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Guide to Initial Fertility Testing and Results

Overview

We’re so glad you’re here. PNWF has helped build families with a combination of the latest technology and research and compassionate care since 2005 and we look forward to helping you.

Some patients excited to get a jumpstart on their evaluation may use this guide to ask their primary care provider or OBGYN to order tests before their visit at PNWF. Other patients may use this guide to review test results before a visit with their PNWF provider.
Pacific NW Fertility has a patient portal that tracks results from labs drawn by our office and the results will be released for you to view at home once available. Our office typically has a “no news is good news” policy for lab results. In general, normal results will be released to your portal and we will reach out to review abnormal results or results that require follow-up. Results with implications to treatment plans are typically discussed in detail at your consultation with our providers. If you need assistance accessing your portal, please contact our front desk team to help.

We are hoping the brief descriptions of common tests and typical reference ranges below will help you process your results and collect questions prior to your consultation with a provider at our office. In addition to this document, there are resources available online through SART, ASRM, and our website (https://pnwfertility.com/) that many find beneficial and educational. Wishing you the best!

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Donor Egg Program

Overview

If you are considering using donor eggs to conceive, Pacific NW Fertility offers the full range of services to meet your needs. Pacific NW Fertility is home to an extremely successful and comprehensive Donor Egg Program which includes the SIMPLIFY Donor Egg Bank as well as our fresh Donor Egg Program. Our donors are carefully screened by PNWF professionals and meet the highest standards for physical, genetic and mental health. Having all of these services under one roof is rare and reduces the anxiety and cost associated with patients coordinating much of their own care.

Pacific NW Fertility has been committed to donor egg services as an extremely important part of our overall program. In 2009 we started the first Donor Egg Bank in the Pacific Northwest and one of the first in the country. We have an excellent record of success using both fresh and frozen eggs, and incorporate the most advanced laboratory techniques and genetic screening to help you have a healthy child. Our team of doctors, embryologists, nurses and other donor egg specialists provide the personalized care that you need to take this important step.

PNWF Approach

There are many different types of fertility testing and family building options offered here at PNWF. Treatment options include medication to induce ovulation, intrauterine inseminations (IUI), in vitro fertilization (IVF), genetic testing of embryos, and options for conceiving with donor sperm, donor egg, and surrogacy. Each patient is unique and we review all options and agree on a path forward that is best for your personal situation.

The entire staff will make every effort to provide you with personal and compassionate care in order to make this difficult time as comfortable and manageable as possible.

Before starting fertility treatment, each patient is evaluated to help maximize the chances for success and a healthy pregnancy. The most common fertility evaluation consists of blood work for pre-conception testing, hormonal levels including ovarian reserve testing, ultrasound assessment of the uterus and ovaries, an anatomical evaluation of the uterus (if applicable, three methods commonly used include a hysterosalpingogram, a saline infusion sonogram, or a hysteroscopy), and a semen analysis (if applicable).

Evaluation Options

Ovarian Reserve

Your fertility evaluation includes tests to evaluate the health of your ovaries. These tests include blood work, usually drawn early in your menstrual (typically days 2, 3 or 4). Sometimes an ultrasound of the ovaries is also done to look at the number of antral follicles (potential eggs for the month). At PNWF, we consider Day 1 of your cycle to be the first day of full menstrual flow that starts before 9:00pm. If full flow starts after this time, the next day is day 1. This does not include days of spotting.

