Episode 91: Fertility Masterclass: Are You Actually Ovulating? What Your Period, AMH, and FSH Results Really Mean

If you have a regular period and assume that means you are ovulating, this episode will change how you understand your cycle, your hormones, and your fertility.In This Episode, We Answer:How do I know if I'm actually ovulating?What does AMH actually mean and is mine too low?Can I have a regular period and still not ovulate?Why does it take so long to get a fertility diagnosis?What blood tests should I ask for if I'm trying to conceive?Key Takeaways:Having a regular period does not mean you are ovulating. A bleed can occur without ovulation, and the only way to confirm ovulation is by tracking LH, progesterone, and estrogen through the cycle. Not just on day 2 or 3.AMH is a useful marker of ovarian reserve but it is not the complete picture. Primordial follicle pools do not contribute to AMH. A low AMH with a normal antral follicle count can indicate ovarian inflammation, stress, or follicles stuck in arrest, not necessarily permanent diminished reserve.Not ovulating has consequences far beyond fertility. Progesterone and estrogen affect the immune system, brain health, glucose metabolism, muscle development, sleep quality, and inflammation. If you are not ovulating at any age, it is worth understanding why.Quick Answers (FAQ):Q: How do I know if I'm actually ovulating?A: A period alone does not confirm ovulation. You need to track LH and progesterone across your full cycle. At-home urinary hormone monitors like Mira can show you the full picture. Blood work on cycle day 2 to 4 (FSH, LH, estradiol) plus a progesterone test 7 days after ovulation gives a clearer view. We go deeper into this at 07:00.Q: What does AMH actually mean and is mine too low?A: AMH (anti-Mullerian hormone) is a marker of how many follicles are actively developing, not a direct count of all your eggs. Primordial follicles, which are eggs in reserve, do not contribute to AMH. A low AMH does not necessarily mean you have no eggs. It can mean your follicles are stuck and not being recruited due to inflammation or stress. We go deeper into this at 18:00.Q: Can I have a regular period and still not ovulate?A: Yes. Dr. Sarah describes a patient who bled every 30 to 40 days but had no evidence of ovulation on cycle monitoring. The bleed was not a true period because no egg had been released and no progesterone had been made. We go deeper into this at 09:30.Q: What blood tests should I ask for if I'm trying to conceive?A: At minimum: FSH, LH, and estradiol on cycle day 2 to 4. AMH. Progesterone 7 days post-ovulation. Prolactin. Thyroid (TSH, T3, T4, anti-TPO, anti-TG). Two-hour insulin and glucose challenge test. Inflammatory markers (ESR, CRP). HbA1c, vitamin D, iron, ferritin. If PMOS or PCOS is suspected, add testosterone and DHEA. We go deeper into this at 49:00.Resources Mentioned:Mira: at-home urinary hormone monitor used at AWH for cycle trackingAWH Fertility Fellowship: advanced fertility training for AWH practitionersNature article referenced: "Anti-Mullerian Hormone as an Ovarian Reserve Marker in Primary Ovarian Insufficiency"Book a fertility consult: advancedwomenshealth.caEmail the team: [email protected] Men's Health (sperm-side fertility): advancedmenshealth.caRelated Episodes:Episode 81: PCOS is now PMOS, what does it mean for youEpisode 86: Metabolic Rehab Type 1, insulin and insulin resistanceConnect With Us:Website: advancedwomenshealth.caInstagram: @drsarah_nd | @advancedwomenshealthBook a fertility consult: advancedwomenshealth.caEmail: [email protected] a review: wherever you're listening, it helps other women find this episode