Understanding Fertility Tests: AMH, FSH, AFC & What Your Numbers Mean

Your doctor hands you a sheet of lab results: AMH 1.2, FSH 8.7, AFC 12. What does any of it mean? Are these good numbers? Bad? Should you be worried?

Fertility testing can feel like learning a new language. This guide decodes the most common tests, explains what your numbers actually mean, and helps you understand how they're used to plan treatment — and their limitations.

🔑 The Most Important Thing to Know First

Ovarian reserve tests measure quantity, not quality. They tell us approximately how many eggs you have left, not whether those eggs are chromosomally normal. Only age predicts egg quality. A 30-year-old with low AMH has young, healthy eggs — just fewer of them. A 42-year-old with high AMH still has older eggs that are more likely to be abnormal.

AMH (Anti-Müllerian Hormone)

AMH is the most widely used test for ovarian reserve. It's produced by small follicles in the ovaries and correlates with the number of eggs remaining.

AMH Testing Basics

What it measures: Hormone produced by small ovarian follicles
What it indicates: Approximate quantity of remaining eggs
When to test: Any day of your cycle (unlike FSH)
Cost: $75-$200
Results time: 2-7 days

AMH Levels by Age

Age	Typical AMH Range	Interpretation
25-30	3.0-4.0 ng/mL	Normal for age
30-34	1.5-3.5 ng/mL	Normal for age
35-39	1.5-2.4 ng/mL	Normal for age
40-44	0.52-0.88 ng/mL	Expected decline
Any age	<1.0 ng/mL	Diminished reserve

What AMH Does Tell You

How you'll respond to stimulation: Higher AMH usually means more eggs retrieved
Risk of OHSS: Very high AMH (>3.5-5.0) may indicate PCOS or OHSS risk
Time sensitivity: Low AMH suggests you may have less time to delay treatment
Medication dosing: Helps doctors choose appropriate stimulation protocols

What AMH Does NOT Tell You

Whether you can get pregnant naturally: Women with low AMH conceive spontaneously all the time
Egg quality: A 30-year-old with AMH of 0.8 has better quality eggs than a 42-year-old with AMH of 2.0
When you'll enter menopause: It's not a reliable menopause predictor
Your fertility in general: ACOG explicitly warns against using AMH to predict fertility in non-infertile women

⚠️ An Important Caveat

Studies show that women of the same age with different AMH levels have similar pregnancy rates per embryo transferred. AMH affects how many eggs you get, but each egg has the same quality-based-on-age as anyone else your age. Don't panic about a low AMH — it doesn't mean your eggs are bad, just that you have fewer.

FSH (Follicle-Stimulating Hormone)

FSH is the hormone your pituitary gland produces to stimulate egg development. When ovarian reserve is declining, your body produces more FSH to compensate — like pressing the gas pedal harder when the engine is struggling.

FSH Testing Basics

What it measures: Brain's signal to ovaries to develop eggs
What high FSH indicates: Ovaries need more stimulation (lower reserve)
When to test: Day 2-4 of your cycle ONLY
Must include: Estradiol (E2) measured same day
Cost: $75-$150 (FSH + E2)

FSH Interpretation

FSH Level (mIU/mL)	Interpretation	IVF Implications
5-8	Ideal range	Expected good response
8-10	Normal	Good response likely
10-15	Diminished reserve suggested	May need higher doses
>15-20	Poor ovarian reserve	Low response expected

Why Estradiol Matters

FSH must be interpreted alongside estradiol (E2). If your E2 is elevated on day 3 (above 60-80 pg/mL), it may be artificially suppressing your FSH, making it look normal when it's actually high. Always ask for both values.

The "Highest Value" Rule

If you've had FSH tested multiple times, the highest value is the most predictive. FSH fluctuates month to month, but once it's been high, that elevated reading indicates diminished reserve — even if subsequent tests are lower.

AFC (Antral Follicle Count)

AFC is an ultrasound-based count of small follicles visible in your ovaries. Each antral follicle (2-10mm) represents a potentially recruitable egg for IVF.

AFC Testing Basics

What it measures: Number of small follicles in both ovaries
When to test: Days 2-5 of your cycle (early follicular phase)
How it's done: Transvaginal ultrasound
Cost: $200-$500 (often part of initial evaluation)
Key advantage: Visual count; predicts IVF response well

AFC Interpretation

Total AFC (Both Ovaries)	Reserve Assessment	Expected IVF Response
<4	Extremely low	Poor response; mini-IVF may be considered
4-9	Low/diminished	Reduced response; may need aggressive protocols
10-15	Normal	Average response expected
16-21	Good to excellent	Good response expected
>35	Very high (PCOS possible)	Watch for OHSS risk

💡 AFC Is Often the Best Predictor

Many reproductive endocrinologists consider AFC the single best predictor of how many eggs you'll retrieve during IVF. It has the advantage of being a direct visual count rather than an indirect hormone measurement.

The Crucial Distinction: Quantity vs. Quality

This bears repeating because it's so often misunderstood:

Reserve Tests = Egg Quantity

AMH, FSH, and AFC tell us approximately how many eggs remain. They predict how many eggs you'll retrieve during IVF stimulation.

