Having Trouble Conceiving

Cycle monitoring is one of the first diagnostic tools in fertility treatment. It usually involves:

• Day 3–5 of Cycle: Hormonal blood tests, including FSH, LH, and estradiol, to assess ovarian function.
• Day 10–12 of Cycle: Ultrasound examination to check follicle growth and uterine lining development.
• 5–8 Days After Ovulation: Blood tests for progesterone to confirm ovulation.

These steps help identify potential irregularities and guide the next steps in treatment.

For women who do not ovulate regularly, clomiphene citrate is often the first line of treatment. This medication, used since the 1960s, works by stimulating the release of hormones needed for egg development and ovulation. Around 70-80% of women who take clomiphene successfully ovulate, and approximately 10-13% of these cycles result in pregnancy. Proper monitoring and timing are crucial for the effectiveness of this therapy.

When natural conception is not possible due to blocked fallopian tubes, severe male infertility, or unexplained infertility, assisted reproductive technologies (ART) such as in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) are recommended.

• IVF involves fertilizing an egg outside the body and then implanting it into the uterus.
• ICSI is often used when sperm quality is low, where a single sperm is injected directly into an egg.

Success rates vary but are generally around 20-30% per cycle, with many couples achieving pregnancy after multiple attempts.

The principle behind LH (luteinizing hormone) ovulation tests is simple and effective. Using test sticks or strips along with a control line, these tests measure how much LH hormone is present in your urine. LH is a key hormone in controlling your menstrual cycle. It triggers ovulation, supports the development of the corpus luteum, which in turn produces progesterone—a hormone essential for preparing the uterus for pregnancy.

Progesterone tests can be performed at home using saliva samples, or at a doctor’s office with a blood test. However, these tests are often criticized because a single test alone may not provide a complete picture of your fertility. Progesterone levels are best measured around 7 days after ovulation, as this hormone peaks during the luteal phase. Low progesterone levels can indicate irregular ovulation or other hormonal imbalances that could affect conception.

The AMH test is another reliable indicator of a woman’s fertility potential. For example, the Berlin-based company Fertilly offers an at-home AMH fertility test that accurately measures anti-Müllerian hormone levels. AMH is produced in the ovarian follicles and is closely linked to the number of eggs (oocyte reserve) a woman has.

When AMH levels are measured in the blood, they can provide a general idea of how many eggs remain. However, AMH levels do not reflect egg quality, only quantity.

The results of an AMH test are divided into categories:

• Normal Range: For fertile women aged 18 to 30, normal AMH values range between 1 and 5 nanograms per milliliter (ng/mL) of blood. A normal AMH level does not guarantee fertility but provides insight into egg reserve.

• High AMH Levels: A value above 5 ng/mL indicates a higher egg count than expected for your age. This can also be a sign of Polycystic Ovary Syndrome (PCOS), a condition affecting 5–10% of women worldwide. However, not every woman with PCOS has a high AMH level.

• Low AMH Levels: A value below 1 ng/mL suggests a reduced number of eggs, which may indicate a limited ovarian reserve. This does not necessarily mean infertility, but it could point to a shorter reproductive window. Women with low AMH levels can still conceive naturally or with medical support.

AMH levels naturally decline with age. Starting around 30 years old, the concentration of AMH gradually drops because the ovarian reserve decreases over time.

• At birth, a girl has about 1–2 million eggs.
• By the time of her first menstrual cycle, this number drops to 300,000–400,000.
• During each menstrual cycle, approximately 800 eggs start developing, but usually only one egg is released for potential fertilization.

This natural decline explains why fertility becomes more challenging as women age. An AMH test can help determine whether fertility preservation options, such as egg freezing (social freezing), might be worth considering.