as a factory: AMH is an indicator of the number of "machines ready to start production" (the antral follicles that can be recruited for growth).

What AMH does not directly reflect:

• The total ovarian reserve of dormant oocytes (pool of primordial follicles): AMH does not directly measure the total number of oocytes remaining in your complete and undeveloped "reserve." It's important to note that there may be a large number of non-antral follicles (primordial and primary) that constitute the true ovarian reserve but do not yet produce AMH significantly.
• Intrinsic fertility: A low AMH level does not mean that you are infertile or unable to conceive naturally. Rather, it indicates a potentially reduced response to ovarian stimulation treatments.

How to interpret your results

These thresholds are general indicators and should always be interpreted by a healthcare professional, taking into account each patient's overall clinical context.

• AMH > 2.5 ng/ml: Generally indicates a good expected ovarian response to stimulation.
• AMH between 1.5 and 2.5 ng/ml: Indicates a satisfactory expected ovarian response.
• AMH between 0.5 and 1.5 ng/ml: Suggests a moderate ovarian response. Specific treatment strategies may be considered.
• AMH < 0,5 ng/ml : Indique une faible réponse ovarienne attendue. Des protocoles de stimulation adaptés et des approches alternatives peuvent être discutés.

💡 Pro Tip: A low AMH does not mean infertility! It mainly indicates a potentially low ovarian response to stimulation treatments. Many women with a low AMH can still conceive, either naturally or with adapted treatment protocols. AMH is a decision-making tool for personalizing assisted reproductive treatments.

Note from our Gynecologist: if you are under 35 and a decrease in ovarian reserve has been detected, know that your age remains a major asset. The quality of your oocytes often compensates for this quantitative decrease, thus preserving your chances of natural conception.

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FSH and LH: the conductors of your cycle

The role of FSH

FSH (follicle-stimulating hormone) is produced by your pituitary gland. It stimulates the growth of ovarian follicles. The more your ovaries need to be "encouraged", the more FSH your pituitary gland produces.

Reference values for FSH (Day 2-3 of the cycle):

• < 10 UI/L : Fonction ovarienne normale
• 10-15 IU/L: Decreasing ovarian reserve
• > 15 IU/L: Low ovarian reserve

LH: The ovulation trigger

LH (luteinizing hormone) triggers ovulation. Its peak in the middle of the cycle releases the mature oocyte. An LH/FSH imbalance can indicate polycystic ovary syndrome (PCOS).

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Progesterone: Evidence of your ovulation

Why measure progesterone levels?

Progesterone is the hormone of the second half of the cycle. It confirms that ovulation has taken place and prepares the uterus to receive an embryo.

Sample collection: 7 days after presumed ovulation (Day 21 for a 28-day cycle)

Interpretation:

• > 10 ng/ml: Ovulation confirmed
• < 3 ng/ml : Ovulation douteuse ou absente

🌟 Did you know: Progesterone is known as the "pregnancy hormone" because it maintains the uterine lining. A deficiency can explain repeated early miscarriages.

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Additional tests: refining the diagnosis

Pelvic ultrasound

The ultrasound counts antral follicles (small visible follicles). This count corroborates the AMH level and assesses the quality of the ovaries.

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The sperm analysis: the essential male test

In 40% of cases, infertility is of male origin. The sperm analysis assesses:

• Ejaculate volume
• Sperm concentration
• Their vitality
• Their motility
• Their morphology

💡 Pro Tip: Gentlemen, abstain from intercourse for 3 to 5 days before collection for optimal results. And avoid hot baths!

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Understanding variations: you're not a robot

Factors that influence your results

Your hormone levels can fluctuate depending on:

• Your age
• Your menstrual cycle
• Your stress levels
• Your weight
• Certain medications

Testimonial: "My initial results terrified me. My AMH was very low. But my gynecologist explained that this didn't prevent me from having good quality eggs. I had my daughter after 6 months of trying naturally!" - Marie, 38 years old

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When should I retest?

Fertility tests evolve. It may be relevant to redo them:

• After 6 months if the results are borderline
• If your situation changes (weight, stress, treatment)
• To adapt an ART protocol

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Taking action: what's next?

Talk to your doctor

Prepare your questions in advance:

• What do my results actually mean?
• What is the recommended strategy?
• When should I repeat the tests?

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Adopt a comprehensive approach

Tests are just a snapshot in time. They guide the strategy but do not determine your future. Take care of yourself:

• Balanced diet
• Appropriate physical activity
• Stress management
• Quality sleep

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🔑 Key Learnings

• AMH is an indicator of ovarian reserve but does not predict the quality of your eggs or your chances of spontaneous conception.
• Elevated FSH indicates that your ovaries are working harder to produce follicles.
• Progesterone confirms ovulation and should be measured at the right time of your cycle.
• Results change over time and should be interpreted by a professional.
• A comprehensive approach combining medical examinations and a healthy lifestyle optimizes your chances.

💝 You deserve support

Your results do not define your worth or your chances of becoming parents. They are a tool to personalize your journey. Don't hesitate to ask for explanations, ask questions, and surround yourself with caring professionals who take the time to explain things to you.

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