31 Jul The ovarian reserve

The main limitation in the reproductive life of women is that she is born with all the eggs that she is going to have in her life and with the passage of time, both the quantity and the quality of the ovules decreases, and so the ovarian reserve.

For this reason, as age increases, the chances of pregnancy decrease and the chance of spontaneous abortion increases.

The probability of pregnancy decreases in all women with age, but the exact age at which a woman can no longer conceive varies from one woman to another. In some women, this occurs at a younger age than would normally be expected. About a third of couples will have trouble getting pregnant when a woman is 35 or older. There are several tests that can help estimate a woman’s fertility potential, also called the ovarian reserve.

Blood test: FSH, estradiol and AMH

A common way to determine ovarian reserve is by measuring the blood levels of the hormone FSH. Follicle stimulating hormone (FSH) and estradiol are checked at the beginning of the menstrual cycle. This is usually done on day 3 of the cycle, but can be done from day 1 to 5. FSH and estradiol give us important information about how the ovaries and the pituitary gland are functioning.

Antimüllerian hormone (AMH) is another test of the ovarian reserve. The test is simple (it is done through a blood test that can be done at any time of the menstrual cycle), and with it, it is possible to estimate the number of oocytes that a woman has and predict the response to an ovarian stimulation.

Laboratory procedures and the “normal” levels of the antimüllerian hormone vary from one laboratory to another, so it can be difficult to compare the results from one laboratory to another.

Antral follicle count

A transvaginal ultrasound can be performed, ideally in the first part of the menstrual cycle, to count the number of small follicles (2mm-10mm) in the ovary. These are called antral follicles. Each antral follicle contains an ovule. The number of antral follicles helps to estimate the ovarian response of women to ovarian stimulation. This test must be done by a fertility specialist.

Response to gonadotropins

Gonadotropins (FSH, LH) are drugs that are given to stimulate the development and growth of several ovules at the same time. They are administered subcutaneously (injections) during some fertility treatments.

The response that patients have had in previous treatments of assisted reproduction also provides information on the expected ovarian response in a treatment.

What these tests tell us

These tests try to predict a woman’s response to fertility treatment and how likely she is to become pregnant compared to other women of the same age. Abnormal results of the ovarian reserve suggest that the fertility potential has decreased but can not determine with certainty whether the woman will be able to become pregnant or not. Some younger women with normal results have difficulty conceiving. The results may vary from cycle to cycle; however, any abnormal test usually shows that the fertility potential has decreased.

The probability of pregnancy is mainly related to the quality of the ovules. Women older than 35 years with abnormal results in ovarian reserve tests who have not been successful in treatment have a lower probability of conceiving. Even with normal ovarian reserve tests, you may have difficulty conceiving due to other factors.

There is not a single test of the ovarian reserve that can predict a woman’s ability to get pregnant. These tests are often used to develop a treatment plan, including the need for egg or embryo donors.

When is it necessary to have ovarian reserve tests?

The ideal time to go to your medical center and perform ovarian reserve tests is when you want to plan your motherhood, or before, if you have a family history of infertility or have suffered from any disease that may affect your reproductive capacity.

It is an excellent method for fertility professionals to determine your prognosis and the most appropriate treatment in your case. It is very important that these tests are evaluated by a fertility specialist.

If you are considering tests to determine your ovarian reserve, you can contact us to receive a full assessment. Call us and ask for your appointment at the clinic.

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