Assessment of the Functional Ovarian Reserve

  • Wellington P. MartinsEmail author
  • Ligita Jokubkiene


The ovarian reserve is composed of primordial and resting follicles. The number of primordial follicles is determined during early fetal life and declines until menopause. The number of antral follicles reflects the size of primordial follicle pool [1]. Follicles destined to ovulate grow from primordial follicles through the accumulation of fluid in the antral cavity and the proliferation of granulosa and theca interna cells until it reaches the diameter of 2 mm. After the antral follicles reach 2 mm in diameter, they become highly sensitive and responsive to follicle-stimulating hormone (FSH). Follicles in diameter of 2–5 mm constitute a pool of follicles of which one follicle destined to ovulate is selected and finally undergoes ovulation [2, 3]. Those follicles constitute the functional ovarian reserve [4].


Assisted Reproductive Technology Ovarian Reserve Antral Follicle Primordial Follicle Antral Follicle Count 
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  1. 1.
    Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12:685–718.CrossRefPubMedGoogle Scholar
  2. 2.
    Nastri CO, Teixeira DM, Moroni RM, Leitao VM, Martins WP. Ovarian hyperstimulation syndrome: pathophysiology, staging, prediction and prevention. Ultrasound Obstet Gynecol. 2014.Google Scholar
  3. 3.
    Gougeon A, Lefevre B. Evolution of the diameters of the largest healthy and atretic follicles during the human menstrual cycle. J Reprod Fertil. 1983;69:497–502.CrossRefPubMedGoogle Scholar
  4. 4.
    Gleicher N, Weghofer A, Barad DH. Defining ovarian reserve to better understand ovarian aging. Reprod Biol Endocrinol. 2011;9:23.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Gougeon A. Ovarian follicular growth in humans: ovarian ageing and population of growing follicles. Maturitas. 1998;30:137–42.CrossRefPubMedGoogle Scholar
  6. 6.
    Crawford NM, Steiner AZ. Age-related infertility. Obstet Gynecol Clin North Am. 2015;42:15–25.CrossRefPubMedGoogle Scholar
  7. 7.
    Dewailly D, Andersen CY, Balen A, Broekmans F, Dilaver N, Fanchin R, Griesinger G, Kelsey TW, La Marca A, Lambalk C, Mason H, Nelson SM, Visser JA, Wallace WH, Anderson RA. The physiology and clinical utility of anti-Mullerian hormone in women. Hum Reprod Update. 2014;20:370–85.CrossRefPubMedGoogle Scholar
  8. 8.
    La Marca A, Sighinolfi G, Radi D, Argento C, Baraldi E, Artenisio AC, Stabile G, Volpe A. Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update. 2010;16:113–30.CrossRefPubMedGoogle Scholar
  9. 9.
    Lambert-Messerlian G, Plante B, Eklund EE, Raker C and Moore RG. Levels of antimullerian hormone in serum during the normal menstrual cycle. Fertil Steril. 2016;105:208–213 e201. PMID: 26477497 DOI:  10.1016/j.fertnstert.2015.09.033.
  10. 10.
    Broer SL, Eijkemans MJ, Scheffer GJ, van Rooij IA, de Vet A, Themmen AP, Laven JS, de Jong FH, Te Velde ER, Fauser BC, Broekmans FJ. Anti-mullerian hormone predicts menopause: a long-term follow-up study in normoovulatory women. J Clin Endocrinol Metab. 2011;96:2532–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Hamdine O, Eijkemans MJ, Lentjes EW, Torrance HL, Macklon NS, Fauser BC, Broekmans FJ. Ovarian response prediction in GnRH antagonist treatment for IVF using anti-Mullerian hormone. Hum Reprod. 2015;30:170–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Nastri CO, Teixeira DM, Moroni RM, Leitao VM, Martins WP. Ovarian hyperstimulation syndrome: pathophysiology, staging, prediction and prevention. Ultrasound Obstet Gynecol. 2015;45:377–93.CrossRefPubMedGoogle Scholar
  13. 13.
    Nelson SM, Klein BM, Arce JC. Comparison of antimullerian hormone levels and antral follicle count as predictor of ovarian response to controlled ovarian stimulation in good-prognosis patients at individual fertility clinics in two multicenter trials. Fertil Steril. 2015;103:923–30 e921.CrossRefPubMedGoogle Scholar
  14. 14.
    La Marca A, Ferraretti AP, Palermo R, Ubaldi FM. The use of ovarian reserve markers in IVF clinical practice: a national consensus. Gynecol Endocrinol. 2015;1–5.Google Scholar
  15. 15.
    Dewailly D, Lujan ME, Carmina E, Cedars MI, Laven J, Norman RJ, Escobar-Morreale HF. Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2014;20:334–52.CrossRefPubMedGoogle Scholar
  16. 16.
