Unlike men—who continue to produce sperm throughout their lives—women are born with every egg that they’re ever going to have. As a result, women do experience a decrease in their fertility over time. Some women start with more eggs (called oocytes) then others. Additionally, some women have a more rapid decline in their fertility then others. That’s why age alone is only a rough estimate for a woman’s fertility.
Over the years, there have been various tests proposed to estimate a woman’s ovarian reserve. Some were better estimates than others but they all had their limitations. Over the last several years however there has been one test that has emerged as the most consistent and predictive of a woman’s fertility; a test called AntiMüllerian Hormone or AMH. Until recently, this test has been widely used around the world, it has had more limited exposure within the USA.
AMH is a hormone that is directly released by immature eggs into a woman’s bloodstream. Better still, it remains stable from day-to-day with minimal fluctuation over subsequent months. That means that the test can be performed on any day in a woman’s monthly fertility cycle and the results are considered to be predictive for months to follow. Other tests proposed to measure ovarian reserve actually tend to be more representative of the specific month that they were performed. AMH is also predictive of how a woman will respond to fertility treatment and can be helpful in diagnosing problems like polycystic ovarian syndrome as well. It is reasonably priced and now easily accessible.
I have been recommending the AMH test to women for several years. Oftentimes, the response that I hear back is that “my doctor isn’t familiar with this test” or worse “my doctor doesn’t believe in this test.” Enough research has now been completed and this test is widely available so those complaints should no longer be acceptable. If you’d like to download a recent article written about this test to initiate a discussion with your doctor then please check out the September 2009 issue of Contemporary OB/GYN.
Enhancing Fertility 
Dr. Greene –
I know this is an old post, but wonder if an update is warranted? Didn’t some research come out this summer about caffeine impacting the ability of the fallopian tubes to move the egg down to the uterus?? What are your thoughts on that?
– Coffee Lover
Dear Coffee Lover,
Although I am familiar with the study you refer to; I do not think it is clinically relevant. Although it was a well designed study, it was performed on tubes from mice. More importantly, it only looked at the effect upon muscle which they then interpreted to have a “possible effect on the ability of a fallopian tube to safely transport an egg.” In reality, fallopian tubes in humans transport embyos not eggs. Additionally, human embryos create certain hormones and growth factors that are believed to promote motility. So although they had an interesting finding; it does not seem clinically useful. That said, I do think that moderation–as with all things–should be practiced. Hope you find this reassuring.
Best thoughts,
~Robert
Robert Greene, MD, FACOG
CNY Fertility Center
Syracuse/Rochester/Albany, New York
Superb post but I was wondering if you could write a litte more on this subject?
I’d be very thankful if you could elaborate a little
bit further. Many thanks!