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Prediction of Fertility Potential
A woman's reproductive potential declines with age. This is reflected in the decreased ability to conceive (become pregnant) and an increase in the rate of spontaneous abortions (miscarriages). Although fecundity (the ability to achieve a pregnancy which results in a live birth) decreases in all women as they age, the precise age when a woman can no longer conceive varies between individuals. Approximately one-third of couples in which the female partner is age 35 or older will have problems with fertility. It is estimated that two-thirds of women will not be able to get pregnant spontaneously after the age of 40. Several tests may be useful in assessing fertility potential in older patients. For those patients with poor fertility potential predictions, the use of donor eggs or embryos can be considered.
Day 3 Levels of FSH, LH, and Estradiol. The determination of blood concentrations of follicle stimulating hormone (FSH) and estradiol levels on menstrual cycle day 3 has been used to estimate fertility potential. Women with elevated levels of FSH and/or estradiol measurements on cycle day 3 have very poor pregnancy rates with both ovulation induction and assisted reproductive technologies (ART) such as In-Vitro Fertilization (IVF). More recently, it has been shown that women with elevated blood levels of luetinizing hormone (LH) on cycle day 3 also have poor pregnancy outcomes with fertility therapy.
Anti-Mullerian Hormone. Another predictor of fertility potential is used to provide an objective measure of ovarian reserve status and potentially will help predict the response to ovarian stimulation protocols.
- Response to Gonadotropins. Gonadotropins are concentrated mixtures of FSH and LH or FSH alone which are given as injections to stimulate the ovary to produce multiple eggs in preparation for various fertility therapies. The amount of gonadotropins required to induce egg development increases with increasing chronological age. Patients requiring large amounts of gonadotropins to induce egg development generally have lower pregnancy rates with both ovulation induction therapy and IVF.
Several laboratory methods are currently used to measure blood levels of FSH, LH, AMH and estradiol. Measurement of these hormone levels may vary considerably depending upon the particular laboratory method used. Therefore, it may be difficult to compare blood levels of these hormones that are measured at different laboratories or by different laboratory techniques. It is important that normal and abnormal test values be based on the pregnancy rates achieved by women studied at a particular center using the same laboratory methods.