Women are born with all of the eggs that they will ever have, and they lose them constantly throughout life until menopause, when none remain. It would be helpful to have a reliable test that would tell us how many eggs a woman has remaining at a point in time – as well as telling us about the quality of those eggs. The term “ovarian reserve” is useful in the field of reproductive medicine. It is an estimate of the “reserve of the woman’s ovaries” – remaining egg supply – to be able to make babies in the future.
Female age is a very important consideration when estimating the probability for conception because it is a strong determinant of egg quality.
A 45 year old can have good quality eggs (for her age) and still be fertile, although this is rare. At the other extreme, a 25 year old can have very poor quality eggs and be infertile – unless she uses donor eggs. These are extreme examples, but the point is that egg quantity and quality tends to decline significantly in the midlle and late 30s and faster in the early 40s. Also, egg quantity and quality in an individual woman can be average for her age, better than average, or worse than average.
It would be nice to have a reliable test to determine how many eggs remain and how good the eggs are in an individual woman at a point in time. These tests are often referred to as tests of “ovarian reserve”.
Do ovarian reserve tests check egg quantity, quality, or both?
Ovarian reserve testing can tell us quite a lot about the remaining quantity of eggs a woman has, but it tells us very little about the quality of those eggs. Age is the best “test” that we have at this time for egg quality.
OVARIAN RESERVE TEST
Day 3 FSH (follicle stimulating hormone) and estradiol (E2) test
By measuring a baseline FSH on day 3 of the cycle, we can sometimes get an indication that the women is closer to menopause and has relatively less “ovarian reserve”. Another way of saying this is that if the baseline FSH is elevated the egg quantity is reduced from what is expected.
Anti-Mullerian hormone levels (AMH)
Blood levels of the hormone AMH are often used by fertility specialists as part of the evaluation of ovarian reserve.
Women with higher AMH values will tend to have better response to ovarian stimulation for IVF and have more eggs retrieved. In general, having more eggs with IVF gives a higher success rate.
AMH levels vary from laboratory to laboratory, but 2 to 4 ng/ml in the age group 18 to 30 years is considered normal.
AFC Antral Follicle Count
AFC is the number of follicles measuring 2-9 mm in both ovaries on trans vaginal sonography.
Normal AFC – 5-20
Poor response – < 5 PCOS(hyper responders) – > 24
Response of the ovaries to ovarian stimulation with injectable gonadotropins (FSH)
This is not really a “test” that we do to help us determine egg quantity and quality – it is part of a treatment for infertility. However, the response of the ovaries when the woman takes injectable FSH for stimulation is often very predictive of the egg quantity – and therefore, also the relative chances for success with infertility treatment.