Female Fertility Tests Explained: AMH, Ultrasound and Hormone Panels

If your doctor has handed you a list of fertility tests with names like AMH, FSH, LH, and antral follicle count, this guide explains what each one actually measures, when in your cycle it must be done, and just as importantly, what these tests cannot tell you.

The short answer: AMH measures how many eggs you have left, not their quality and not whether you can conceive this month. An antral follicle count on ultrasound measures the same thing visually. Day 2 to 5 hormones assess how hard your pituitary is working to recruit eggs. Day 21 progesterone confirms whether you ovulated. Together they build a picture. Individually, none of them is a verdict.

The AMH Test: What It Does and Does Not Tell You

Anti-Mullerian Hormone is produced by the small developing follicles in your ovaries. The more follicles in that pool, the higher the AMH. It is the most widely used marker of ovarian reserve.

What makes AMH clinically convenient is that it can be measured on any day of the cycle, unlike FSH which must be drawn on day 2 to 5.

Ranges vary between laboratories and by age, so your result should always be interpreted against age-specific reference values by your doctor, not against a generic chart.

Here is the part that gets misunderstood most often. AMH predicts how many eggs are likely to be retrieved in an IVF cycle. It does not predict egg quality, it does not predict your chance of conceiving naturally this month, and a low AMH does not mean you cannot get pregnant. Women with low AMH conceive naturally. Women with excellent AMH sometimes do not.

AMH is a planning tool and an IVF response predictor. It is not a fertility verdict, and it should never be presented as one.

Antral Follicle Count: The Ultrasound Equivalent

An antral follicle count (AFC) is performed on a transvaginal ultrasound, usually on day 2 to 5 of your cycle. The sonologist counts the small resting follicles, typically 2 to 10 mm, visible across both ovaries.

AFC and AMH measure the same underlying thing from different angles. When both agree, confidence in the assessment is high. When they disagree, your doctor will investigate why, which sometimes reveals a laboratory assay issue or a cycle-timing problem.

The Day 2 to 5 Hormone Panel

These tests must be drawn in the early follicular phase, meaning day 2, 3, 4, or 5 counting the first day of full flow as day 1.

TSH deserves particular emphasis. Hypothyroidism is common in Indian women, frequently undiagnosed, and is one of the most easily corrected contributors to difficulty conceiving. Most fertility guidelines aim for a TSH below 2.5 mIU/L in women trying to conceive, which is stricter than the general population target.

Day 21 Progesterone: Did You Actually Ovulate?

Progesterone rises after ovulation. A blood test taken roughly seven days before your expected period confirms whether ovulation occurred.

The common error is taking it on day 21 regardless of cycle length. Day 21 is correct only for a 28-day cycle. If your cycle is 32 days, the right day is approximately day 25. If your cycles are irregular, serial testing or follicular monitoring on ultrasound is more reliable.

A progesterone level above 10 ng/mL (around 30 nmol/L) generally confirms ovulation occurred in that cycle.

Tubal Testing: HSG and HyCoSy

If the fallopian tubes are blocked, the egg and sperm cannot meet regardless of how good your hormones look. Tubal patency testing is part of a complete evaluation.

HSG (hysterosalpingogram) uses X-ray with contrast dye injected through the cervix. HyCoSy uses ultrasound with a contrast agent instead and avoids radiation. Both are done after your period has ended and before ovulation, typically day 6 to 11.

Both involve some cramping. Taking a painkiller an hour beforehand, as advised by your doctor, makes the experience considerably more comfortable.

Cost of Fertility Tests in Bangalore

 

How to Prepare for Your Tests

Know the first day of your last period and track it going forward, since most of these tests are cycle-timed. Fasting is not required for AMH, FSH, LH, or prolactin, but have prolactin drawn in the morning and avoid breast stimulation or strenuous exercise beforehand, as both can transiently elevate it.

Tell your doctor if you are on hormonal contraception. Combined oral contraceptives suppress FSH, LH, and can lower AMH readings, so testing is usually deferred until after a washout period.

Book Fertility Testing at Stepcare Whitefield

Stepcare offers in-house hormone testing, ultrasound imaging, and fertility screening with Dr. Kunzang Dolma available Monday – Saturday from 5 PM to 8 PM and Dr. P. V. Vasavi Devi, available every second and fourth Friday from 4 PM to 6 PM at the Whitefield clinic. Lab tests can be booked directly online.

Call or WhatsApp: +91 9606910113 Email: appointments@stepcare.co.in Address: G-01, Ground Floor, Brigade IRV Center, Nallurhalli, Whitefield, Bengaluru 560066 

Disclaimer: This content is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional before making any medical decisions.