Does age have an effect in a woman's fertility if she had normal hormones?

This is a good question which is commonly asked during consultation. In short, irrespective of the hormonal status, age is an important factor.

FSH is the most widely used hormone to test the ovarian reserve. It is a good marker if it is high even once but not sensitive enough if it is normal. It is easy to understand why if you know that it is produced by the pituitary gland at the base of the brain and not the ovaries themselves. Furthermore it is produced in pulses every 90 minute. So the time the blood sample is taken would decide the level of FSH level within the 90 minute pulse rather than how true the level is a reflection of the ovarian reserve. As well with deterioration in ovarian function FSH might be high in one cycle but normal in the others. The number of bad months would increase with time till a sustained high level is recordable.

The American Society of Reproductive Medicine patients' information sheets stated clearly that one high FSH reading by a reputable laboratory is enough to indicate a reduced fertility potential even if subsequent results proved normal.

In recent years other hormones are introduced to test the ovarian reserve including inhibin B and anti-mullerian hormone. The later one could be done at any time of the cycle and does not need to be done during the first few days after menstruation. Potentially it has a superior value to test the ovarian reserve.

It is my view that ovarian reserve tests give more valuable information to the clinician in women between 30 and 40 years of age than in older women.