Fertility
Before egg freezing – the key tests I booked, and what I learned
Emma Harpham, Editor, in partnership with CRGH | 11 Dec 2024
Tests before egg freezing – what I looked into
Since I started working in the fertility and wellbeing space two years ago, I’ve definitely become a whole lot more curious about my own personal fertility status.
I’m still in my 20s (just) and not currently trying to conceive, but I’ve always been egg freezing curious and I think it’s incredible that we live in a world where we have the option to preserve our fertility and have better control over our reproductive health.
But since there’s so much information out there – most of it accompanied by a not insignificant dose of urgency to ‘act now’ – finding out exactly where and when to start the process, and who to ask about my options, felt kind of overwhelming.
Recently, I was lucky enough to have the opportunity to book in with the world-class team at the London-based clinic group CRGH – the Centre for Reproductive and Genetic Health – to get assessed and learn more from the experts about whether egg freezing might be for me.
Here’s what I learned, and my mini-guide to the recommended tests before egg freezing, including what to expect, how to read your results, and the next steps to ask about.
Navigating fertility unknowns
First, a bit more about me. I’m turning 30 next year, and I’ve always had a pretty regular monthly cycle. So far, so good, right?
I do struggle with killer period cramps and mid-cycle pain though, and have had multiple ruptured ovarian cysts over the last four years along with some fairly significant changes in my bleed patterns as well as irregular ovulation.
In short, I’ve had the feeling that my reproductive system has been going through the wringer lately. And whilst I’m not trying to conceive right now, I’m getting closer to being in that place and I’m really keen to make sure I’ve set myself up in the best way, approaching age 30.
But with the only recommendations from gynaecologists being to a) take hormonal birth control and wait and see or b) start your family asap just in case, where did that actually leave me, in terms of my ovarian reserve and fertility potential? I was left none the wiser – until now.
My appointment, and how I prepped
I booked in at CRGH’s City clinic, right next to Farringdon station. The tests needed to be scheduled within the first five days of my period, which my trusty Cycles app helped me plan for.
On the day of the visit, I showed up with an empty bladder, as the CRGH team recommended. You’ll also be asked to remove your tampon or cup, if you use them on your period. Beyond that, there wasn’t much else I needed to do, which helped keep things quick and fuss-free.
Once done – it all took about 15 minutes in total – I was promptly booked in to have a detailed follow-up and discussion of my results and fertility options with a consultant, within 24 hours. The consultation was digital too, which was a super handy option during a really busy week at the office!
The tests before egg freezing, explained
Typically, the recommended tests before egg freezing will include:
- An Ovarian Reserve Test (ORT), which consists of:
- A transvaginal ultrasound scan to perform an Antral Follicle Count (AFC)
- A blood test to monitor Follicle-stimulating Hormone (FSH), Oestradiol (E2) and Anti-Müllerian hormone (AMH) levels
- A visual assessment of your ovarian and reproductive tract health
- A detailed consultation to discuss your medical history
I knew beforehand that I’d be having an internal ultrasound and a blood sample taken during my appointment, but not much more than that. The brilliant Dr Jara Ben Nagi, who did my consult, was really kind and talked me through everything as it was happening. Here’s the nutshell.
1. What is an Antral Follicle Count?
An Antral Follicle Count is performed via transvaginal ultrasound and lets your doctor count the number of small follicles (around 2-10mm in size) visible in both of your ovaries.
This count provides a reliable indication of your ovarian reserve, AKA. your remaining egg supply.
Dr Ben Nagi explained that whilst higher Antral Follicle Counts generally indicate better fertility potential – and a higher chance you’d be able to retrieve and freeze a greater number of eggs – it doesn’t tell you anything about your egg quality, which is another crucial aspect of fertility.
Chronological age is a better predictor of egg quality, meaning the younger your age, the healthier your eggs.
