Determining Fertility After Treatment
If you haven’t had your period for one year after treatment ends, there is up to a 30 percent chance your periods will start again.
But having periods or menopausal symptoms is not a reliable sign of whether you are fertile, able to become pregnant. The most reliable test for fertility is trying to become pregnant. There are a number of tests and other methods that may help determine if you have a reduced number of eggs in your ovaries. None of these tests are perfect, and fertility specialists will often use a combination of tests to try to get a better estimate of your remaining egg supply.
Follicle-stimulating hormone (FSH) is released by the pituitary gland at the base of the brain. It is the most important hormone involved in regulating the menstrual cycle and producing mature eggs in the ovaries. The level of FSH in a woman’s body gradually increases as she begins running out of eggs in her ovaries. High FSH levels may indicate ovarian failure and menopause.
Measuring the level of FSH in a blood sample is one of the most widely used tests to determine whether the ovaries are working properly and evaluate egg supply. It is typically taken on day 2 or 3 of your menstrual cycle.
Test results may be affected by the use of hormones (such as birth control pills, tamoxifen, and GnRH agonists such as leuprolide), smoking, age, and the use of certain medicines. Before you get this test, be sure to tell your doctor about any medicines you are taking, including vitamins, herbal supplements, and over-the-counter medicines.
The anti-mullerian hormone (AMH) test is not routinely ordered, but it may be ordered in combination with other tests to evaluate your egg supply and determine whether your ovaries are working properly. It may also be ordered if you are undergoing assisted reproduction procedures such as in-vitro fertilization (IVF).
AMH is a hormone produced by cells in your ovaries. Low levels of AMH indicate low numbers of eggs. The AMH test can be done on any day of your menstrual cycle.
Because this test is not routinely ordered, experts do not yet agree on what is considered a “normal” level of AMH. Lab procedures for conducting this test differ, and it can be difficult to compare results from lab to lab.
Ask your doctor if the AMH test may be right for you.
Inhibin B is another blood test given to estimate egg supply. It is typically taken on day 3 of your menstrual cycle.
Inhibin B is a hormone produced by the ovarian follicles. Levels of this hormone are low in women with low numbers of eggs. If your inhibin B level is low, you have a lower chance of getting pregnant.
Several studies have shown that a combination of results from the inhibin B and FSH tests can better predict pregnancy outcome than the FSH test alone. Since the inhibin B test is relatively new, it is not frequently covered by health insurance. Talk to your doctor to ask if this test may be right for you.
Many fertility specialist believe that counting the antral follicles, small follicles in the ovaries, is the best tool for estimating egg count. These follicles are visible on an ultrasound. Measuring the volume of the ovaries, also done by ultrasound, can also help.
This test is not frequently performed. Ask your doctor if this test may be appropriate for you.
It may take months after you finish treatment to get accurate readings from fertility tests.
Many factors unrelated to breast cancer treatment can also affect your fertility, such as
- blocked fallopian tubes
- uterine fibroids
- sperm problems in your partner
- other issues that any woman could have
Talk about any and all concerns with your doctor.