Ovarian Reserve Testing

Ovarian reserve testing may be useful in predicting the fertility potential in women. Typically, a woman has approximately one to two million eggs in her ovaries at birth. That number begins to decrease monthly and, bythe time she reaches menopause, the egg supply has virtually disappeared.

What is Ovarian Reserve Testing?

Reproductive endocrinologists sometimes use ovarian reserve testing to evaluate the oocytes – immature eggs – present in the ovaries. In addition to the number of remaining oocytes, your fertility specialist will also evaluate oocyte quality and your reproductive potential.

Ovarian reserve testing is conducted on infertile women to identify those at risk of diminished ovarian reserve, or DOR. Diminished ovarian reserve can inhibit a woman’s ability to become pregnant, although the condition doesn’t always mean a woman cannot conceive. Ovarian reserve testing also evaluates the ovarian response to gonadotropin stimulation.

Ovarian Reserve Tests

The following blood tests, medications and imaging tests are used to measure hormone levelsin ovarian reserve testing:

• Follicle stimulation hormone (FSH) and Estrodiol are measured during day 1-5 of the menstrual cycle – typically day 2 or 3 – this indicates whether or not the ovaries and pituitary gland are working correctly and together.FSH assists in follicle growth and helps the egg to mature. During this process, the follicle releases estradiol, alerting the pituitary gland to reduce FSH production. An imbalance of these hormones can interfere with egg maturation.
• Antimullerian hormone (AMH) also plays a role ovarian reserve testing. Produced in the ovarian follicle, the AMH hormone level is indicative of the remaining ovarian supply and can be measured at anytime throughout the menstrual cycle.
• Clomiphene citrate challenge – done early in the menstrual cycle, this test measures the FSH and estradiol blood levels before and after clomiphene citrate is administered. High levels of FSH detected at either pointin the challenge are associated with lower pregnancy rates in both ovulation induction therapy and IVF.
• Transvaginal ultrasound–performed in the early part of the menstrual cycle, this test allows the fertility specialist to count the number of follicles present in the ovary. These tiny antral follicles indicate how many eggs remain in a woman’s ovaries and can also be useful in determining the ovarian response to gonadotropin hormones.

Benefit of Ovarian Reserve Testing

Since no single test can definitively determine a woman’s ability to become pregnant, most reproductive endocrinologists recommend a combination of ovarian reserve tests.

Abnormal ovarian reserve tests can reveal information about a woman’s declining fertility potential, but they cannot determine whether or not she will become pregnant. Ovarian reserve testing is most often used for help in designing an appropriate treatment plan.