With fertility, do you have golden or goose eggs? Are they scrambled or just needing a little coddling? When trying to conceive, knowing what eggs are “in your basket” is essential to avoid being surprised.
Though there aren’t good tests beyond age (and IVF) for egg quality, there are multiple approaches to looking at quantity. When hunting for how many eggs remain (“ovarian reserve”), the classic standard was FSH (Follicle Stimulating Hormone). However, because of unreliability (to the point some joke it should be called Fluctuating Severely Hormone), OB/GYN’s are moving away from it as a standard. The reason is that 75% of women ages 40-45 and 50% of women ages 45-50 have normal FSH, even though we know that most women have difficulties with their eggs by the time they reach 40. The new gold standards are AMH (anti-Müllerian hormone) and AFC (antral follicle count). AMH requires a blood draw and can take a few weeks for results to return, but can be tested by most physicians. AFC is usually only done by OB/GYN’s (including fertility specialists), and while it generates instant results, a clinician has to be used to measuring it in order for a reliable answer.
As a society, we overemphasize age’s role with eggs for fertility (being 25 won’t fix blocked tubes or a spouse who is “firing blanks”), but if the ovaries stop working well, one can be stuck between using poor quality eggs and an egg donor. Roughly 80% of eggs have the usual amount of DNA at 25, 60% at 30, 40% at 35, and 20% at 40, though this can vary. Eggs with too much or too little DNA are more likely to dissolve after fertilization or miscarry. (For example, Down syndrome comes from an egg having an extra chromosome (piece of DNA), and as a result of this extra DNA many Down syndrome pregnancies don’t make it to delivery.) However, some older women assume they have “rotten eggs” when they actually can make very cute babies. On a similar note, some worry because of irregular cycles that their basket may be empty, when in fact they have too many eggs because of PCOS (polycystic ovarian syndrome).
Options for treating egg issues include ovulation induction/superovulation (get a few more), in vitro fertilization (get a lot more and put sperm directly with them), and donor egg (get them from someone else). Though the more effective the approach, often the greater cost, the value truly depends on the reasons for underlying subfertility. This is the true role of a specialist in guiding you on your fertility journey — it isn’t enough to get a test; rather you want peace of mind knowing it was interpreted correctly and that you’re choosing the most effective solution (as well as not wasting money on unnecessary tests or treatments).
All that being said, this time of year matters for far more than just “Easter eggs.” Regardless of your fertility and family goals, we at Positive Steps Fertility wish you a very happy Easter!