There are a number of relatively simple ways to assess egg quality:
Age. As part of the aging process, egg quality and quantity naturally decline, leading to more problematic pregnancies and lower pregnancy rates. A woman's age is a primary factor when evaluating egg health and of all factors, age is the most important in predicting delivered pregnancy rates.
FSH and Estradiol blood test. Given on day 2 or 3 of the menstrual cycle, this routine evaluation measures FSH, the primary hormone responsible for prompting egg production, and also estradiol, the most important estrogen hormone, responsible for reproductive anatomy health and function. An increase in these hormones signals that the body is having difficulty making eggs and is working harder to 'make up' for this shortfall. In most clinics, an FSH level of around 10 mIU/ml or higher and Estradiol of 70 pg/ml or higher indicates low ovarian reserve. (While it is helpful to have these numbers as a guide, our nurses and physicians will always walk you through your test results and explain these measurements as they apply to your situation.)
Anti-Mullerian Hormone (AMH). A newer test is the Anti-Mullerian Hormone test. This hormone is directly produced by developing follicles in the ovary and is less dependent on where a woman is in her cycle. The ideal level is 1.0 or higher. Higher levels are better.
CCCT (Clomid citrate challenge) blood test. This is a more sensitive assessment of a woman's egg supply, in which FSH and Estradiol hormone levels are measured before and after taking the fertility drug Clomid. About 5% of women will have normal day 3 FSH and Estradiol levels but have abnormal levels on Day 10, indicating they do have decreased ovarian reserve. This test is often recommended for those who have not responded to fertility medication, for those above the age of 37 and those who have symptoms of decreased fertility due to surgical complications or other conditions. A level of 10 mIU/mL for FSH on either cycle day 3 or day 10 indicates low ovarian reserve.
Shorter menstrual cycle. A shorter cycle may signal a change or imbalance in the hormone production that drives egg production and quality, and thus is often an indication of decreased fertility. Higher basal FSH levels drive the egg selected for ovulation that month to mature faster, leading to a short follicular phase (that part of the cycle starting with the onset of menstruation until ovulation). If a woman has had 28-30 day menstrual cycles, from the start of one menstrual period until the next, but in later years the cycle shortens to 24-26 days this may be the only clinical sign of decreased ovarian reserve.
Response to treatment with fertility medication. Sometimes ovarian function is so compromised that the body simply does not respond adequately, even to 'superovulation' with fertility medication.
Response to IVF. Sometimes poor egg function during IVF treatment is the first indication that there is a problem with ovarian function or egg quality. While a woman's eggs may initially appear to be adequate for an IVF cycle, they prove to be incapable of fertilizing or producing a healthy embryo.
Prior ovarian surgery. Surgery to address such conditions as cancer, ovarian cysts, polycystic ovaries or endometriosis may result in scar tissue or other conditions that interfere with hormone or egg production.