Age = Egg Quality

Only age predicts the percentage of eggs that will be chromosomally normal. Quality declines with age regardless of reserve test results.

Chromosomally Normal Embryo Rates by Age

Age	% Eggs Chromosomally Normal
Under 35	65-70%
35-37	50-60%
38-40	30-40%
41-42	20-30%
Over 42	<20%

This is why a 30-year-old with low AMH may still have excellent success — she just needs to retrieve enough eggs. And why a 42-year-old with high AMH still faces challenges — she may get many eggs, but fewer will be normal.

Male Fertility Testing

Male factor contributes to approximately 40-50% of infertility cases. Semen analysis is the cornerstone of male fertility evaluation.

Semen Analysis (WHO 2021 Reference Values)

Volume: ≥1.4 mL
Sperm concentration: ≥16 million/mL
Total sperm count: ≥39 million per ejaculate
Progressive motility: ≥30%
Total motility: ≥42%
Morphology (strict criteria): ≥4% normal forms

Interpreting Semen Analysis

Important: "Normal" on a semen analysis doesn't guarantee fertility. Studies show that approximately 50% of men in infertile couples have "normal" parameters. The test identifies obvious problems but doesn't assess everything.

Terms You May See

Oligozoospermia: Low sperm count (<16 million/mL)
Asthenozoospermia: Low motility (<42% total)
Teratozoospermia: Poor morphology (<4% normal)
OAT: Combination of all three
Azoospermia: No sperm in ejaculate

Additional Male Tests

Sperm DNA Fragmentation

Measures the integrity of DNA within sperm. Not routinely ordered but may be helpful after recurrent pregnancy loss or failed IVF.

Normal: DFI <15%
Borderline: DFI 15-30%
High: DFI >30%
Cost: $300-$500

High fragmentation is associated with lower implantation rates and higher miscarriage risk, even when standard semen analysis is normal.

Other Important Tests

HSG (Hysterosalpingogram)

An X-ray test that checks whether fallopian tubes are open and identifies uterine abnormalities.

What it shows: Tubal patency, uterine shape, some abnormalities
How it's done: Dye injected through cervix, X-rays taken
Timing: Days 5-12 of cycle (after period, before ovulation)
Discomfort: Cramping during procedure; varies by individual
Cost: $500-$1,500

Saline Sonogram (SIS/SHG)

Ultrasound with saline to better visualize the uterine cavity.

What it shows: Polyps, fibroids, septum, other cavity abnormalities
Better than regular ultrasound: Saline separates uterine walls for clearer view
Cost: $300-$500

Thyroid Panel (TSH)

Thyroid dysfunction affects fertility and pregnancy. TSH should be between 0.5-2.5 mIU/L for optimal fertility (stricter than general population ranges).

Prolactin

Elevated prolactin can interfere with ovulation. Should be tested if cycles are irregular.

Complete Fertility Workup Costs

Test	US Cost Range
AMH	$75-$200
FSH + Estradiol (Day 3)	$75-$150
AFC Ultrasound	$200-$500
HSG	$500-$1,500
Semen Analysis	$100-$300
Thyroid/Prolactin/Infectious	$100-$300
Complete Female Workup	$1,000-$3,000

How Tests Guide IVF Treatment

Protocol Selection

Your test results help determine your stimulation protocol:

High reserve (high AMH, high AFC): Lower medication doses to avoid OHSS
Normal reserve: Standard protocols
Low reserve (low AMH, low AFC, high FSH): Higher doses, possibly mini-IVF approach

Setting Expectations

Tests help predict approximately how many eggs you'll retrieve:

Low reserve: 1-5 eggs typical
Normal reserve: 8-15 eggs typical
High reserve: 15-25+ eggs possible

Male Factor Decisions

Normal semen analysis: Conventional IVF usually fine
Mild abnormalities: May still succeed with conventional IVF
Moderate-severe abnormalities: ICSI recommended
Azoospermia: Surgical sperm retrieval + ICSI

Need Help Interpreting Your Results?

We can connect you with Colombian fertility specialists who can review your test results and discuss what they mean for your treatment options.

Get Free Consultation

Questions to Ask About Your Results

"What do these numbers mean for my specific situation?" — Context matters more than absolute values
"How many eggs might I expect to retrieve?" — Get a realistic estimate
"Does my age change how we interpret these results?" — Age + reserve = full picture
"Are there any concerning findings that affect our approach?"
"Should any tests be repeated or are additional tests needed?"
"How do my partner's results affect our treatment plan?"

The Bottom Line

Fertility testing provides valuable information for planning treatment, but numbers don't tell the whole story. Remember:

AMH, FSH, and AFC measure quantity, not quality — only age predicts quality
Low reserve doesn't mean you can't get pregnant — it may mean fewer eggs, not bad eggs
High reserve doesn't guarantee success — quality still matters
"Normal" semen analysis doesn't rule out male factor — 50% of infertile men have normal parameters
Tests guide treatment but don't determine outcomes — medicine is probability, not certainty

Use your test results as information, not as a verdict. Work with your doctor to understand what they mean for your specific situation and treatment plan.