🔬 What Your Fertility Tests Actually Tell You
- AMH measures egg quantity, NOT quality—high AMH doesn't guarantee success
- Low AMH doesn't mean you can't conceive—it means time matters more
- AFC (antral follicle count) and AMH together give the best picture
- These tests predict IVF response, not natural fertility
- Age remains the strongest predictor of egg quality and success
Getting your fertility test results can feel overwhelming. Numbers like "AMH 0.8" or "AFC 6" seem to carry enormous weight—and they do matter. But understanding what these tests actually measure (and don't measure) can help you interpret them accurately and make informed decisions.
The Main Players: AMH, FSH, and AFC
🧪 AMH (Anti-Müllerian Hormone)
What it measures: A hormone produced by the small follicles in your ovaries. It reflects your remaining egg supply (ovarian reserve).
How it's tested: Simple blood draw, can be done any day of your cycle.
What it tells you: How many eggs you're likely to retrieve during IVF stimulation. Higher AMH = more eggs expected.
What it doesn't tell you: Egg quality. A woman with AMH of 4.0 at age 42 will likely have worse outcomes than a woman with AMH of 1.0 at age 28.
📊 AFC (Antral Follicle Count)
What it measures: The number of small resting follicles visible on ultrasound. Each follicle contains an egg.
How it's tested: Transvaginal ultrasound, best done on days 2-5 of your cycle.
What it tells you: Similar information to AMH—your expected response to stimulation.
What it doesn't tell you: Egg quality, and counts can vary slightly month to month.
🔬 FSH (Follicle-Stimulating Hormone)
What it measures: The hormone your brain produces to stimulate your ovaries. High FSH means your brain is working harder to stimulate fewer follicles.
How it's tested: Blood draw on day 2-4 of your cycle (cycle-dependent!).
What it tells you: Elevated FSH (>10-12) suggests diminished reserve. Very high FSH (>20) indicates significant depletion.
Limitations: FSH fluctuates month to month. A single high reading doesn't tell the whole story.
AMH Reference Ranges
| AMH Level (ng/mL) | Interpretation | Expected IVF Response |
|---|---|---|
| >3.0 | High reserve (watch for OHSS) | 15-30+ eggs likely |
| 1.5-3.0 | Normal/good reserve | 10-15 eggs typical |
| 1.0-1.5 | Slightly reduced | 6-10 eggs typical |
| 0.5-1.0 | Low reserve | 3-6 eggs typical |
| <0.5 | Very low reserve | 1-3 eggs typical, may need multiple cycles |
⚠️ Important Context
AMH naturally declines with age. An AMH of 1.5 at age 40 is actually quite good for that age, while the same number at age 28 might warrant investigation. Always interpret AMH in the context of your age.
AFC Reference Ranges
| AFC (Total Both Ovaries) | Interpretation | Notes |
|---|---|---|
| >20 | High—possible PCOS | Higher OHSS risk; may need lower doses |
| 10-20 | Normal reserve | Good IVF prognosis |
| 6-10 | Low-normal to reduced | May need higher doses; fewer eggs |
| <6 | Diminished reserve | Aggressive protocols may be needed |
The Critical Distinction: Quantity vs. Quality
This is the most important thing to understand about ovarian reserve testing:
💡 AMH and AFC measure QUANTITY, not QUALITY
Egg quality is determined primarily by age, not by your hormone levels. A 30-year-old with low AMH has younger, better-quality eggs than a 40-year-old with high AMH—even though she'll retrieve fewer of them.
This is why:
- A young woman with "low" AMH can still have excellent IVF success—she just needs fewer eggs because more are likely to be good quality
- An older woman with "great" AMH may still face challenges—she'll get more eggs, but fewer will be chromosomally normal
- Per-embryo success rates depend more on age than on starting egg numbers
What Low AMH Really Means
A low AMH result can feel devastating. Here's the realistic picture:
The Challenges
- You'll likely retrieve fewer eggs per IVF cycle
- You may have fewer embryos to work with
- You might need multiple retrieval cycles to bank enough embryos
- Time is more of a factor—reserve continues to decline
The Hopeful Reality
- You only need ONE good embryo to have a baby
- Quality matters more than quantity
- Women with low AMH get pregnant every day
- Mini IVF or natural cycle IVF may work well for you
- If you're young with low AMH, your eggs are still young—that's what matters most
📊 The Numbers
Research shows that while low AMH predicts fewer eggs, it doesn't significantly predict lower success rates per embryo transferred—especially in women under 35. Getting to embryo transfer is harder, but once you have a good embryo, your chances are similar.
