Ovarian Reserve Testing

Ovarian Reserve Testing Through Hormone Tests & Ultrasound

While age alone is currently the most reliable indicator of egg number and quality, several tests can be utilized to help evaluate a woman’s ovarian reserve or ability to produce eggs. Ovarian reserve testing gives fertility specialists important insight into a female’s reproductive potential and can help guide the recommendation of fertility treatment protocols. 

Antimullerian Hormone (AMH) Level

Evaluating AMH levels is a common approach used in ovarian reserve testing. Studies have demonstrated a gradual decrease in AMH levels as a woman gets older. This decline has been attributed to a decreasing number of eggs within the ovary. A low level of AMH suggests that the ovary may be depleted of eggs, and is predictive of low egg production (poor response) during In Vitro Fertilization (IVF). Low AMH levels are typically seen in older women, and in women with a history of ovarian surgery, chemotherapy, radiation and/or endometriosis. Patients with endometriosis who undergo surgery to remove ovarian endometriosis cysts experience significant reduction in their AMH levels.

Follicle Stimulating Hormone (FSH) Level

FSH is an important hormone that regulates the recruitment and development of your eggs. The FSH level is less predictive of ovarian reserve status than the AMH level. In general, a low FSH level is reassuring, and indicates that you probably have good quality eggs. A high FSH level suggests that there is a reduction in both the number and quality of eggs remaining in your ovaries (Diminished Ovarian Reserve). 

The most reliable indicator of egg quality, however, is your age. Patients over the age of 44 with normal FSH levels should still consider ovarian reserve testing to ensure that the quality of their eggs is good and viable enough to undergo IVF. 

Likewise, young women with high FSH may have fewer eggs remaining but their egg quality may still be good yielding satisfactory IVF pregnancy rates. Generally speaking, FSH levels below 10miu/ml are reassuring. Women with FSH levels over 20miu/ml are less likely to benefit from treatment utilizing their own eggs and may be encouraged to consider donor egg IVF or adoption.

Estradiol (E2) Level

High estrogen level on day 3 of your menstrual cycle is indicative of Diminished Ovarian Reserve (DOR) even if the FSH level is completely normal. It is very important to measure both day 3 FSH and estrogen (E2) levels since an elevation in one or both tests may be equally predictive of decreased egg number and lower egg quality. Ideally, day 3 estrogen levels should be less than 50pg/ml. Day 3 estrogen level greater than 100pg/ml is considered abnormal.

Antral Follicle Count (AFC)

AFC is an ovarian reserve testing method that involves an ultrasound examination to determine the number of antral follicles (immature eggs smaller than 10mm) present within the ovary. A low number of antral follicles is suggestive of Diminished Ovarian Reserve (DOR) and may correlate with poorer IVF outcome. Patients with low egg numbers may consider IVF treatment as soon as possible. The egg count can also help the doctor determine which IVF stimulation protocol may be best for you.

The Importance of Ovarian Reserve Testing

Ovarian reserve testing is an important fertility assessment that provides insight into a female’s fertility potential. Insights gained through ovarian reserve testing can help indicate the most appropriate fertility treatment approach. 

Keep in mind that the ovary has a finite number of oocytes (eggs) available for ovulation during a woman’s reproductive years. Fertility in women begins to decline around the age of 27, and drops off more rapidly after the age of 35, reflecting the decline in the number and quality of eggs available for ovulation. A good ovarian reserve is most often correlated with younger reproductive age, high AMH, high Antral Follicle Count (AFC) and low FSH and estrogen levels.