Your TTC Strategy 1: Prepare to Be Pregnant

The most pressing issue in women is whether they have a sufficient number and quality of eggs in the ovary (ovarian reserve) to become pregnant. This is particularly important in women over 35, when fertility begins to decrease dramatically. Diminished ovarian reserve is usually age related and occurs due to the natural loss of eggs and decrease in the average quality of the eggs that remain. However, young women may have reduced ovarian reserve due to smoking, family history of premature menopause, prior ovarian surgery, or even if they have no known risk factors. Several tests are used to determine ovarian reserve.

FSH and estradiol testing Day three estradiol and FSH blood testing is the most common and easiest test to perform. The basis for the test is that as you approach menopause, your ovaries begin to respond poorly to FSH and LH. As a result, your body produces more of these hormones in an attempt to "jump start" egg development in your ovaries. High levels of FSH and/or estradiol indicate that your ovarian reserve is low, and that your chances of conception are poor, but still possible. However, normal levels of FSH do not guarantee conception. Although FSH and/or estradiol can fluctuate monthly, a single elevation is predictive of poor ovarian function.

Clomiphene citrate challenge test A variation of the day three FSH test is the clomiphene citrate challenge test (CCCT), which assesses a woman's response to clomiphene citrate given on cycle days five through nine. Blood levels of FSH are obtained on days three and 10. Abnormally elevated blood levels of FSH on either cycle day three or cycle day 10 are associated with reduced spontaneous pregnancy rates.

Inhibin B Inhibin B is a relatively new blood test that may be more predictive of ovarian reserve. Because inhibin B is produced directly by ovarian follicles, the amount of inhibin B in your blood directly correlates to the number of eggs that you have in your ovaries, though standardized levels are still being determined. Low levels of inhibin B are associated with impaired ovulation, lower spontaneous pregnancy rates, increased risk of miscarriage, and decreased success with IVF. Women who would benefit from the test are over the age of 35, have unexplained infertility, have shown a poor response to fertility drugs, or have had a positive CCCT.

Ultrasound Transvaginal ultrasound may be performed in the early part of the menstrual cycle to count the number of small (2mm-10mm) follicles (cysts) in the ovary. The number of these follicles reflects the egg supply and chance of conceiving. A low ovarian volume and/or a low follicle count indicate a reduced chance of conceiving.

Unfortunately, even with a normal ovarian reserve test, older women may have difficulty achieving a pregnancy. Moreover, the results may vary from cycle to cycle. Any single abnormal test, however, generally indicates that fertility potential has diminished.

These tests only indicate fertility potential. Those with abnormal tests do get pregnant and those with normal tests may have difficulty conceiving. The true test of fertility potential is conceiving!