Join Dr. Mark Amols in this insightful episode of 'Taco Bout Fertility Tuesday,' as he explores the pivotal aspects of ovarian reserve testing. Focusing on AMH, FSH, and antral follicle count, Dr. Amols clarifies these essential tests, explaining their implications for fertility and treatment response. Uncover why these tests are not definitive indicators of fertility and understand their significance in context. This episode is particularly enlightening for those grappling with low AMH levels or anyone curious about fertility assessments. It's an informative journey that reassures listeners that test results are not the final word on their fertility journey. Dive in to learn why the antral follicle count might be the most significant test and how it fits into the broader picture of reproductive health. Knowledge is empowering in the journey of fertility, and this episode is here to illuminate and guide. Don't forget to rate us with five stars on your favorite platform and spread the word about 'Taco Bout Fertility Tuesday.' Stay tuned for more engaging discussions every week!
Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.
Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com.
Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com.
Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.
Join Dr. Mark Amols in this insightful episode of 'Taco Bout Fertility Tuesday,' as he explores the pivotal aspects of ovarian reserve testing. Focusing on AMH, FSH, and antral follicle count, Dr. Amols clarifies these essential tests, explaining their implications for fertility and treatment response. Uncover why these tests are not definitive indicators of fertility and understand their significance in context. This episode is particularly enlightening for those grappling with low AMH levels or anyone curious about fertility assessments. It's an informative journey that reassures listeners that test results are not the final word on their fertility journey. Dive in to learn why the antral follicle count might be the most significant test and how it fits into the broader picture of reproductive health. Knowledge is empowering in the journey of fertility, and this episode is here to illuminate and guide. Don't forget to rate us with five stars on your favorite platform and spread the word about 'Taco Bout Fertility Tuesday.' Stay tuned for more engaging discussions every week!
Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.
Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com.
Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com.
Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.
Today we talk about what matters the. Most when you're looking at ovarian reserve testing. I'm, Dr. Mark Amos, and this is Taco. About fertility Tuesday. I have patients come to me all the time with ovarian reserve testing that doesn't look good. I get people come with me with low amhs, high FSHs, or even low antrophophopal counts. But the question is, there's all these tests, which is the most important? Well, the thing is, if you probably. Asked 100 physicians, you might get 100 different opinions. So what I want to do is. Talk about what I think is the most important and why in those situations, I think it's the most important. And what I want you to get. From this podcast today is that if you have one of those tests that, let's say, are not favorable, that you realize it's not the end of the road. Because from what you probably read on the Internet, a low amh means it's over, and when in reality it's not. so we're going to talk about each one of those and when you need to be worried and which I feel is the most important. So let's talk about what is ovarian reserve testing and the standpoint of what tests can be done. To look at ovarian reserve testing, as. I've talked about in other podcasts, is not your ability to get pregnant. Now, yes, there's some correlation between getting pregnant, but it is not a measure of your ability to get pregnant. It's a measure of how well you will respond to medication. Meaning there are women out there who can get pregnant easily. They literally look at their husband and they get pregnant. But their ovarian reserve may not be. Amazing, it might be just okay. And then there are people out there. Who have troubles getting pregnant, and their ovarian reserve is amazing looking. And that's because ovarian reserve is a measure of how well you will respond to treatments such as medications. But it does not mean that you're going to get pregnant. And why that's important is because ovarian reserve matters more in certain situations than others. Meaning when you need to make a. Lot of eggs, it's good to have a high ovarian reserve. But if you don't need to make. A lot of eggs, such as, let's. Say IUIs, a high ovarian reserve doesn't matter as much. I always make the joke that it's. Not a who can make the most egg contest. The goal is to get pregnant now it's true. If you can make more eggs, it makes it easier to get pregnant with treatment because you get more chances. But in the end, ovarian reserve is not a measure of your ability to get pregnant, but a measure of how well you will respond to the medications we use to help you get pregnant. Although there are multiple tests out there. Such as Inhibin and other factors people look at, the three main tests looking at ovarian reserve are going to be AMH, which stands for antimalarian hormone, FSH. And estrogen levels, which