Ovarian reserve testing is used to assess the quality and function of the ovaries. This is not the same as testing whether or not a woman is ovulating, rather it is an assessment of how likely it is that a woman will achieve a natural pregnancy and, if a natural pregnancy is unlikely, which fertility treatments would be most appropriate.
The first part of this testing is to analyse the Anti-Mullerian Hormone (AMH) which is a measurement of both quality and quantity of a woman’s eggs and therefore ability to conceive. The result of this testing will range from “excellent” at 28
to 45pmol/L (picomoles per litre) through to “low” at 2.2 to 15pmol/L or even “undetectable” at 0
to 2.2pmol/L. A diagnosis of “low” or “undetectable” will often mean that a woman will be told by doctors and specialists that she is unlikely to get pregnant without assistance, or in the worst case scenario, without donated eggs.
In a normal healthy woman the ovaries release oestrogen as they develop and release eggs. If the body senses that there is not enough oestrogen in the blood then the pituitary gland will release higher levels of follicular stimulating hormone (FSH) in order to stimulate the ovaries to develop and release eggs. Therefore high levels of FSH in the blood early on in a woman’s menstrual cycle can suggest a lower ovarian reserve (the number of eggs left in the ovaries) or the onset of the menopause. For this reason an FSH test is normally conducted on day three of a woman’s cycle.
In some cases the level of FSH will fluctuate or will be “masked” by a high level of oestrogen. For this reason the day three FSH test will also test the oestrogen level. If the FSH levels are normal but the oestrogen levels are high then this can also be a sign of a lower ovarian reserve or the onset of the menopause. Ideally on day three there is a low FSH level in conjunction with a low oestrogen level.
The idea of using day three oestrogen levels as an adjunct in evaluating egg quantity and quality is relatively new. Each laboratory has its own views on the right values for “normal” and “abnormal” ranges. There is not much data that suggests that an elevated day three oestrogen level is a problem in itself.
If tests show a consistently elevated or fluctuating level of FSH and or oestrogen, even when the woman is relatively young, it may indicate that the body has entered the beginning of premature menopause which will make it more difficult to conceive even with Assisted Reproductive Techniques (ART).
Using Traditional Chinese Medicine to support women with low ovarian reserve
Although woman with a low ovarian reserve are less likely to succeed in achieve pregnancy naturally and through ART, it is by no means impossible as even in these women eggs are released by the ovaries. While AMH levels are fixed, the levels of FSH and oestrogen are responsive to intervention. Traditional Chinese Medicine uses the concept of Qi (energy) to define the imbalance that results in sub-optimal hormone levels. By seeking to balance the energy in the body using acupuncture and herbal medicine, Traditional Chinese Medicine aims to create the optimum conditions for the egg to mature and be released at the right time in order for a healthy pregnancy to go ahead.
Naava Carman has a significant amount of experience of working with women with low AMH and high FSH levels to support them and their bodies using acupuncture and herbal medicine. In most cases Naava will focus her treatments on preparing these patients for IVF (or other ART procedure) according to the precepts of Traditional Chinese Medicine, however on occasions these patients have gone on to conceive naturally. When treating patients with abnormal FSH levels Naava will recommend an FSH test each month on the same day of the cycle in order to target her treatment to the changing needs of her patient. In recent years Naava has treated a number of patients who have “low” or “undetectable” AMH levels but have gone on to conceive naturally.
Traditional Chinese Medicine is a complementary therapy and the Fertility Support Company does not advocate it as an alternative to Western medicine. If you are in any doubt about your health or symptoms you are experiencing you should consult your doctor. The Fertility Support Company and its practitioners do not claim to “cure” low ovarian reserves, low abnormal hormone levels or any other ailment.
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