Ovarian Reserve
Ovarian reserve is a term used to determine the capacity of the ovary to provide eggs. Essentially egg quantity is what is being measured and gives an estimation of the number of eggs a woman has remaining for future use. Each ovary has a predetermined number of follicles (fluid-filled sacs that develop into eggs) that are potentially available during the course of a woman’s reproductive life. The actual number varies from individual to individual. During a normal monthly menstrual cycle one egg is released by either one of the two ovaries while approximately one thousand additional follicles are lost due to atresia (a process in which immature eggs or follicles degenerate and are resorbed). Tests of ovarian reserve can help estimate a woman’s remaining egg supply.
The level of Anti-Müllerian Hormone (AMH) in a woman's blood is generally a good indicator of her ovarian reserve.
Women are born with their lifetime supply of eggs, and these gradually decrease in both quality and quantity with age.Anti-Mullerian Hormone (AMH) is a hormone secreted by cells in developing egg sacs (follicles).
Ovarian Reserve Fertility Tests
Anti-Mullerian Hormone (AMH):
A hormone produced by cells located in developing eggs (preantral and early antral follicles). As the follicles develop into mature eggs or die off (a normal process called atresia), they no longer produce AMH. By measuring the amount of this hormone in a woman’s body, a physician can get a good estimate as to supply of eggs remaining or ovarian reserve. This information can be used to determine odds for success with various IVF procedures and help to determine the optimal ovarian stimulation protocol. This test is different from other tests used to measure ovarian reserve since it does not fluctuate throughout a woman’s menstrual cycle. It has also shown to be a tool that can aid in the diagnosis of PCOS (Polycystic Ovarian Syndrome).
Clomiphene Citrate Challenge Test (CCCT):
Provides an additional assessment of ovarian reserve. On day 3 FSH and estradiol levels are measured. On days 5-9 Clomiphene citrate, a drug prescribed to stimulate or regulate ovulation, is taken. FSH levels are measured again on day 10. An elevated FSH level on either day 3 or 10 is considered abnormal. This indicates a reduced ovarian reserve and a decreased response to ovarian stimulation by FSH injection during an assisted reproductive cycle attempt.
Estradiol:
A hormone produced in the ovaries by cells that surround a developing egg (follicle). In terms of ovarian reserve, this test is used to confirm the results of a day 3 FSH. A high estradiol level may artificially lower (or mask) what otherwise would be a higher (potentially abnormal) FSH. The other two uses of this test are: 1.) for the diagnosis of amenorrhea (the absence of a menstrual period) and 2.) to monitor progress during ovulation induction.
Exogenous FSH Ovarian Reserve Test (EFORT):
A hormone test used to assess a woman’s egg production potential by measuring the response of the ovaries to Gonadotropin (FSH) stimulation. On day 3 of a woman’s menstrual cycle her blood is tested for Inhibin B levels. The woman is then injected with FSH and 24 hours later a second Inhibin B level measurement is done. This test may be useful in predicting a woman’s response to IVF cycle stimulation.
Follicle Stimulating Hormone (FSH-female):
A hormone produced by the pituitary gland that is located in the brain. It plays a key role in the development of follicles (immature eggs) into mature eggs. FSH also plays an important role in telling the ovaries when it is time to release a mature egg (ovulation). A normal FSH level indicates a woman has a good supply of eggs (ovarian reserve) and is a good candidate for ovarian stimulation in IVF. As a woman gets older and the number of eggs she has remaining becomes low it takes more FSH to produce an egg. Therefore a high FSH score indicates a low or declining egg supply (ovarian reserve). FSH values can fluctuate from one cycle to the next, so when looking at multiple FSH values the highest value is the one that is considered to be the most accurate. For example if a woman had an initial FSH of 9 and had another FSH a month later with an FSH of 5 it does not mean her ovarian reserve had improved. Her true score is still considered to be an FSH of 9.
Inhibin B (Female):
A hormone test typically done to assess a woman’s ovarian reserve. This test is performed on day 3 of a woman’s menstrual cycle. A high level of this hormone indicates a woman has a good ovarian reserve and typically will respond well to stimulation during an IVF cycle. Conversely, a low Inhibin B level correlates with diminished ovarian reserve and a diminished ability to produce eggs during an IVF cycle.
LH (Luteinizing Hormone, lutropin – female):
Serum LH determinations have been very useful in the diagnosis and treatment of infertility in women. A midcycle rise is a good indication that ovulation will occur approximately 24 hours later. Subfertile couples, and women being treated with gonadotropin for infertility, can be informed that ovulation is imminent. In the woman LH is necessary for the production of estrogen. When estrogen reaches a critical peak, the pituitary releases a surge of LH (the LH spike), which releases the egg from the follicle.
Progesterone:
Progesterone is a steroid hormone secreted by the ovary during the second half of the menstrual cycle (luteal phase). It plays an important role in the preparation for and maintenance of pregnancy. Daily progesterone levels are considered the most accurate means for documenting a defective luteal phase. Measurements of serum progesterone have also been used to check the effectiveness of ovulation induction, to monitor progesterone replacement therapy and to detect and evaluate patients at risk of abortion during the early weeks of pregnancy.
Prolactin:
A hormone that stimulates the production of milk in breastfeeding women. Increased prolactin levels in women not breastfeeding may interfere with ovulation and fertility. Prolactin has become an important tool in the investigation of amenorrhea (absence of menstruation), galactorrhea (abnormal milk production at times other than when nursing) and hypothalamic-pituitary disorders. Prolactin is a stress hormone, surgery; venipuncture, an interview, etc. may cause a transient rise.
