Ovarian Reserve Testing

What is Ovarian Reserve?

Ovarian reserve refers to the pool of available eggs (oocytes) in a woman’s ovaries at any given time. It provides insight into a woman’s reproductive potential and is influenced by various factors, including age, genetics, and overall health.

Importance of Ovarian Reserve Testing

  1. Evaluating Fertility: Helps in understanding a woman’s likelihood of conceiving naturally or with assisted reproductive technologies (ART).
  2. Personalized Treatment Plans: Results guide fertility specialists in recommending appropriate treatments, such as IVF or ovulation induction.
  3. Family Planning Decisions: Aids women in making informed choices about family planning, especially as they age.

Methods of Ovarian Reserve Testing

  1. Hormonal Blood Tests:
    • Follicle-Stimulating Hormone (FSH): Typically measured on day 3 of the menstrual cycle. Elevated FSH levels may indicate decreased ovarian reserve.
    • Luteinizing Hormone (LH): Also measured on day 3; plays a role in regulating the menstrual cycle and ovulation.
    • Estradiol: Elevated estradiol levels on day 3 can suggest diminished ovarian reserve.
    • Anti-Müllerian Hormone (AMH): A more reliable marker for ovarian reserve. It indicates the number of developing follicles. Lower AMH levels suggest a reduced ovarian reserve.
  2. Ultrasound Assessment:
    • Antral Follicle Count (AFC): A transvaginal ultrasound is used to count the number of small follicles in the ovaries at the start of the menstrual cycle. A higher count typically indicates better ovarian reserve.
    • Ovarian Volume Measurement: This ultrasound can also assess the size of the ovaries. Smaller ovarian volume may suggest reduced reserve.
  3. Clomid Challenge Test:
    • This test assesses ovarian response. It involves taking Clomiphene citrate (Clomid) for five days, followed by measuring FSH levels on day 10. Elevated FSH levels may indicate lower ovarian reserve.

Factors Influencing Ovarian Reserve

  • Age: The most significant factor affecting ovarian reserve. Women are born with a finite number of eggs, which decreases as they age, particularly after 35.
  • Genetics: Family history of early menopause or fertility issues can indicate potential problems with ovarian reserve.
  • Health Conditions: Conditions like polycystic ovary syndrome (PCOS), endometriosis, or prior surgeries can impact ovarian function.
  • Lifestyle Factors: Smoking, obesity, and excessive alcohol consumption can negatively affect ovarian reserve.

Limitations of Ovarian Reserve Testing

  • Individual Variability: Test results can vary significantly from one woman to another, and factors beyond ovarian reserve can influence fertility.
  • Not a Definitive Predictor: While low ovarian reserve may indicate challenges in conceiving, some women with low reserve can still conceive naturally or with treatment, and vice versa.