What is Ovarian Reserve Testing?
Ovarian Reserve Testing:
Ovarian reserve plays a crucial role in achieving successful pregnancy outcome. Ovarian Reserve tests (ORTs) provide an indirect estimate of a woman's remaining follicular pool. Most widely used tests are basal follicle stimulating hormone and anti-Mullerian hormone and antral follicle count.
Basal follicle stimulating hormone (FSH) levels measured on day 3 of the menstrual cycle is a common ORT to assess ovarian reserve.
Anti-Mullerian hormone (AMH) is a glycoprotein exclusively produced in the ovary. AMH production appears to diminish and become undetectable at and after menopause. AMH levels strongly correlate with basal antral follicle count; and can be tested at any day of the cycle. AMH is used to assess ovarian reserve and response to medications and can help your doctor choose the right stimulation protocol for you.
Inhibin B: Inhibin B is a glycoprotein released by the follicle. Women with a low day 3 inhibin B concentration (<45 pg/ml) have a poor response to superovulation for IVF and are less likely to conceive a clinical pregnancy.
Basal estradiol: Basal estradiol (E2)—measured on Day 3—has been evaluated as a marker of ovarian reserve in women, prior to IVF. An elevated basal E2 level may mask abnormal FSH levels and hence, FSH levels alone may not be predictable of the ovarian response in such women. Initial studies showed an association between an elevated basal E2 level and a poor ovarian response.
Clomiphene citrate challenge test: CCCT is a dynamic test involving the administration of 100 mg of clomiphene citrate from the fifth day of the cycle for 5 days. Basal FSH is estimated on day 3 of the cycle and stimulated FSH levels on day 10. Abnormal values on day 3 or day 10, or on addition of the two, is considered as a predictor of a poor ovarian response.
Note: Some insurances require CCCT for women above the age of 40 before approving an IVF cycle.
Reference:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276943/
https://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/ovarian_reserve_predicting_fertility_potential_in_women_factsheet.pdf
https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/testing_and_interpreting_measures_of_ovarian_reserve.pdf
Last updated- 2/14/24
