When a donor goes in for screening, one of the most common tests that will be performed are your fertility hormone levels to ensure they are where they should be. Here are the items that could be requested, what they mean, and their correlating numbers. If any female is simply visiting this blog and curious to know what her fertility levels are for any reason, the items below are what you will want to discuss with your OB/GYN to order for you.

FSH (follicle-stimulating hormone)

This is a very crucial test to determine how hard your body works to ovulate an egg each month. What makes this one a little challenging is that it can only be read on Day 3 of your menses. If this hormone is not read within this particular window of time, it will change quickly and it could return a number that does not look good. If a person doesn't take their instruction seriously enough to report the moment they started their period, and they go in to take this test with the wrong timing, it may just disqualify them as a fertile candidate, or cause a one-month delay to wait for their next period to arrive just to gather this result. Another challenge that some clinics pose is that they don't like to draw this test when a person is on BCPs, so they must stop for one month and have a natural menses cycle and then draw at the next one - they can resume taking BCPs after the blood sample is drawn.

Here is a good analogy I like to use, provided by a Chicago doctor's blog explaining the role of FSH... think of it like fuel for a car. A good car requires minimal fuel to get going, whereas an older model may require you to essentially "floor it" and yet the car is still barely able to reach high speed by the time you need to merge onto the highway. The higher the FSH number is on your test result, the harder your body is working to produce an egg for ovulation.

The number range should start >4.0, and for donor candidates, most IVF clinics ideally like to see this number <9.0. For any woman just trying to get pregnant on their own, it's still possible to get pregnant with an FSH level up to 12.0, especially if using fertility medication, but it could still be a challenge. The body will continuously work harder to produce this hormone, and women approaching menopause can see levels above 40.0.

Side Note: If you were to test this value while on BCPs, the value should be <1.0. The estrogen supplied by BCPs suppress the body from making this hormone so that the ovaries cannot stimulate an egg to ovulate. Which brings us to the next test...

E2 (estradiol/estrogen)

This is typically tested in conjunction with FSH because estradiol directly affects FSH levels. To know that the FSH levels are accurate, the estradiol should be <50. If it's higher, then it could be suppressing the FSH level, masking what the true reading should be and would be considered invalid. You want to see a low estradiol reading in order to know that your FSH results are more accurate.

This is why many clinics will have a woman stop taking BCPs for one month, just to make sure it doesn't tamper with the FSH results if there is still too much estradiol in her body by Day 3 testing.

Side Note: On an NYU doctor's blog, he mentioned there is a theory in the fertility field that a woman constantly producing a high FSH level could be causing her ovaries to stop responding to it all together, which may explain why some women don't have any response to fertility medication trying to deliver high doses of FSH to help produce eggs. He says it's not been studied or proven, but it would make an interesting case to the benefit of long-term BCP use if it turns out to be fact.

Antral Follicle Count

Okay, this is not a hormone test, but is a vaginal ultrasound typically ordered alongside the Day 3 hormone tests to observe what the ovaries look like. The female body produces a steady average number of follicles (each containing an egg) every menstrual cycle. The number of follicles seen on the ultrasound can provide a prediction of how many eggs the doctor may be able to stimulate and retrieve. If the number is very low (for Asians, <8) this could be a sign of diminished ovarian reserve and egg quality is also likely to be poor. Ideally, the total number of follicles from both ovaries should be 15 or greater. Again, the Chicago IVF doctor's blog does a great job to explain this in detail.

Side Note: Each month, any extra follicles that didn't ovulate will discard the extra immature eggs and grow a whole new set the next month. This is why fertility is not affected by donating these eggs. Read my previous blog post for more detail.

AMH (Anti-Mullerian Hormone)

This is a hormone test that we see IVF clinics more commonly substituting for the ultrasound these days. AMH is constant and can be tested at anytime of the menstrual cycle, making it one of the most convenient tests. This hormone is released by all the microscopic follicles that have not been released by the ovaries yet, making this test a measure of your possible ovarian reserve (how many eggs you potentially have left in your fertile life). The higher this number is, the better fertile state your ovaries are in.

As a donor candidate, ideally the AMH level should be >1.0, meaning her body is fertile with ample number of eggs to last her a good while. A higher number tends to correlate with higher antral follicles and more eggs at a retrieval. If it is >3.0, donors tend to also stimulate much more easily to fertility medication and also indicates they could be at higher risk for OHSS after their donation.

I have seen one donor's value as high as 11.0, and the doctor made sure to start her on a low dose of medication and asked us to arrange for her to stay in town (it was an out-of-state cycle) extra days after her retrieval to ensure she was treated for inevitable OHSS. She did retrieve over 30 eggs at her retrieval, and she did have OHSS with close monitoring and treatment by the IVF doctor to return home safely.

Side Note: Many clinics are not even using FSH, E2, or ultrasounds to screen their donors anymore, but simply relying on AMH since it tends to be more accurate, conveniently can be tested anytime, and still tells a lot of the fertility story. Here is a final link to the Chicago IVF doctor's blog explaining it and an interpretation of the value ranges in detail.

Determining Egg Quality

Unfortunately, this cannot be tested prior to the egg retrieval. This is the one risk all Intended Parents must take, especially with first time donors. Even if all your testing goes smoothly, there is still a small possibility that the egg quality is poor and cannot achieve pregnancy. We will know a donor's egg quality once we receive fertilization results back, as well as how many embryos survived until the blastocyst stage (Day 5 after retrieval). Granted, it's no longer only the egg quality that will be reflected in these final results, there are other factors at play too, but it does normally help to provide a better overall picture.

In Summary...

I personally would recommend having all 4 values tested (your doctor may also bring up a 5th one, LH or leutenizing hormone, but it's sort of similar to E2 where it's just to make sure the FSH value is accurate, and not really necessary unless you need a really good picture of what's going on if experiencing infertility). If you are especially nearing the age of 30 and are still postponing having children, it's a good idea to check these values to make sure you're not blindly running out of time. If you don't have insurance, I understand these tests could be a bit expensive (~$75 each hormone test, ~$175 for ultrasound) to pay out of pocket, so if you had to ask your OB/GYN to write you a lab order for only one, make it the AMH test. However, seeing the whole picture with just the 3 hormone tests alone will be very enlightening too.