Common Fertility Questions: AMH, Egg Freezing, IVF and Fertility Testing

This Consilium Fertility Insight post explores some of the most common questions about fertility, from AMH testing and ovarian reserve to egg freezing, IVF and fertility assessment. Ms Jara Ben Nagi, Consultant Gynaecologist and accredited specialist in Reproductive Medicine and Surgery, provides clear, evidence-based guidance to help you better understand your fertility and the options available to you.

When should I see a fertility specialist?

If you are 35 or younger and have been trying to conceive regularly for approximately one year without success, it is reasonable to seek specialist fertility advice.

If you are 36 or older, we recommend seeking advice earlier rather than automatically waiting for a year.

You should also consider seeing a fertility specialist without delay if you already know of a potential fertility problem, such as blocked or damaged fallopian tubes, endometriosis, significantly irregular periods, reduced ovarian reserve or male-factor infertility.

You do not, however, need to have been diagnosed with infertility to see us.

You do not need a diagnosis of infertility to arrange a fertility specialist consultation. Consilium Clinic also sees individuals and couples who want to understand their fertility, consider egg or embryo freezing for fertility preservation or seek a second opinion after previous treatment.

A fertility consultation should provide more than a set of test results. Our aim is to understand your individual circumstances, explain what the findings actually mean and help you decide what – if anything – you need to do next.

When should I have fertility tests?

There is no single answer that is appropriate for everyone because the timing depends on age, medical history and personal circumstances.

As a general guide, if the female partner is 35 or younger, fertility assessment is usually considered after approximately 12 months of regular unprotected intercourse without conception.

From the age of 36 onwards, earlier specialist advice is appropriate because fertility declines with age and avoiding unnecessary delay becomes increasingly important.

You should also consider seeking advice earlier if either partner has a known or suspected factor that could affect fertility, such as irregular or absent periods, endometriosis, previous pelvic infection or surgery, known tubal disease, previous chemotherapy, or concerns regarding sperm quality.

Some people also choose to have a fertility assessment before trying to conceive because they want more information when planning their future. We are happy to discuss the benefits and limitations of fertility testing in this situation. You can find more detailed information on fertility assessment in the NICE guideline on defining infertility and initial assessment.

What does a fertility MOT include?

A fertility MOT is a comprehensive assessment designed to give you a clearer picture of your current reproductive health.

At Consilium Clinic, fertility assessment in London can include a detailed consultation, review of your menstrual and reproductive history, fertility hormone tests including AMH where appropriate, and specialist ultrasound assessment of the uterus and ovaries, including antral follicle count.

Depending on your circumstances, additional investigations such as tubal patency testing or semen analysis may also be recommended.

The purpose of fertility assessment is to identify factors that may affect fertility and help you make informed decisions about your reproductive plans.

What does an AMH test tell you about ovarian reserve?

Anti-Müllerian hormone (AMH) is produced by the small follicles within the ovaries. Measuring AMH provides an estimate of ovarian reserve and the likely response to ovarian stimulation.

However, AMH does not directly measure egg quality and is not an accurate stand-alone predictor of whether you will conceive naturally. Female age remains a much more important predictor of egg quality.

When planning IVF or egg or embryo freezing, AMH is particularly useful because, together with the antral follicle count, it helps us predict how the ovaries may respond to stimulation and assists us in selecting an appropriate stimulation protocol and starting dose.

At Consilium Clinic, we therefore interpret your AMH as part of your overall fertility assessment rather than treating an AMH result as a fertility score.

What is a good AMH level for my age?

Anti-Müllerian hormone (AMH) levels naturally vary with age and there is a wide range of normal values. In general, AMH levels decline as women get older because the number of eggs remaining in the ovaries gradually decreases.

It is important, however, not to interpret an AMH result in isolation. AMH is principally a marker of ovarian reserve – the estimated number of eggs remaining – and is useful in predicting how the ovaries may respond to stimulation during IVF. It is not an accurate test of egg quality or of your ability to conceive naturally.

Female age remains a much more important predictor of egg quality and reproductive potential.

At Consilium Clinic, we assess AMH alongside your age, menstrual history, antral follicle count on ultrasound and other relevant fertility investigations to provide a more complete assessment of your ovarian reserve.

Can I get pregnant with low AMH?

Yes. Pregnancy is possible with a low AMH result. Low AMH may indicate a lower ovarian reserve or a lower expected egg yield during IVF, but it does not mean that natural conception is impossible.

As discussed above, AMH reflects ovarian reserve rather than egg quality and should always be interpreted alongside age. If your AMH is low, we can assess this in the context of your age, ultrasound findings and individual circumstances and discuss whether you should continue trying naturally or consider fertility treatment.

