Tempted by fertility testing? Take a look at this first.
If you’re thinking about investigating your fertility, you might be tempted to look into ‘fertility tests’. These are common tests, but best understand the test before you search them out.
AMH testing, aka The Egg Timer Test
What is it?
AMH testing is a simple blood test, measuring the amount of Anti Mullerian Hormone (AMH) in the blood. AMH is made by the follicles, so those women with lots of follicles have more higher AMH in their blood. Generally speaking, as we age and our number of follicles naturally decreases, our AMH falls. Testing AMH gives us an idea of ovarian reserve. Sounds simple.
When it is best used?
This test was designed to be used in IVF labs to help accurately prescribe medication during the stimulation phase to ensure women were not overstimulated, which can be dangerous to women and detrimental to egg quality. Higher AMH results requires a lower dose and vice versa.
When can it be problematic?
This test is often used out of context, to the point that it has been nicknamed the “egg timer test” and is used somewhat casually with the simplistic view that the test will give you an idea of how many eggs you have and thus, how fertile you are.
Why is this a problem? Knowledge is power right?
1. No test is infallible, and in this case, chances of false positives are high - particularly in low risk populations like younger women with no history of risk factors. This means that a woman with a healthy, normal ovarian reserve can get a result that suggests she has low ovarian reserve. Stressful.
2. This is a big and important one; directly from the Practice Committee of the American Society for Reproductive Medicine, “evidence of diminished ovarian reserve does not necessarily equate with inability to conceive”. It means that you can have a low AMH, and still conceive naturally. If you’re still ovulating regularly, there’s no reason you won’t. After all, you only need one egg.
3. Just as having a low AMH doesn’t mean you can’t conceive naturally, a high AMH cannot guarantee an easy peasy conception. It is only one aspect of fertility and it is concerning that women are being given a false sense of security, when any number of factors could influence how easily she becomes pregnant.
CD21 test, aka Progesterone 21 Day Test
What is it?
A blood test measuring progesterone in the middle of the luteal phase, to confirm ovulation and healthy progesterone levels.
What can go wrong?
Timing! Progesterone peaks close to 7 days before the period starts. CD21 works just perfectly for women who have a 28 day cycle and who ovulate on CD14. For the rest of us mere mortal women, ensuring the right day can take a little more work. If you have a negative CD21 test, it’s well worth engaging with your body to get a better idea of ovulation and giving the test another shot. Alternatively, consider BBT charting to look for the rise in temperature that progesterone gives us.
HyCoSy
What it is?
Can the egg meet sperm? HyCoSy stands for Hystero-salpingo contrast sonography. Essentially it’s an investigation performed by a sonography, monitoring dye movement through the fallopian tube to ensure tubal patency - confirming the egg can move freely down the fallopian tubes to meet the sperm swimming up.
Being prepared
It’s an important test to rule out tubal factor infertility quite definitively. The majority of the women I have worked with were warned that it can be a little uncomfortable and to take two panadol before the test. In practice, I think the pain the or sensations experienced varies drastically and beyond the physical, in my clinical experience (most definitely not science based) many women seem to have a bit of an emotional release after a hycosy. Perhaps it’s a bit unsettling, or perhaps as women we hold something primal in our womb. I don’t know the answer, I just see the patterns and I’m just letting you know that after the examination you might want to give yourself some love and go easy on yourself.
Semen Analysis
A semen analysis is quick, easy, non-invasive, mostly covered by medicare and can quickly give practitioners information about what can be done to improve the swimmers, depending on the different parameters.
Most semen assays will look into
Morphology
Count or Concentration
Motility
Additional testing can look at DNA fragmentation.
A note on ranges
Ideal ranges are based on a global average. This means that what is considered “normal” should be more accurately referred to as “average”. Since the 1970’s, there has been a 52% decrease in sperm count and with it, the ideal or normal parameters drop too. To read about what can be done to support sperm health, take a look at the Men’s Suite.
The point that I want to make about semen analysis though, is that the examination is every bit as important as tests focusing on the female role. Ladies, before you go ahead with any testing beyond a simple blood test, a semen analysis should definitely be booked and completed. No mistake - semen analysis is a manly thing to do.
Testing often gives us more questions than answers. Understanding the tests and their implications is crucial.
To read more about making conception easier, read more here