2. What is the ideal Antral Follicle Count for egg freezing?
Antral Follicle Count is variable depending on age. For example, a 35 year-old patient’s antral follicle count can range from approximately 8-31, according to a recent study.
My result: 32
3. Which blood test before egg freezing?
The blood test before egg freezing should measure various key hormones, including:
- FSH (Follicle Stimulating Hormone) – is a hormone which stimulates the ovary to grow, and helps to check ovarian reserve
- AMH (Anti-Müllerian Hormone) – an indicator of your ovarian reserve
- E2 (Oestradiol) – helps to interpret the FSH
These results, Dr Ben Nagi explained, paired with the Antral Follicle Count, would help the CRGH team understand whether egg freezing might be suitable for me, and also help to decide on the starting dose of stimulation, when embarking on egg freezing.
4. What should FSH levels be for egg freezing?
According to Dr Ben Nagi, FSH levels for egg freezing should ideally be below 10 IU/L for optimal results.
Additionally, results can vary from one cycle to another cycle.
My result: 8.9
5. What AMH level is needed for egg freezing?
The optimal AMH level for egg freezing can vary, just like the Antral Follicle Count.
A high antral follicle count and higher AMH levels are associated with a higher number of eggs retrieved, and vice versa if a lower antral follicle count and AMH.
It is important to note that ovarian reserve tests are not accurate predictors of ability to conceive naturally and a low ovarian reserve does not mean a lower chance of spontaneous conception.
Also, it was explained that my ovarian reserve test wouldn’t predict the number of eggs that I might be able to retrieve, during the egg freezing process.
My result: 30.3
6. What about oestrogen levels for egg freezing?
The range for oestrogen (E2) levels is between 98 – 571 pmol/L in your follicular phase (day 1-day 14 of your menstrual cycle).
Oestrogen levels are also checked during the monitoring phase of an egg freezing cycle.
My result: 276
7. What other tests before egg freezing are recommended?
Other pre-egg freezing assessments include a look at your reproductive tract during the transvaginal ultrasound, which will check for:
- Signs of PCO (polycystic ovary)
- Visible signs of endometriosis such as endometriomas
- Fibroids
- Any other ovarian pathology
A nurse also took my height and weight, as BMI can help to determine the starting dose of medication for egg freezing.
If you do move forward with freezing, you’ll need to be tested for infectious diseases like HIV and hepatitis B and C too.
You will also receive detailed counseling regarding the success rates and risks of egg freezing treatment, ensuring that you fully understand the process before moving forward.
My results, personal notes, and next steps with CRGH
So, looking at my results during my follow-up consultation, my overall fertility picture is promising.
I’m in a pretty good place right now, and although it doesn’t shine a light on my egg quality and my ability to conceive naturally, based on the testing above, the CRGH team explained that I would be a good candidate for egg freezing at this stage.
The CRGH team also explained that egg freezing is not a guarantee of a live birth. I was thoughtfully walked through all of the risks involved with freezing my eggs, as well the success rates, and full range of treatment pathways available at CRGH.
For those that are curious, these include:
- fertility preservation if suitable, including embryo freezing with donor or partner sperm
- IVF/IUI/ embryo screening
- lifestyle modifications to help improve fertility
- genetic screening to assess whether couples are at risk of having a child affected by a inheritable condition
Freezing your eggs is no small thing, and as a self-proclaimed chronic Googler, having all of the facts clearly laid out for me was a big plus.
I also really appreciated that there was no pressure to freeze right away. If you do choose to delay egg freezing, the team recommends that you pop back in for another assessment in 6 months.
This is especially important if initial tests showed low ovarian reserve, and will allow you to track any changes in your fertility status, and make informed decisions about the timing of egg freezing.
Got questions about egg freezing, the testing process, or success rates in 2024? Bookmark CRGH’s handy egg freezing resources, and get in touch with the team today for an initial consultation.
With over 30 years’ experience in delivering bespoke fertility care, you’ll be in expert hands.
