What is Ovarian Reserve Testing?
Ovarian Reserve Testing:
Ovarian reserve refers to the number and quality of eggs remaining in your ovaries. Women (assigned females at birth) are born with all of the eggs they will ever have. Over time, the number and quality of these eggs declines. While the decline is initially steady, it begins to speed up after 35 years of age. This is why women over 35 are more likely to require fertility treatment compared to women 35 and under.
Your ovarian reserve plays a crucial role in achieving successful pregnancy outcome. Ovarian reserve tests (ORTs) provide an indirect estimate of your ovarian reserve. Some common ORTs include:
Basal follicle stimulating hormone (FSH) testing: FSH is a hormone produced by the brain during the first part of the menstrual cycle. It helps stimulate follicles (eggs) to develop in the ovaries. Your doctor can measure your FSH level around the third day of your menstrual cycle. Abnormally high levels may be indicative of a low ovarian reserve.
Anti-Mullerian hormone (AMH) testing: 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.
Antral follicle count (AFC): this ultrasound test is typically performed around the third day of your menstrual cycle. The doctor counts the number of small follicles that have begun to develop during that cycle, which can help estimate the number of eggs remaining inside the ovaries. A low AFC is typically indicative of a low ovarian reserve.
Inhibin B testing: Inhibin B is a glycoprotein released by the developing follicles in the ovaries during the first part of the menstrual cycle. It’s typically tested around day 3 of the menstrual cycle. Women with a low day 3 inhibin B concentrations (<45 pg/ml) tend to have a poor response to IVF medications and are less likely to conceive a clinical pregnancy than those with higher levels.
Basal estradiol testing: Estradiol (E2) is a hormone produced by the developing follicles during the first part of the menstrual cycle. E2 levels are typically measured around the third day of the menstrual cycle. An elevated basal E2 level may mask abnormal FSH levels. Hence, FSH levels alone may not be predictable of the ovarian reserve in such women. Initial studies showed an association between an elevated basal E2 levels and a low ovarian reserve.
Clomiphene citrate challenge test: CCCT is a dynamic test involving the administration of 100 mg of clomiphene citrate from days 5-9 of the menstrual cycle. FSH levels are measured on days 3 and 10 of the cycle. Abnormal values on day 3 or day 10, or on addition of the two, is indicative of low ovarian reserve.
Note: Some insurance companies require CCCT for women above the age of 40 before approving an IVF cycle.
References:
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- 4/4/25
