The Eggs have it
When it comes to Infertility, determining ovarian reserve is crucial in creating a treatment plan. Ovarian reserve is a term that is used to determine the capacity of the ovary to provide healthy eggs that are capable of fertilization and further normal embryo development, resulting in successful pregnancy and live birth.
Testing for ovarian reserve is part of the evaluation for couples presenting with infertility.
After initial evaluation, the patient might be noted to have normal ovarian reserve or diminished ovarian reserve, an important guide for moving forward.
Just as it can be said that location, location and…location are the three most important qualifiers in Real Estate, it can be said that age, age and…age (of the female partner) are the most important factors to predict normal ovarian reserve as well as normal egg quality. Egg quality and quantity slowly declines with (here’s that word again) age, with the decline becoming more significant after 35 and especially after 40 years of age.
The Tests of Time
While age of the female partner gives us an overall ‘guesstimate’ of ovarian reserve, a clearer picture is achieved by performing the following tests routinely used for measuring ovarian reserve:
1. Day 3 FSH and corresponding estradiol serum levels. Ideally day 3 FSH should be below 12 mIU/ML and corresponding E below 65 pg/ml. Elevated FSH or estradiol level might specify that the women is getting closer to transition from normal reproductive function to perimenopause, and might have less eggs available then her age-matched peers. There is some data that elevated FSH might also reflect on low quality of the remaining eggs.
2. Antral follicle count. Ultrasound is performed and antral follicles are visualized and counted in both ovaries. Identification of 10 or more antral follicles in both ovaries is consistent with normal ovarian reserve.
3. Anti-mulerian hormone serum level. AMH is produced by granulosa cells in primary, pre-antral and antral ovarian follicles. The levels are quite constant for 6-12 months and can be measured on any day of the menstrual cycle. AMH level of 1 ng/ml and above is consistent with normal ovarian reserve.
4. Previous clinical performance. Poor response to gonadotropins during controlled ovarian hyperstimulation or an IVF cycle, as well as poor quality of the eggs retrieved during IVF and poor embryo development, can also serve as an indication of diminished ovarian reserve.
The Whole Picture
In general, once testing for ovarian reserve is performed, as well as the rest of the clinical evaluation for infertility, the couple can be counseled about their individual chances to conceive, and the best treatment options available to them.
Age is always our guide when it comes to Infertility. Testing for Ovarian Reserve can either confirm or question that which a woman’s age tells us, allowing for the most comprehensive understanding and approach.