  • “Day 3 Labs” include FSH (follicle stimulating hormone) and estradiol.
  • FSH is released from the pituitary gland near the brain that signals the ovary to begin maturing the follicles (the fluid filled sacs containing eggs).
  • Estradiol, sometimes referred to as E2, is released from the ovary. Estradiol should be lower at the beginning of the cycle and increase as the follicle matures.
  • Anti-Mullerian Hormone (AMH) can be done any day of the menstrual cycle. AMH is made by supporting cells within the ovary. The higher the AMH, the higher the number of supporting cells, and the higher the egg supply. AMH as a reflection of egg supply is a relatively new test and the exact level considered normal by age is still being studied. The higher the AMH the more eggs up for grabs each cycle and the higher the success rate with fertility treatment options. An AMH <1.0 may mean a lower success rate with fertility treatment like IVF.
  • Often you will have a TSH (thyroid simulating hormone) level done. The TSH helps evaluate thyroid function.
What Do We Know When FSH is High?
  • It signals diminished ovarian reserve and may mean fewer good quality eggs remain.
  • It is found more commonly when someone is having difficulty conceiving.
  • It may explain recurrent miscarriage that is otherwise unexplained (due to conceiving with poor quality eggs).
  • It can mean a lower success rate with any fertility treatment.
  • It may mean that the fertility window is shorter (it doesn’t tell us how long someone has until menopause).
  • It may mean you want to be more aggressive with treatment.
  • It may mean that your chances of success with certain treatments is low enough that you will want to make other plans for building your family (for example, a donor egg).
    FSH
    FSH Estradiol Interpretation
    <10 mIU/mL <80 pg/mL Reassuring results
    10-20 mIU/mL <80 pg/mL Diminished ovarian reserve (low egg supply and potentially poor egg quality)
    >20 mIU/mL <80 pg/mL Significant diminished ovarian reserve; limited success with any fertility treatment
What Is A High AMH?

 

AMH

Age Expected/Average Age Expected/Average
20s 3.0-4.0 ng/mL 40 1.0 ng/mL
30-34 2.0-3.0 ng/mL 41+ <1.0 ng/mL
35-39 1.0-2.0 ng/mL    

 

What Is A Low AMH?
    • Is often called diminished ovarian reserve (DOR), no matter what your age.
    • Often means a higher dose of medications may be recommended.
    • Does not predict someone’s ability to conceive naturally.
    • Does not predict when you will run out of eggs or your age of menopause (charts online where you plug in a current age and AMH value and get a predicted age of menopause are not reliable!).

Breaking It Down: Egg Supply Equations

·Ovarian reserve = egg supply = a combination of FSH, AMH (blood tests), and AFC (by transvaginal ultrasound)

· “Good” egg supply = ⇓FSH (<10 mIU/mL), ⇑AMH (>1-2 ng/mL), and ⇑AFC (>10-12)

· “Less good” egg supply = ⇑FSH (>10 mIU/mL), ⇓AMH (<1 ng/mL), and ⇓AFC (<10-12)
Why Are You Testing?
Why are you testing?

Reassuring results

FSH <10 mIU/mL

AMH >1-2 ng/mL

Diminished ovarian reserve (DOR)

FSH >10 mIU/mL

and/or AMH <1.0 ng/mL
Trying to conceive  Does not mean every egg is perfect, but reassuring that there are good eggs left! Can explain one reason why it is taking a long time to conceive. Fewer good quality eggs available.
Planning fertility treatment Success rates are most likely consistent with general success rates with age. Success rates with any fertility treatment will be lower than expected for age as there are fewer good eggs in reserve.

 

What If My Results Are Really 'Abnormal For My Age'?

If the FSH is >15 and/or the AMH is <0.5:

  • Know that nothing is ever based on only one level – it is always okay to recheck.
  • Remember that abnormal ovarian reserve numbers do not mean someone cannot conceive if they are currently trying.
  • Be careful of what you read on the internet – it’s always okay to educate yourself, but remember that not everything you find online is true.
  • Write down questions to review with your doctor.
Key Points About Ovarian Reserve Testing

1. These numbers do NOT tell you if you are fertile or infertile.

2. Getting ovarian reserve testing can be emotional. Don’t let it define you.

3. Knowledge is power. It’s important to know these numbers so you can make informed choices about your health.

4. It’s important to stay realistic.

5. How people make choices about these numbers varies widely, and that is okay. The important part is that it’s your choice. No doctor or friend can decide what’s right for you.

