National Fertility Awareness Week 2015 (2nd to 8th November) is all about raising awareness of the #1in6 couples who struggle to become parents. To mark this week, we are looking at how egg counting tests (ovarian reserve tests) can give women a clearer idea of how fertile they are.

We’ve spoken to Dr Amin Gorgy, a Fertility Consultant at The Fertility & Gynaecology Academy, to find out more about egg counting tests and find what the results may mean for women planning a family.

Egg counting tests

For woman in their thirties or forties who want to get pregnant or delay having a family, the decision may come with feelings of apprehensive. It can be daunting to embark upon a journey towards conception (or delay conception) without knowing quite what your chances are or whether you’ll need any assistance.

Many couples have used up valuable time ‘trying’ on their own, when they actually needed some kind of treatment. This is where fertility egg counting tests come in – they provide a comprehensive assessment of your fertility potential to check that all is well, or if there are any potential stumbling blocks, either way, understanding your fertility potential will allow you to know what your options are.

What is an egg counting test?

An egg count test measures a woman’s ovarian reserve, or her remaining egg supply to make babies. It involves counting the small developing follicles (cyst like structures) in the ovaries that contain the eggs and have the potential to mature and ovulate. The number of these growing follicle reflect the capacity of the ovaries to produce eggs; what we call the ovarian reserve.

egg counting tests

Credit: J.K. Califf

The ovarian reserve reflects a woman’s fertility potential. Unlike men, who produce sperm on an ongoing basis, females are born with a lifetime supply of eggs in their ovaries. Women are born with all the eggs they will ever have, and eggs are constantly lost until they woman reaches menopause – when no more eggs remain.

The count predicts the ovarian reserve (egg storage/egg count) and not fecundity (ability to conceive). The chances of the patient conceiving depend on the ovarian reserve (egg storage) and the egg quality. The latter is more directly related to the patient’s age. Ovarian reserve is reduced with advanced age and starts to diminish quickly from the age of 37 and even faster after 40.

How is it done?

The count is done during a standard transvaginal scan using a high resolution ultrasound machine. The procedure takes about 10 minutes. It is not associated with pain or discomfort whatsoever and the patient can get off the examination couch and walk home straightaway.

There many tests to predict the ovarian reserve but our fertility egg counting test, which involves an antral follicle count via ultrasound scan and Anti Mullarian Hormone (AMH) level via a blood test, is most consistent and accurate of them all. Doing both gives us a bi-dimensional picture and more precise assessment of the ovarian reserve.

What do the results mean?

The total antral follicle count in both ovaries is the indication for ovarian reserve. 15 to 25 antral follicles indicate a good ovarian reserve. 8 to 14 follicle represent moderate ovarian reserve while 5 to 7 antral follicles indicate poor and less than 5 very poor ovarian reserve.

The assessment of ovarian reserve is important in at least two situations:

1. In patients going through ovarian stimulation for IVF treatment, assessing the ovarian reserve beforehand helps to predict the number of eggs expected to be retrieved, the chances of success and to determine the necessary dose of the ovarian stimulation drugs to mature a reasonable number of eggs. The lower the antral follicle count is, the higher the dose the drugs will be. The ovarian reserve is taken into consideration together with other factor e.g. the patient’s age.

2. Women who are not ready to start a family yet but concerned about missing the boat. It is advisable that these women have their fertility checked with an egg count fertility test. If the ovarian reserve is low they might reconsider their plans and try to start a family sooner rather than later. Alternatively they can create embryos through IVF and freeze them until they are ready to start the family. If the woman is single she can produce eggs through ovarian stimulation similar to IVF and freeze them for future use or create and freeze embryos using donor sperm.