stand for follicle stimulating hormone and estradiol. And last is called an antifolcal count. As I've discussed in other podcasts, AMH. Is more of a measure of your. Longevity, of fertility, than it really is. An exact idea of your fertility. Now, I've seen people with very high AMH levels, and they have very low anthrophocal count. And I've seen it the other way where people have a high anthropological count and have a lower amh. So it's more of a measure of how much time you have. And the way I would look at. Is, let's say you're 35 and. You have a great amh level, then you probably don't need to be worried about being able to have success in the future, even with fertility treatment at 38, because you have a good ovarian. Reserve to always pull from. But if you're 36 and your aMH. Is severely low, then you probably don't want to wait two years to find out if your reserve drops too much, because you won't have the reserve to pull from when you need help trying to get pregnant in the future. An antifolk count is when the doctor. Counts the number of follicles on your ovary. And the problem with this is that every doctor does it slightly different. Now, technically, it should be small antifolcles, 5 mm or greater, but a lot of times, people will measure very small. Follicles that are pre entra follicles and those don't grow. And so the thought process is an ancho follicle count should tell you your kind of general amount of Vegas you can get if someone gave you all the drugs in the world. So if you start with ten follicles and someone gives you all the drugs in the world and you respond perfect. You could get up to ten eggs. But if you only have three follicles. Then the most you will get is three eggs. It doesn't matter what your FSH level is, it doesn't matter what your amh ah level is you can never get. More than what you start with. The last test is the FSH estrogen ratio. And essentially you're looking at the FSH level compared to the estrogen level. And the estrogen level is really just there to make sure the test was done at the correct time. You want the estrogen level to be low. Most people use 80 as the maximum number. You can have to consider the test accurate. I tend to use 50. I feel when it goes above 50, it will falsely lower the FSH. So if your estrogen level is 120. And your FSH is nine, don't feel. Good about that, because that high estrogen level falsely lowered the FSH and made you think your a quality is good, but in reality, you don't know the result. Doesn't mean it's bad, just means you. Can'T use that test accurately. That's where you now have to look. At the AMH or the anthrofocal count. But if your FSH level is high, for example, let's say it's 15 or. 18, and your estrogen level is under. 50, that is concerning. What that means is your brain has to work extra hard to make an egg. And if it has to work extra. Hard to make one egg, then it's. Going to take, more medicine to make more eggs. And that's really the important thing about ovarian reserve testing. The purpose is not to tell someone. They can't get pregnant. It's there to help us know what we need to do to get a similar amount of eggs. So someone with a very good ovarian. Reserve, I might be able to give. Them very low dosage, and they can get twelve eggs. Someone with a poor ovarian reserve, I. Might have to use a stronger protocol, might have to use higher dosage and even less suppression to still get the same twelve eggs that the other person got. it just took more to get there. That is the purpose of ovarian reserve testing, but there are times it can be very concerning. So let's start with antimalarian hormone. Antimalarian hormone is released from the granulosa. Cells, and it's associated with a good anthro follicle count. It's not always perfect, but usually if. The number is above 1.5, it usually is pretty good. And person has a normal anthropological count for their age. Now, when someone has a low amates, let's say 0.3, that lets me know. That things are poor and that there's probably going to be fewer follicles on their ovary. It also tells me that their ovarian reserve is going to be decreasing, probably faster compared to their peers. But context matters. If the person is 45, then I'm. Not very surprised by that. That's actually pretty appropriate for someone who's 45. But if that's for someone who's 23, I'm extremely concerned, because that tells me that their ovarian reserve is significantly lower than their peers. I bet if I looked at their ovaries, they're going to only have a. Few follicles on their ovary, and they. Probably don't have many years to be. Able to try to get pregnant. And so a number like that would tell me, we need to go now. We need to get as many eggs or embryos we can now, because I. Don'T know what the future is going to hold. No, Amh can definitely tell you things will get horrible in the future, but it also doesn't tell you it won't. And so that's why when you see a severely low AMH in someone who's. Younger, you take it very serious. FSH levels are more of a measure of how well you'll respond. So I don't get too worried about. A level of FSH until it starts getting in the high teens. So in the past, even an FSH level of 14, many clinics wouldn't even. Let you go through IVF. Nowadays, if you're younger, it's not unreasonable. I even start treatment on people with. FSH levels at 20, and there's protocols we've come up with to help patients with that. But I do get worried anytime