  • The best use of ovarian reserve testing is to predict outcomes and set expectations for fertility treatment like IVF.
  • Your provider can help you interpret results in context with other factors like age, reproductive history, and overall health.
Semen Analysis

Approximately 30-50% of couples pursuing treatment have sperm factors as a contributing cause to their infertility. The initial infertility evaluation starts with a medical and reproductive history, along with a semen analysis. A semen analysis helps your provider in determining if there is a problem surrounding sperm parameters. The main components in a semen analysis report include: number of sperm (sperm count), motility (sperm actively moving), morphology (appropriate size and shape) of the sperm, and the volume of fluid.

Seminal Fluid Analysis Reference Range
Result Expected/Average
Volume 1.5-5.0 ML
Sperm Concentration >=15 Million/ML
Motility >=40%
Total Motile Sperm Calculation
Speed 3-4
Forward Progression 3-4
Viscosity 3-4
Sperm Agglutination None
pH 7.2-8.0
Morphology <4% Abnormal
Immature Forms (SABs) <3 Million/ML
WBC <1 Million/ML

 

The most common parameter in a semen analysis to be abnormal is the morphology. This test is subjective meaning an andrologist is looking at approximately 200 sperm under the microscope and evaluating each sperm for a normal shape vs. abnormal shape. Abnormal shape sperm does not predict an abnormal baby or birth defects or miscarriage. A high percentage of abnormal shape sperm is a signal to review lifestyle modifications and discuss how fertility treatment may help your family building plans.

While abnormal results decrease the chances of fertilization – this does not mean pregnancy is not possible or that the health of your baby will be affected. As long as sperm can be obtained, then pregnancy can be possible with specialized fertility treatments. Your provider will review your results with you at your visit, along with recommendations for next steps going forward. In some cases, a referral to a Urologist may be recommended.

Emotional Health Resources

Fertility treatment has the potential to be an emotionally, physically, and financially exhausting experience. Fertility care is more than medications and procedures. The emotional wellness of our patients is very important to the providers and staff here at Pacific Northwest Fertility. Although research studies find that stress does not directly cause infertility or alter the success of fertility treatments, the ups and downs of difficulty conceiving and miscarriages can certainly have a significant emotional impact.

Below you will find some resources for support. Ask us for more – we’re here to help.

Therapy

Individual Therapy – Counseling and therapy can provide one on one support. Ask your team for a list of counselors that have experience with PNWF patients. You can also ask your insurance provider for a list of in network providers.

For additional help in finding the right therapist for you, please visit the following websites:
https://therapyreferral.org
https://freshchalk.com/PNWF
https://directory.perinatalsupport.org/therapist – Perinatal support of Puget sound is a Washington State nonprofit supporting families with pregnancy loss.

Group Support

Group support – There are several groups in the Seattle area and online that support each other through the family building journey.

Books

Planting the Seeds of Pregnancy: An Integrative Approach to Fertility Care by Lora Shahine MD and Stephanie Gianarelli Lac: A step-by-step guide for anyone wanting to learn more about fertility enhancement and increasing egg quality from both an Eastern and Western medicine perspective.

Not Broken: An Approachable Guide to Miscarriage and Recurrent Pregnancy Loss by Lora Shahine MD is a comprehensive, evidence-based but easy-to-read guide for anyone who wants to understand all aspects of miscarriage and recurrent pregnancy loss.

The Fertility Experts’ Guide to Egg Freezing: Everything You Need to Know About Putting Your Fertility on Ice by Julie Lamb MD and Emily Gray RN is your go-to resource for learning about the process of egg freezing from start to finish. It’s a quick field guide to everything you need to know about the process, boiled down by an expert doctor and nurse team.

Conquering Infertility: Dr. Alice Domar’s Mind/Body Guide to Enhancing Fertility and Coping with Infertility. By Alice Domar and Alice Lesch Kelly

Conceiving with Love by Denise Wiesner – maintaining intimacy and your relationship through infertility and miscarriage.

Stick It To Me, Baby! Inserting Spirit into the Science of Infertility by Danica Thornberry, L.Ac. Spiritual but not faith based support through family building. Focus on forgiveness, gratitude, and encouragement.

Not Pregnant: A Companion for The Emotional Journey of Infertility by Cathie Quillet. The author shares her own journey through infertility and miscarriage and with warmth giving others permission to feel how they feel and heal.

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