Does low AMH mean poor egg quality?

No. A low AMH does not necessarily mean poor egg quality.

AMH is primarily a marker of egg quantity rather than egg quality. Female age remains the most important predictor of egg quality.

For example, a woman under 35 with a low AMH will generally have a higher proportion of chromosomally normal eggs than a woman in her late 30s or 40s who has a much higher AMH.

Low AMH can be important when planning IVF because it may predict fewer eggs being collected following ovarian stimulation. This is different from saying that the eggs themselves are of poor quality.

What is a HyCoSy test and when is it used?

A HyCoSy, or hysterosalpingo-contrast sonography, is an ultrasound test used to assess whether the fallopian tubes are open.

A small catheter is passed through the cervix, and ultrasound contrast is introduced into the uterus. Ultrasound is then used to observe the contrast passing through the fallopian tubes.

At Consilium Clinic, we can combine tubal assessment with detailed ultrasound evaluation of the uterus, uterine cavity and ovaries, providing a comprehensive fertility assessment in a single visit where appropriate.

HyCoSy is normally performed during the first half of the menstrual cycle, after menstruation has finished and before ovulation.

Is HyCoSy painful?

Most women tolerate HyCoSy well, although some experience cramping or period-like discomfort while the contrast is being introduced. Taking simple pain relief beforehand may help, and the procedure can be paused if you experience significant discomfort.

Before starting, we explain each stage of the procedure and give you an opportunity to ask questions. We aim to make the examination as comfortable as possible and can pause or stop if you experience significant discomfort.

How many eggs should I freeze?

There are no single number frozen eggs that guarantees a future baby.

The number of mature eggs you may wish to freeze depends particularly on your age at the time the eggs are frozen. This is because the proportion of eggs that are chromosomally normal decreases as women get older.

Some predictive models suggest aiming for approximately 15-20 mature eggs in younger women to provide a reasonable chance of at least one future live birth, although individual circumstances vary and no number can guarantee success.

It is equally important to recognise that collecting a high number of eggs does not guarantee a future live birth, while collecting only a small number does not mean that you cannot have a baby.

At Consilium Clinic, we use your age, AMH and antral follicle count to estimate your likely response to stimulation and discuss what may be a realistic egg-freezing target for you.

Is 35 too late to freeze my eggs?

No. Being 35 does not automatically mean that it is too late to consider egg freezing.

However, the age at which your eggs are frozen is one of the most important factors determining their future reproductive potential. Egg quality gradually declines with age, and this decline becomes more significant during the late 30s.

For this reason, where circumstances allow, freezing eggs before the age of 35 generally provides a better chance of future success than freezing them later.

That does not mean that egg freezing at 35, 36, 37 or beyond is inappropriate. The decision should be individualised according to your age, ovarian reserve, personal circumstances and reproductive plans. If you are considering egg freezing in London at 35 or later, an individual ovarian reserve assessment can help clarify the likely egg yield, possible number of cycles and realistic expectations.

The HFEA emphasises the importance of age at freezing but also stresses that treatment offers no guarantee. HFEA egg-freezing guidance.

Can I have IVF at 40, and what affects IVF success rates?

Yes. Many women undergo IVF at 40 and beyond.

The important consideration is that egg quality declines with advancing female age. This means that a greater proportion of embryos may have chromosomal abnormalities, resulting in a lower chance of implantation, a lower live-birth rate and a higher risk of miscarriage.

PGT-A (preimplantation genetic testing for aneuploidy) can be discussed as part of treatment. PGT-A assesses embryos for abnormalities in chromosome number and may help to avoid the transfer of embryos identified as aneuploid. However, it is not suitable or beneficial for every patient and has not been shown to increase the chance of a baby for all women undergoing IVF. Its advantages, limitations and potential disadvantages should therefore be discussed carefully before treatment.

For some women at more advanced reproductive ages, treatment using donor eggs may offer a higher chance of a live birth because treatment outcome is predominantly related to the age of the egg donor rather than the age of the recipient.

Pregnancy at an older maternal age is also associated with increased obstetric risks, including high blood pressure, gestational diabetes, blood clots and Caesarean delivery. Where appropriate, we may therefore recommend pre-pregnancy assessment by a maternal medicine specialist.

At Consilium Clinic, we offer IVF, PGT-A where clinically appropriate, and treatment using donor eggs. Our aim is to give you a realistic and individualised assessment of your options rather than considering age alone.

Why can IVF fail even with good-quality embryos?

