How Fertile Are You?

WHETHER it’s your high flying career goals, the unrelenting search for Mr Right or simply the fact you like your life the way it is for now, these days procreation is more likely to be left on the back burner when compared to previous generations.

As the trend towards delaying parenthood rises, resulting in greater numbers of women trying to conceive later in life, sometimes with associated risks, the need for more readily available AMH testing becomes greater.

And it’s for this reason fertility testing is becoming increasingly more popular among all ages of women for a variety of reasons. Sub fertile women are the most obvious candidates for keeping an eye on the biological clock, as are those with irregular periods and approaching menopause, to name but a few. What they all share is the longing for peace of mind.

AMH (Anti Mullerian hormone) testing allows doctors to accurately assess how well the ovaries are functioning and is determined by the number of follicles remaining ie. the ovarian reserve. Both the quantity and quality of follicles are known to decline with increasing age, but age alone cannot always be used as an indicator of ovarian reserve.

Dr Luciano Nardo (Consultant in Gynaecology and Reproductive Medicine and GyneHealth Director) first began AMH testing on patients six years ago in an NHS clinic. The clinic was the first to do so in the country and the tests have since become popular due to their accuracy in identifying many areas of women’s health, as well as low or high fertility.

Procreation is more likely to be left on the backburner in the modern age

Dr Nardo said: “I always use the following example with my patients. If you’re in Manchester and you want to get to Leeds, you use a map. If you don’t have a map and you don’t know where you’re going you may end up travelling the long route. AMH is like having a map for your journey. It is a direct marker to your fertility.

“AMH is produced directly by small follicles within the ovaries, unlike other hormones such as FSH and LH which are produced by the pituitary gland. If we measure FSH and LH instead, we’re not measuring what is in the ovary, but what is indirectly going into it.

“AMH is only produced by what is in the ovaries so it measures the egg storage. It’s a reliable marker that doesn’t change with the menstrual cycle or pregnancy so can be tested anytime and is very accurate. Eventually it will become more readily available, but for now AMH testing is more time consuming and costly because the blood has to be tested manually rather than by a machine in the lab.”

It’s for this reason that AMH testing is currently only available on the NHS to IVF patients. This means you can't go to the GP to ask to find out your fertility because for example, you plan on starting a new job rather than a family at this moment in time. Such cases are not classed as clinical or a problem, but rather a social reason.

However, as the trend towards delaying parenthood rises, resulting in greater numbers of women trying to conceive later in life, sometimes with associated risks, the need for more readily available AMH testing becomes greater. 

As Dr Nardo concludes: “It comes back to choice. There are lots of reasons these days why people delay having children. Women don’t come to me just so I can tell them to hurry up and get pregnant. AMH testing provides a good tool to increase chance of conception, open up the opportunity to gain advice, individualise any treatment and discuss options objectively.”

Lynda has an AMH blood test

The reference ranges for AMH are:

Optimal fertility: 28.6-48.5 (pmol/l)

Satisfactory fertility: 15.7-28.6 (pmol/l)

Low fertility: 2.2-15.7 (pmol/l)

Very low fertility: 0.0-2.2 (pmol/l)

Women over the age of 37 who have been trying to conceive for 12 months:  35-40 per cent will have low AMH levels.

General population of women: 15-20 per cent will have low AMH levels. 10 per cent will have a high AMH (polycystic ovaries).

With modern day life, comes a modern day attitude to planning the future and this is why more and more women who do intend to have children one day are taking the sensible approach of checking how fertile they are or are likely to be in the future.

You may already be trying to conceive or you may have no intentions of having children until later in life, if at all. The test is pain free and simply gives you an overview to go with your options. Better the devil you know and all that....

Dr Luciano G Nardo is a Consultant in Gynaecology and Reproductive Medicine. He is a Director of North West Fertility and GyneHealth - a comprehensive multidisciplinary independent sector service for women's health. He sees private patients regularly at his clinics in central Manchester, Cheshire and London, and is supported by a team of consultant colleagues, specialist nurses, counsellors, acupuncturists, reflexologists, dieticians, physiotherapists and administrative staff.

Useful links:

www.gyne-health.co.uk  (0161 834 6065 or email info@gyne-health.co.uk)

www.spiremanchester.com

www.lucianonardo.com

www.northwestfertility.co.uk