From the Guidelines
Assessing Female Fertility
A woman's fertility can be assessed through various methods, including physical examination, medical history review, and diagnostic tests such as follicle-stimulating hormone (FSH) level assessment, typically using a blood test to measure FSH levels on day 3 of the menstrual cycle, with levels above 10-15 mIU/mL indicating reduced ovarian reserve 1.
Diagnostic Tests
- Transvaginal ultrasound can be used to evaluate ovarian function and antral follicle count, with ovarian volume <3 cm3 and <5 antral follicles present suggesting diminished ovarian reserve 1.
- MRI Pelvis with T2-weighted imaging can be used to determine antral follicle counts and was shown to be superior to transvaginal ultrasound for detecting follicles 3 mm in size 1.
- Anti-Müllerian hormone (AMH) levels can be used as an indirect marker of ovarian reserve in women aged 25 years and above 1.
Additional Evaluations
In some cases, medication such as clomiphene citrate may be administered to stimulate ovulation and assess response, with subsequent progesterone level measurement to confirm ovulation. Imaging can also be useful in diagnosing polycystic ovarian morphology (PCOM) and endometriosis, which are common causes of female infertility 1.
Important Considerations
It is essential to note that the size of the primordial follicle pool is reflected by the number of early, growing follicles, and direct measurement of the ovarian reserve is not possible 1. Therefore, a combination of diagnostic tests and evaluations is necessary to assess female fertility accurately.
From the FDA Drug Label
A basal body temperature graph or other appropriate tests may help the patient and her physician determine if ovulation occurred. Appropriate tests to determine ovulation may be useful during this time. The methods that assess female fertility include:
- Basal body temperature graph
- Other appropriate tests to determine ovulation, although the specific tests are not specified in the label 2 2.
From the Research
Methods to Assess Female Fertility
- Pelvic examination: a fundamental component of the well-woman visit, used to detect gynecologic cancer, infection, and asymptomatic pelvic inflammatory disease 3
- Blood pressure measurement: required by most providers before initiating hormonal or intrauterine contraception (IUC) 4
- Papanicolaou (Pap) smear: required by some providers, although it may be unnecessary for healthy women 4
- Clinical breast examination (CBE): required by some providers, although it may be unnecessary for healthy women 4
- Chlamydia and gonorrhea (CT/GC) screening: required by some providers, although it may be unnecessary for healthy women 4
- Anti-Müllerian hormone (AMH) testing: used to assess ovarian reserve and potential fertility 5
- Antral follicle count: used to assess ovarian reserve and potential fertility 5
Factors Affecting Female Fertility
- History of ovarian cyst surgery: may negatively impact ovarian reserve and increase the risk of infertility 5
- Cervical dilation: may increase the risk of preterm birth and pregnancy loss in twin pregnancies 6
- Physical activity: regular exercise may improve fertility and reduce the risk of pregnancy complications 7