Ovarian Reserve Testing

Ovarian reserve tests are used to identify women with decreased ovarian reserve.  Women with decreased ovarian reserve are at risk for having a poor response to or success with fertility treatment.

Ovarian reserve testing should be considered in any woman who meets the following criteria: 

o Age above 35
o History of Infertility
o History of smoking
o History of having undergone previous ovarian Surgery (Removal of a cyst, or surgery for endometriosis)
o History of exposure to Chemotherapy or Pelvic Radiation
o Family history of early menopause 

Day 3 Follicle Stimulating hormone and estradiol

What to expect: You will be asked to contact the office on the first day of your menstrual cycle (first day of bleeding) and you will return to the office on cycle days 2-4 for a blood draw.

What this test tells you: Follicle Stimulating hormone (FSH) is released by the pituitary gland and functions to recruit ovarian follicles.  As the follicles mature, they release the female sex hormone, estradiol.  If a woman’s ovaries contain a healthy number of follicles, the FSH level, when measured between cycle days 2-4, is generally 10-20 IU/L and corresponding estradiol levels are <50 pg/mL.  Elevated FSH and estradiol levels in the early follicular phase can signify decreased ovarian reserve and a high risk for poor response to fertility treatment. 

Anti-Mullerian Hormone (AMH)

What to expect: AMH is a blood test that can be drawn at any time during the menstrual cycle and can even be reliable while on birth control pills.  However, it is typically drawn with other blood work that your physician may recommend.

What this test tells you: AMH is a secreted by the small follicles within the ovaries, and is one of the best measures available today to determine ovarian reserve.  Like FSH, AMH can be used to predict response to ovarian stimulation, and as such, the level is useful in individualizing treatment protocols.  Importantly, AMH is the only test that can be used to compare your reserve to what would be expected for your age.  As such, interpretation of AMH should be done with caution, with normal values ranging from 1 – 4 ng/mL.

Antral Follicle Count

What to expect: On cycle days 2-4, a transvaginal ultrasound is performed to determine the antral follicle count (AFC), another helpful measure of ovarian reserve.  An added benefit of the ultrasound is to survey general pelvic anatomy, including the uterus.

What this test tells you: A normal AFC is 10-20.  A low AFC (<10) can signify decreased ovarian reserve, and predict poor response to fertility treatment, while a high, AFC (>20) can signify the presence of polycystic ovaries and an increased risk for over response to fertility treatment.

For more information on ovarian reserve testing:

http://www.reproductivefacts.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Practice_Committee_Guidelines/Testing_and_interpreting_measures_of_ovarian_reserve_a_committee_opinion-noprint.pdf
 


 

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