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Ovarian reserve testing: How do we test?

Mr Anil Gudi, Mr Amit Shah and Prof Roy homburg

With advancing female age, the chances of conceiving start declining and this downward slope becomes particularly alarming over the age of 37 years. This decline is really a reflection of the biological age of the eggs in the ovaries and particularly in the reduction of the number of eggs that are available for fertilisation.

When assessing ovarian reserve, we are looking for the number of eggs, in their follicles, which remain potentially available for ovulation. This gives us an indirect rough guide for the chances for pregnancy as the more eggs that are available for this purpose often indicates a better chance to conceive.

Female age is generally still the best guide to ovarian reserve. However, up to a short time ago, measuring blood levels of follicle stimulating hormone (FSH) on day 3 of the menstrual cycle was the standard method. Values of over 17 units, especially in women over 40 years old, usually indicate a poor ovarian reserve. A more direct method is an ultrasound examination of the number of small follicles called antral follicles (that contain the eggs) in both ovaries. A total of 5 or less indicates a poor ovarian reserve. These small follicles can be evaluated better by a 3D ultrasound scan. .Probably the most reliable test is a measurement of anti-Mullerian hormone (AMH) in a blood sample that can be taken at any time during the monthly cycle. The amount of AMH produced by the ovaries and released into the circulation decreases with increasing age and is a good indication of ovarian reserve.

As every woman is different, also regarding her ovarian reserve, we have found that the AMH combined with age gives the best indication of the number of available eggs and an indirect guide to the chances for pregnancy.

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