Reproductive Health

Fertility tests: how to understand if we can still have a child naturally

What should a woman do to understand if she can still postpone a pregnancy or is it preferable to speed it up?

Let’s take as an example a 35-year-old woman in a stable relationship or just married, who wants to figure out whether to start the search now or if she can wait a little longer. What should you ask your gynecologist?

When a woman puts herself in this situation she knows that based on the answer, wanting a child anyway sooner or later, she will have to be ready to change her plans and that is also to start the search earlier than expected.

What could help a woman in this decision? Fertility tests.

Fertility tests

The simplest way to understand the state of fertility (also defined as a woman’s ovarian reserve ) is to undergo medical checks (ultrasound scans and specific tests). Hormonal tests are performed through a normal blood draw.

Before undergoing these tests, it is essential to keep in mind some very important concepts.

The first tests that are carried out concern some hormonal dosages. One above all the AMH, anti-Müllerian hormone . This hormone is released from a woman’s eggs, and its levels decrease as the number of eggs decreases with increasing age.

An AMH hormone test can give a good indication of the number of egg cells left.

In addition to AMH, follicle-stimulating hormone FSH is also usually measured.  This hormone rises when a woman’s egg count decreases, so it can indicate whether ‘ovarian reserve’, or the number of eggs left, is normal for her age.

For couples who are trying to get pregnant without results, doctors will surely recommend other tests as well. These may include other blood and urine tests, and hysterosalpingography : an X-ray of the uterus and fallopian tubes to check for abnormalities. Males are instead invited to provide a sperm sample, to test its quantity and quality (spermiogram).

The whole process can be long, expensive and sometimes destabilizing. Italy lacks an adequate system for dealing with these problems at a public level. Often these couples wander from one specialist to another: gynecologist, andrologist, endocrinologist, nutritionist…each of whom proposes different paths and solutions.

Instead, it would be desirable for there to always be a team that works together by exchanging outcomes and results to propose to the couple the best path to follow in a coordinated and coherent way .

Does a negative fertility test result preclude any possibility of natural pregnancy?

Some research suggests that AMH levels do not have an absolute meaning in defining a woman’s fertility.
study published in JAMA found that the results of the levels of these hormones are not necessarily a perfect indicator of fertility. The researchers gave blood and urine tests to 750 women who had been trying to become pregnant for three months or less, aged 30 to 44, and then followed them up for the next 6 to 12 months. Nearly 500 of those women conceived naturally during that time, and female levels of AMH and FSH had no significant effect on who became pregnant or not.

According to the study’s lead author, Anne Z. Steiner, professor of obstetrics and gynecology at the University of North Carolina,  the AMH and FSH findings shouldn’t deter women in their 30s and 40s unless we’ve already tried to get pregnant for many months and without success.

These tests are really to test the quantity of eggs, but the most important thing to consider is the quality of the eggs themselves . There are currently no tests that are really useful for assessing egg quality.

Lifestyle can affect fertility

Even if a couple’s fertility test results are all normal, there may be other factors that can hinder conception first, and then a healthy pregnancy.

For example, body mass index (BMI) can affect fertility for both women and their male partners. A 2017 study published in Human Reproduction found that couples in which both partners are obese take longer to get pregnant than those in the normal weight range.

Other lifestyle factors that can affect fertility include stress, smoking, diet and physical activity. (Moderate exercise appears to increase fertility, while too vigorous exercise can affect a woman’s menstrual cycle and make it harder for her to get pregnant.) A woman’s job type and job responsibilities can also affect a woman’s fertility. she.

A “good” result doesn’t mean you have to wait

Many women think that if they have a normal AMH level for their age, they can afford to postpone research.

This is incorrect reasoning. The decision to plan or delay a pregnancy cannot be made on the basis of an exam result alone.

There are many couples who struggle to get pregnant even with normal AMH values. And an adverse AMH score doesn’t mean you can’t have children.

Ultimately, fertility tests should be considered just one piece of that very complicated puzzle that defines the fertility of a woman or a couple. 

Surely there is no doubt about one factor and everyone agrees: the age, that of the woman in particular.

The younger the woman is when she decides to try to get pregnant, the more likely she is to get pregnant without difficulty. However, we must not forget that the best time to start a family is when you feel ready, not on the basis of the outcome of a test, but on the basis of what a woman and a couple feel within themselves.

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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