Ovarian Reserve Testing

The general purpose of ovarian reserve testing is to assess the quantity and quality of the remaining oocytes in an attempt to predict reproductive potential. Ovarian reserve testing should be performed in women older than 35 years who have not conceived after 6 months of attempting pregnancy (or women less than 35 who have not conceived after 1 year) and women at higher risk of diminished ovarian reserve, such as those with a history of cancer or other medical condition treated with gonadotoxic therapy and/or pelvic irradiation, or women who have had ovarian surgery for endometriomas. Available tests for ovarian reserve include biochemical markers, i.e., FSH, estradiol, AMH, and inhibin B and ovarian ultrasound imaging, i.e., antral follicle count and ovarian volume. For general obstetrician-gynecologists, the most appropriate ovarian reserve screening tests to use in practice are basal FSH plus estradiol levels or anti-Müllerian hormone (AMH) levels. An antral follicle count (AFC) may also be useful if there is an indication to perform transvaginal ultrasonography. These screening tests are better predictors of oocyte yield from ovarian stimulation during in vitro fertilization (IVF) than rate of pregnancy. Low ovarian response to stimulation, usually defined as fewer than three to five developing follicles during an IVF cycle, is an indicator of a poor reproductive outcome. It is important to recognize, however, that a poor result from ovarian reserve testing does not signify an absolute inability to conceive and should not be the sole criteria considered to limit or deny access to infertility treatment. Although these tests are used to assess oocyte quantity and quality, the best surrogate marker for oocyte quality is age. At this time, ovarian reserve testing results cannot be extrapolated to predict the likelihood of spontaneous conception.