I see it above 1618, because I know it's going to be harder. And at that point, it matters more about the context. Is it a young person or is. Someone who's more mature? If it's someone who's, let's say, 42 and their anthro follicle count of, let's say, ten, I'm concerned I'm not going to be able to get ten eggs. I might only be able to get four or five eggs, and it's going to make it harder for me to help them get pregnant because they can't make as many eggs. Now, if it's someone, let's say, who. Is 28 or 32, well, in that. Situation, I don't need ten eggs to be able to get them pregnant. I know with a few eggs, I'm going to be able to get them pregnant, so it doesn't worry me as much. Now, there is a point though, where it is concerning, if that number gets into the high twenty s, thirty s. At that point, it can get to. The point where you won't even respond to medication. Meaning if I can't give you meds to make an egg grow, there's not. Much more I can do. And so a very high FSH level can be very concerning. Now that doesn't mean if you have one, you should freak out, because sometimes. When people draw it randomly, they can. Draw it right when you're ovulating. And in that situation it can be highly elevated and not represent poor egg reserve. And that's usually seen because both the LH is elevated and the estrogen level at that time. But in the end, yes, it can. Be very concerning if it's elevated. For me, if there was one test. I could do, it would be the anthrofocal count. Personally, I think that is the most important test because one I get to. See something and so I feel comfortable. With my ability to look at ovarian reserve. And I find it actually is quite accurate. When you look at an anthropocal count and you can determine how well someone's going to respond, how many eggs they're going to get, and even just a general idea of their ovarian reserve, usually an anthropological count is going to be pretty accurate. Now, there are situations where it may not be. For example, if someone is missing an ovary or if they've had surgery on their ovary, it could potentially adjust their anthrophocal count, especially if you're looking on paper and not knowing that they're missing ovary and adjust your view. But personally, I think it is by far the best estimate. Now, if someone else is doing it, it's almost useless. I have colleagues that have done anthro follicle counts and state that someone has 20 eggs and I see them and I only see four. I don't know where they get them from. But the point is, it does have a lot of subjectiveness to it. And so this is why not every. Doctor is going to be its go to for some people. They don't like to give bad news, so they like to give people an extra focal count to make them feel good. And although you may feel good, that may not be your true focal count. I tend to be on the more conservative side. I only call what are absolutely antifolcals antifolcals. And like I said, I'm able to predict how people do just based off of that test. And that's why for many of my patients. At the very first consult, I'll do an ultrasound so I can get an antifolcal count for myself. The best time to do that is somewhere between like the second day and the 8th day of the cycle. You can do it at any time during the cycle, but it won't be. As accurate if you ask me. Well, what's the best test to do at any time? Well, that is going to be the AMH level. That is by far going to be the most accurate test to give you at least an idea at any time in the cycle. But what we find is it's just not as accurate as telling how well someone's going to respond to medications. It's good. I think it's very good, but I. Don'T think it's as good as an angio follicle count. That being said, when it comes to. All those tests, if someone told me I had a high fsh, I wouldn't be that worried. If someone told me I had a low amh, again, I wouldn't be that worried. But if someone tells me my antrofocalcal. Count is only two or three, I. Don'T see many situations where that isn't a worrisome situation. And that is why to me, it's. My go to for egg reserve. And I feel like I'm able to. Really decipher what to do for people. It's important to know that they have actually looked at this in studies and shown that there really isn't a best test. And that's why I can't tell you there is a best test. I can tell you what I believe is the best test for me, which I feel I'm able to give a. Better idea of how people respond. Hopefully this was helpful for some of you. Maybe you're going through this, maybe you got a test, or a friend got a test and found out that they. Have lower ovarian reserve and they're scared. Let them know about this podcast. It might help cheer them up so they can know that it doesn't mean that they are going to have a bad chance, of getting pregnant or a bad cycle of treatment. In the end, these tests are just tests to figure out how will you respond. And no test is a dream killer. It just means that we have to make some adjustments. In my opinion, I think the angio focal count is the best. But if that's not your doctor's best test, then you have them do the test that they think is the best, because that's what they need to be able to make the right adjustments for your situation. As always, if you love us, please give us a five star review on your favorite medium and tell your friends about us. As always, I look forward to talking to you again next week on talk about fertility Tuesday.