One of the most important reasons is that embryo grading describes an embryo’s development and appearance, not necessarily its chromosome status.

Embryologists grade embryos according to their development and microscopic appearance. An embryo can look excellent under the microscope but still have an abnormal number of chromosomes.

The likelihood of chromosomal abnormalities increases with female age and is largely related to the age of the person whose eggs were used.

However, embryo chromosome abnormalities are not the only possible explanation for unsuccessful IVF. Other factors may include abnormalities within the uterine cavity, such as polyps or fibroids, as well as technical and biological factors. In some cases, despite detailed investigation, no definite explanation is identified.

Following repeated unsuccessful embryo transfers, we believe it is important to review the whole treatment journey rather than automatically adding multiple unproven investigations or treatments.

What tests might be recommended after unsuccessful IVF?

The appropriate investigations depend on your age, previous treatment, embryo quality and number of unsuccessful transfers. Not every patient needs every available investigation.

Assessment may include reviewing your previous IVF cycles and embryology results, ovarian reserve, semen parameters and the uterine cavity.

The uterine cavity can be assessed using specialist ultrasound, 3D saline infusion sonography (3D SIS) or, where appropriate, hysteroscopy. In selected cases we may also consider infection screening and parental chromosome testing (karyotyping), particularly where there has been repeated implantation failure or recurrent pregnancy loss.

At Consilium Clinic, our approach is to investigate clinically relevant, potentially treatable factors while avoiding unnecessary tests and unproven fertility add-ons where there is insufficient evidence that they improve the chance of a baby.

What is recurrent implantation failure?

Recurrent implantation failure describes repeated unsuccessful embryo transfers despite embryos having a reasonable chance of implantation. There is no single definition that applies to every patient.

Historically, definitions often referred to failure after three or more transfers of good-quality embryos. We now recognise that this definition can be too simplistic. The significance of an unsuccessful transfer depends on several factors, particularly female age, embryo development, whether the embryos have undergone PGT-A and the number of embryos previously transferred.

For this reason, assessment should be individualised rather than based solely on a fixed number of failed transfers.

At Consilium Clinic, patients experiencing repeated unsuccessful IVF treatment can undergo a detailed review of their previous cycles, embryos, uterine anatomy and other relevant clinical factors before deciding whether further investigations or a change in treatment strategy is appropriate.

Can fibroids affect embryo implantation?

Some fibroids can affect implantation, but this depends primarily on their size and location.

Fibroids are non-cancerous growths that develop from the muscular wall of the uterus. They are broadly classified according to their relationship to the uterine cavity.

Submucosal fibroids, which project into or distort the cavity of the womb, have the clearest association with reduced fertility and may interfere with implantation.

Subserosal fibroids, which grow predominantly on the outside of the uterus, generally have little effect on implantation.

Intramural fibroids, which lie within the muscular wall of the uterus, require more individual assessment, particularly if they are large or distort the uterine cavity.

At Consilium Clinic, we use specialist 2D and 3D ultrasound to map the number, size and precise location of fibroids. 3D saline infusion sonography (3D SIS) can provide additional information about whether a fibroid is affecting the uterine cavity.

Should fibroids be removed before IVF?

Not all fibroids need to be removed before IVF.

If a fibroid is submucosal or significantly distorts the uterine cavity, removal is often considered because cavity-distorting fibroids are associated with reduced fertility.

Subserosal fibroids on the outside of the uterus generally do not need to be removed purely to improve fertility.

Decisions about intramural fibroids are more complex. The evidence regarding whether removing non-cavity-distorting intramural fibroids improves IVF outcomes is less clear. The decision therefore needs to consider the size and location of the fibroid, symptoms, previous IVF history and the potential benefits and risks of surgery.

Our approach at Consilium Clinic is to map the fibroids carefully and discuss the evidence with you before recommending surgery. Having a fibroid does not automatically mean that you need an operation before IVF.

Does endometriosis affect IVF success rates?

Endometriosis can affect fertility, but its effect on IVF outcomes varies considerably between women.

Factors such as the severity and location of endometriosis, age, ovarian reserve, previous ovarian surgery and the presence of endometriomas can all influence fertility treatment.

Importantly, the presence of endometriosis does not mean that IVF will be unsuccessful, and many women with endometriosis conceive following IVF.

Treatment should therefore be individualised. We assess ovarian reserve, pelvic anatomy and previous treatment before deciding on the most appropriate IVF or embryo-transfer strategy.

We do not recommend additional surgery simply because endometriosis is present unless there is a clear clinical rationale.

Contact Consilium Clinic to start the journey with personalised advice and clarity.