Fertility hormone tests are blood tests. FSH (follicular stimulation hormone) and LH (luteinising hormone) are the hormones released by the pituitary gland (a part in the brain). FSH travels through the bloodstream to the ovaries where it stimulates the growth of follicles. A normal FSH level is somewhere between 2 and 8.9, this is enough to support the growth of one follicle and is how nature normally limits us to singleton pregnancies. FSH levels vary through the cycle it must be measured in the first few days of menstruation (day 2-5 of the cycle). When bleeding starts is considered as day 1 of the period.

Estradiol is an ovarian hormone. It is tested along with FSH and LH. It helps to understand whether low FSH is a result of high estradiol or low production of FSH by pituitary.

The most commonly used test for ovulation is a progesterone hormone test. It is a blood test. After ovulation, this hormone is released by the ovary. After 7 days of ovulation (release of the egg) progesterone levels reaches to peak, which is 7 days before next expected period. Therefore progesterone test is advised on day 21 of the period based on the cycle length of 28 days. If the cycle is 30 days long, progesterone should be done on day 23. If cycles are irregular, sometimes, it is advised on two occasions in a cycle. Value more than 20, normally indicates ovulation (always check local laboratory standards and reference range).

Another reliable test for ovulation is use of ultrasound to check the growth and release of follicle. It is expensive as compared to blood test.

AMH test is a blood test which can be done at any time during the cycle. AMH is a hormone produced by the growing follicles in the ovaries and is a direct marker of the number of follicles. Therefore, it is used as an ovarian reserve marker. AMH varies with age. Normal levels are interpreted with age. AMH <5pmol/ml is considered as a poor ovarian reserve. Lower levels are indicative of poor reserve and higher levels associated with, but not diagnostic of, polycystic ovaries. AMH varies less through the period cycle and so can be measured at any time. AMH should not be measured with long term use of contraceptive pills, it may show lower levels than normal.

No. AMH is not a good predictor for chances of natural conception.

AMH gives an idea of number of eggs in the ovary.

Broadly speaking AMH = quantity of eggs in the ovary (high value of AMH, high number of eggs)

Age= quality of eggs. (Higher the age, lower is the quality)

The stimulation protocols are based on age and AMH results. At p4 fertility, we analyse all factors including AMH and age to personalise the IVF protocols.