By Nicole Condon, Chief Operating Officer
“My FSH is 7”
“My AMH is 25”
“My AFC is 12”
“My hCG is 212”
“I have 10 MIIs”
“I have 4 blastocysts”
“My lining is 12mm”
There are a lot of numbers to keep track of when going through fertility treatment. Patients often wonder: How do I compare with other patients? What do these numbers tell me about my chances of success? How do they help me make decisions on my treatment path? Do my numbers change over time? How can I make my numbers better?
These are questions we hear a lot. And these are discussions that patients often have with each other. Patients compare test results, IUI sperm counts, egg retrieval numbers, blastocyst numbers. Every possible number is dissected and analyzed. But what do all these numbers mean? How do we interpret the numbers?
Here are some very basic averages from Dr. Jim Meriano, the Lab Director at TRIO:
AMH is a measure of ovarian competence and is age dependant.
Average AMH (pmol/l)
IVF Egg Retrieval Numbers. This is all patients, not taking into consideration age or antral follicle count or AMH level, which all can affect the number of eggs:
IVF Egg Retrieval Metrics
|Average Number of Oocytes retrieved||11.1|
|Average % of mature oocytes||75%|
|Average fertilization rate||55%|
|Frozen Embryo Survival rate||95%|
|Pregnancy Rate||45% ongoing|
Normal sperm is considered in an initial count of greater than 15 million/ml and normal sperm motility is considered when, on average, 35% of sperm is moving progressively. Another measure of sperm quality is DNA fragmentation. If DNA fragmentation of sperm is below 20-25%, sperm has a good ability to fertilize.
While averages are helpful overall, it’s important to remember that a single number often doesn’t mean very much for any one individual patient. For example, FSH is a blood test result that can give us an indication of one’s fertility. A high FSH can point towards a decline in ovarian function or the ability of the ovaries to respond to stimulation. Another test result is Antral Follicle Count (AFC). This is the number of small follicles that are seen with ultrasound at the start of a cycle telling us how many follicles are potentially available for stimulation. Thus, a high AFC is generally good – but not always! Too high can be a sign of Polycystic Ovary Syndrome, (PCOS) and a risk of ovarian hyperstimulation. If a patient had a low FSH (desirable) combined with a low AFC (undesirable), this paints a different picture than one would have thought from the FSH alone. With the addition of AMH, the test results paint the most complete picture of a patient’s baseline fertility. AMH naturally declines with age and is thus dependent on age. And age is yet another number that needs to be considered. An AMH of 10 may be reasonable for a patient over 40. But that same number in a 25-year-old could be cause for concern and poor prognosis. These two patients could have identical FSH levels but knowing the AMH number gives them a different prognosis/diagnosis…and this is just the testing phase.
For IUI cycles, sperm count is another number that is focussed on. The average person on the street would think a sperm count that was one million was amazing. Wow, one million sperm! But your doctor would deem that as low and would certainly recommend not doing IUI and moving straight to an IVF cycle with ICSI.
When a patient goes to IVF, there is a whole new set of numbers to dissect and analyze. The results from AMH, FSH and AFC testing will inform your physician on what protocol to use. From there, numbers such as estrogen, LH, progesterone, follicle count, eggs retrieved, mature eggs retrieved, fertilized eggs, embryos and blastocysts are discussed by physicians and patients alike. Again, on its own, one single number doesn’t tell us all that much. For example, the number of eggs retrieved is often compared. However, it’s more important to know how many mature eggs, MIIs, were retrieved. When a doctor is performing an egg retrieval, the doctor will often drain all follicles to help reduce the chances of hyperstimulation even though there is no expectation by the physician that tiny follicles (less than 1.3cm) will be mature and useable. Thus, when a patient says 20 eggs were retrieved but only 5 made it to blastocyst, the more valuable number to note would be how many mature eggs were retrieved and how many of those grew to blastocyst.
What about the often-asked question about changing your numbers? What control does a patient have there? That’s a tough one.
Age is the biggest culprit in a patient’s numbers changing, and not for the better. I recall being asked once by a friend “you work in fertility, when’s the best time to try to get pregnant?” My answer was “Now. You’ll never be more fertile than you are today.” Over time, AMH will go down and FSH will go up. We can’t fight that. But like most things when it comes to our health, there are things we can do to help you maximize your response to fertility treatments (not cure the effects of advancing age or diminishing ovarian reserve). As always, an active, healthy lifestyle with healthy body weight can go a long way. As well, there are nutraceutical interventions that can potentially help improve the odds. A visit to our naturopaths would be the best way to learn about these.
It’s easy to get caught up in the numbers game: Fertility treatment takes away some of the control you have over your life and in your planning for the future. Sometimes, all the analyzing and dissecting can seem like it’s giving you back some of that control, simply because it gives you something to focus on. But the reality is that everyone is different, and everyone’s situation is unique. Your numbers are unique to you. So, it’s important not to be tempted to compare yourself with others. The best way to find out what your numbers really mean is to talk with your doctor. Using their experience and expertise, they will analyze all your results and provide direction on what they think is the best approach for you in achieving a pregnancy. Trust your doctor. And be sure to ask them questions so that you have a good understanding of your own unique numbers.
Finally, I want you to know that everyone at TRIO (all 85 of us) is behind you, supporting you on every step of your journey.