From the Guidelines
Ovarian reserve is best assessed through a combination of blood tests measuring anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH), as well as an antral follicle count via transvaginal ultrasound, with normal AMH levels ranging from 1.0-4.0 ng/mL and FSH levels above 10 IU/L indicating reduced ovarian function. Assessment of ovarian reserve is crucial in determining fertility potential, particularly in women over 35 years old or those with a family history of early menopause or other risk factors such as prior ovarian surgery, chemotherapy, or radiation 1.
Key Factors in Ovarian Reserve Assessment
- Blood tests: AMH, FSH, and estradiol, ideally on day 3 of the menstrual cycle
- Antral follicle count via transvaginal ultrasound
- Normal AMH levels: 1.0-4.0 ng/mL
- FSH levels above 10 IU/L: indicate reduced ovarian function
- Lifestyle factors: avoiding smoking, maintaining healthy weight, and reducing stress may help preserve existing reserve
Importance of Early Assessment
Women concerned about fertility should consider assessment before age 35, or earlier if there's a family history of early menopause or other risk factors, as diminished ovarian reserve can indicate lower success rates with fertility treatments and potentially shorter reproductive timeframes 1.
Diagnostic Approaches
Transvaginal ultrasound (TVUS) is a valuable tool for monitoring follicle development, performing antral follicle counts, and measuring ovarian volume, with an ovarian volume <3 cm3 and <5 antral follicles present suggesting diminished ovarian reserve 1. MRI Pelvis with T2-weighted imaging can also be used to determine antral follicle counts, particularly in cases where TVUS is not feasible.
Clinical Implications
While diminished ovarian reserve does not necessarily mean pregnancy is impossible, it often indicates lower success rates with fertility treatments and potentially shorter reproductive timeframes, emphasizing the importance of early assessment and lifestyle modifications to preserve ovarian function 1.
From the Research
Ovarian Reserve Assessment
- Ovarian reserve refers to the quantity and quality of oocytes in the ovaries, which declines with age 2
- Various measures have been developed to predict response to ovarian stimulation and reproductive potential, including antral follicle count (AFC) and anti-Müllerian hormone (AMH) levels 3
Methods for Assessing Ovarian Reserve
- Antral follicle count (AFC) is an ultrasound biomarker of follicle number 3
- Anti-Müllerian hormone (AMH) is a hormone biomarker of follicle number, with levels strongly correlating with the number of growing follicles 4
- Other methods include follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, inhibin, and ovarian biopsy 2
Predictive Value of Ovarian Reserve Measures
- AMH levels have good predictive value for ovarian reserve and response to stimulation, and are considered the gold-standard biomarker 3
- AFC also has good predictive value, but may be less convenient than AMH levels as it requires ultrasound examination 3
- The simultaneous evaluation of a combination of tests, including AMH and AFC, may provide a more accurate assessment of ovarian reserve 2
Clinical Applications of Ovarian Reserve Assessment
- Ovarian reserve assessment can aid in the personalization of treatment to achieve good response and minimize risks in assisted reproductive techniques 3
- AMH levels can be used to predict the risk of poor response or ovarian hyperstimulation syndrome, and to individualize follicle-stimulating hormone dosing protocols 4
- Ovarian reserve assessment can also inform fertility preservation decisions, such as ovarian tissue cryopreservation, in patients with diminished ovarian reserve 5