Thei Udayan

Co-Founder @ Grow With the Flow Coach
Ovarian reserve testing!

We are born with all the eggs (oocytes) we will ever have!

- When we are born- around 3-4 million eggs

- When we hit puberty- around 300-400 thousand eggs

- Reproductive years- as we ovulate, we naturally lose a pool of eggs and it is thought from the age of 35 this decline becomes increasingly faster, but remember everyone is different, has different backgrounds/lifestyles/genetics etc.

Each cycle during ovulation, some of these eggs will get recruited into a “pool” in hopes of one of them becoming the dominant egg. Think about it this way:

1. We are getting ready for the ovulation olympics

2. We have a bunch of swimmers waiting on the side line to get picked (primordial follicles)

3. We pick a few of our best swimmers (antral follicles, this changes from cycle to cycle. Sometimes 6 can recruited, sometime 10, it depends on that cycle. Some follicles naturally have defects like a chromosomal/genetic issue)

4. Out of all these swimmers, only one will be the ultimate winner (dominant egg released during ovulation)

What happens to the other swimmers in stage 3? They are left out of the team forever (aka the follicles that don't release an egg disintegrate, basically all but the dominant follicle.. This process is known as atresia).

The swimmers in stage 2, they get “old” and naturally decline and can’t be recruited to the Olympic team again.

So what does AMH and AFC tell us?

Note: these tests combined with FSH and estrogen give us the full picture, none of these tests should be done in isolation, it will provide an inaccurate conclusion. Some doctors will do ovarian reserve testing whenever you go for your usual check- up so you are always in the know about where you stand with your reserve which I think is great.

- AMH is a protein hormone produced by cells inside the ovarian follicles; the level of AMH in the blood can help doctors estimate the number of follicles inside the ovaries (long term reserve and this can be tested at any part of the cycle).

- An antral follicle count (AFC), on the other hand, is performed by a doctor during an ultrasound. After a visualization of the ovaries, the doctor can count the “activated” follicles, and use that number to estimate a woman’s total ovarian reserve 

Something to remember, these ovarian reserve tests tell us about a woman’s egg count (QUANTITY), not the QUALITY. So you can have a high AMH but maybe the quality of the eggs aren’t good, or a low AMH but the quality of the eggs are great. Don’t let low values get you down!

Currently there is no test to to determine quality of the egg unless you are going through IVF.

Again, we know that with age there is an inevitable decline in reserve, this is natural and meant to happen. If anyone tries to sell you that you can increase your count, run!

But you can improve the quality of the eggs!

AFC works the same as AMH, you could be 25 with with a low reserve or 35 with a high reserve. 

No test is perfect, it just gives you the best overview it can to help you understand your reserve and plan ahead.

Also, don’t let your tests define you, I have seen many women get pregnant naturally on low AMH values. You may not have control over your quantity, but there are things you can do for the quality!

Your reserve quality (internal) responds to what you eat, environmental toxins and endocrine disruptors, lifestyle (external). By just nourishing the eggs you do have left, you are trying your best to ensure quality! The egg follicle is the largest cell in a woman's body after all!

Menopause is the chapter of life when we no longer have eggs left, your body is focusing on your preservation, not baby-making.

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