Ovarian Reserve Tests — AMH, AFC, and FSH Explained Together

Three tests, each looking at ovarian reserve from a different angle — and together painting a picture far clearer than any one alone. If you’re planning fertility treatment, egg freezing, or simply want to understand where you stand, understanding all three removes the guesswork. Our AMH deep-dive covers the first in detail; this guide shows how the three work as a panel.

AMH — the Blood Test

What it measures: anti-Müllerian hormone, produced by small resting follicles. Higher = more follicles in reserve.

When to test: any day of the cycle — it’s stable across the month.

Strengths: convenient (just blood), reproducible, doesn’t need ultrasound skill. Best single predictor of how many eggs a stimulation cycle will yield.

Limitations: doesn’t measure egg quality (that tracks age, not AMH). Can be transiently suppressed by illness, oral contraceptives, or vitamin D deficiency. Lab assay variation means results from different labs aren’t perfectly comparable — use the same lab for repeat testing.

Reference: Above 3.0 ng/ml = strong; 1.0–3.0 = normal; 0.5–1.0 = reduced; below 0.5 = significantly diminished. Very high (above 5–6) suggests PCOS.

AFC — the Ultrasound

What it measures: antral follicle count — the number of small (2–10mm) follicles visible on both ovaries at the start of a cycle.

When to test: day 2–5 of the menstrual cycle, via transvaginal ultrasound.

Strengths: directly visualises what AMH estimates. Also reveals ovarian cysts, uterine fibroids, polyps, and other structural findings in the same scan. The fertility specialist gets diagnostic information beyond just reserve.

Limitations: operator-dependent — the count varies with the sonographer’s skill, equipment quality, and the patient’s anatomy. Slightly less reproducible than AMH across different examiners.

Reference: Total AFC (both ovaries) above 12 = good response expected; 6–12 = moderate; below 6 = low response likely. Above 20 suggests PCOS-pattern ovaries.

FSH — the Older Test

What it measures: follicle-stimulating hormone, produced by the brain to signal the ovaries. When the ovaries have fewer follicles responding, the brain raises FSH to compensate — like shouting louder because fewer people are listening.

When to test: day 2–3 of the cycle only. Results on other days are uninterpretable.

Strengths: the original reserve marker, well-understood, cheap. Still useful as a flag: very high FSH (above 15–20 mIU/ml) on day 3 confirms diminished reserve.

Limitations: fluctuates cycle to cycle — a normal FSH one month doesn’t rule out declining reserve (the ovary had a good month). A single normal result is less reassuring than a consistently normal AMH. Largely superseded by AMH for IVF planning but still routinely included.

How They Fit Together

All three agree (e.g., good AMH + high AFC + normal FSH): high confidence in the assessment. Plan accordingly.

AMH low + AFC low + FSH high: consistent picture of diminished reserve. Act sooner — freeze eggs if not ready for pregnancy, or start IVF promptly if you are.

Discordant results (e.g., low AMH but normal AFC): retest AMH (could be lab variation or transient suppression). The AFC provides real-time visual confirmation that AMH alone can’t. Discordance is common and doesn’t always mean the worst scenario.

High AMH + high AFC + irregular cycles: PCOS pattern. Reserve is plentiful; the issue is ovulation, not egg supply. Treatment is usually ovulation induction, not reserve-based urgency. PCOS guide.

The Combined Cost

AMH blood test: ₹500–1,500. AFC ultrasound: ₹500–1,500 (often included in a fertility consultation). FSH: ₹300–800. Total panel: under ₹3,000 — less than a dinner out, for information that shapes every decision ahead. Add a semen analysis for the partner (₹300–800) and you’ve mapped both sides of the equation for under ₹4,000.

Full female infertility assessment guide · Ask Pregology for help interpreting your results