What High AMH Might Mean
Very high AMH (>4-5 ng/mL) often indicates PCOS and comes with its own considerations:
- More eggs: You'll likely retrieve many eggs during IVF
- OHSS risk: Higher risk of ovarian hyperstimulation—clinics will use protective protocols
- Quality concerns: With PCOS, fertilization rates may be slightly lower
- Overall prognosis: Actually very good—PCOS patients often have excellent cumulative success
Why Tests Can Vary
If you've had multiple tests with different results, that's normal. Here's why:
- AMH: Relatively stable but can fluctuate 10-20% month to month. Different labs may give slightly different values.
- FSH: Can vary significantly month to month. One high reading doesn't define you.
- AFC: Depends on who's counting and the quality of the ultrasound. Can vary by a few follicles.
This is why good clinics look at the full picture—all three tests, plus your age and history—rather than focusing on any single number.
DOR: Diminished Ovarian Reserve
If you've been diagnosed with DOR (diminished ovarian reserve), it means your egg supply is lower than expected for your age. This diagnosis typically requires:
- Low AMH (<1.0-1.1 ng/mL), OR
- Low AFC (<5-7), OR
- Elevated FSH (>10-12), OR
- Poor response to previous IVF stimulation
DOR Treatment Strategies
- Act quickly: Time matters more with DOR—don't delay treatment
- Mini IVF: May be as effective as high-dose stimulation with fewer side effects
- Embryo banking: Multiple cycles to accumulate embryos before transfer
- Supplements: CoQ10, DHEA (under doctor supervision), may help
- Consider your goals: One child may require different planning than multiple children
When to Test
Consider ovarian reserve testing if:
- You're starting fertility treatment
- You're over 35 and planning to conceive
- You want to understand your fertility timeline (family planning)
- You have risk factors for early menopause (family history, ovarian surgery, autoimmune conditions)
- You're considering egg freezing
You can request testing from your OB-GYN, or it will be done as part of a fertility clinic evaluation.
What These Tests DON'T Tell You
Important limitations to understand:
- Natural fertility: Low AMH doesn't mean you can't get pregnant naturally—it's best at predicting IVF response
- Egg quality: Only age and, to some extent, genetic testing can assess quality
- Whether you'll have a baby: Many factors beyond reserve determine success
- Exact timeline: These tests can't tell you exactly when menopause will occur
Questions to Ask Your Doctor
- "What do my numbers mean for someone my age specifically?"
- "How many eggs might I expect to retrieve during IVF?"
- "Does my reserve change the protocol you'd recommend?"
- "Should I consider acting more urgently?"
- "Would egg freezing now be a reasonable option?"
- "Are there any additional tests you'd recommend?"
Testing in Colombia
All standard fertility testing is available in Colombia at significantly lower cost:
- AMH testing: ~$50-100 (vs. $100-300 US)
- Full hormone panel: ~$100-200 (vs. $300-600 US)
- Ultrasound with AFC: ~$50-100 (vs. $200-400 US)
- Complete fertility workup: ~$300-500 (vs. $1,000-2,000 US)
Results are just as accurate, and many patients choose to have comprehensive testing done in Colombia before starting treatment.
Get Your Complete Fertility Assessment
Understand your full fertility picture with comprehensive testing at our partner clinics. Results reviewed by experienced reproductive endocrinologists.
Request Free ConsultationThe Bottom Line
Your AMH, FSH, and AFC are important pieces of information—but they're just pieces, not the whole puzzle. Remember:
- Quantity ≠ Quality: Age matters more for egg quality than hormone levels
- Low AMH ≠ No chance: You need ONE good egg, not 20
- Context matters: Interpret results based on your age and situation
- Time is valuable: If reserve is low, don't delay treatment
- Many paths exist: Mini IVF, multiple cycles, donor eggs—options abound
Your numbers are a starting point for planning, not a verdict on your future. 💚