    Jonard S, Robert Y, Cortet-Rudelli C, Pigny P, Decanter C, Dewailly D. Ultrasound examination of polycystic ovaries: is it worth counting the follicles? Hum Reprod. 2003;18:598–603.CrossRefPubMedGoogle Scholar
  17. 17.
    Broekmans FJ, de Ziegler D, Howles CM, Gougeon A, Trew G, Olivennes F. The antral follicle count: practical recommendations for better standardization. Fertil Steril. 2010;94:1044–51.CrossRefPubMedGoogle Scholar
  18. 18.
    Martins WP, Kollmann M, Raine-Fenning N. Counting ovarian follicles: updated threshold for diagnosis of hyperandrogenic anovulation. Ultrasound Obstet Gynecol. 2014;44:131–4.CrossRefPubMedGoogle Scholar
  19. 19.
    Wellons MF, Bates GW, Schreiner PJ, Siscovick DS, Sternfeld B, Lewis CE. Antral follicle count predicts natural menopause in a population-based sample: the Coronary Artery Risk Development in Young Adults Women’s Study. Menopause. 2013;20:825–30.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Sun N, Lin SQ, Lin HJ, He Z, Wang YH, Zhang Y, Chen FL, Jiang Y. Comparison of follicle-stimulating hormone, estradiol, ovarian volume, and antral follicle count, based on the Stages of Reproductive Aging Workshop system, among community-based women in China. Menopause. 2013;20:736–41.CrossRefPubMedGoogle Scholar
  21. 21.
    Mutlu MF, Erdem M, Erdem A, Yildiz S, Mutlu I, Arisoy O, Oktem M. Antral follicle count determines poor ovarian response better than anti-Mullerian hormone but age is the only predictor for live birth in in vitro fertilization cycles. J Assist Reprod Genet. 2013;30:657–65.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Coelho Neto MA, Martins WP, Lima ML, Barbosa MA, Nastri CO, Ferriani RA, Navarro PA. Ovarian response is a better predictor of clinical pregnancy rate following embryo transfer than is thin endometrium or presence of an endometrioma. Ultrasound Obstet Gynecol. 2015;46:501–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Nastri CO, Ferriani RA, Rocha IA, Martins WP. Ovarian hyperstimulation syndrome: pathophysiology and prevention. J Assist Reprod Genet. 2010;27:121–8.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    ESHRE/ASRM. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19:41–7.CrossRefGoogle Scholar
  25. 25.
    Bentzen JG, Forman JL, Pinborg A, Lidegaard O, Larsen EC, Friis-Hansen L, Johannsen TH, Nyboe Andersen A. Ovarian reserve parameters: a comparison between users and non-users of hormonal contraception. Reprod Biomed Online. 2012;25:612–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Jayaprakasan K, Walker KF, Clewes JS, Johnson IR, Raine-Fenning NJ. The interobserver reliability of off-line antral follicle counts made from stored three-dimensional ultrasound data: a comparative study of different measurement techniques. Ultrasound Obstet Gynecol. 2007;29:335–41.CrossRefPubMedGoogle Scholar
  27. 27.
    Lima ML, Martins WP, Coelho Neto MA, Nastri CO, Ferriani RA, Navarro PA. The assessment of ovarian reserve by antral follicle count in ovaries with endometrioma. Ultrasound Obstet Gynecol. 2014.Google Scholar
  28. 28.
    Lima ML, Nastri CO, Coelho Neto MA, Ferriani RA, Navarro PA, Martins WP. Antral follicle count might be underestimated in the presence of an ovarian endometrioma. Hum Reprod. 2015;30:250.CrossRefPubMedGoogle Scholar
  29. 29.
    Alborzi S, Keramati P, Younesi M, Samsami A, Dadras N. The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometriomas. Fertil Steril. 2014;101:427–34.CrossRefPubMedGoogle Scholar
  30. 30.
    Kwon SK, Kim SH, Yun SC, Kim DY, Chae HD, Kim CH, Kang BM. Decline of serum antimullerian hormone levels after laparoscopic ovarian cystectomy in endometrioma and other benign cysts: a prospective cohort study. Fertil Steril. 2014;101:435–41.CrossRefPubMedGoogle Scholar
  31. 31.
    Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012;97:3146–54.CrossRefPubMedGoogle Scholar
  32. 32.
    Somigliana E, Berlanda N, Benaglia L, Vigano P, Vercellini P, Fedele L. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimullerian hormone level modifications. Fertil Steril. 2012;98:1531–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Muzii L, Di Tucci C, Di Feliciantonio M, Marchetti C, Perniola G, Panici PB. The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis. Hum Reprod. 2014;29:2190–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyRibeirão Preto Medical School, University of São PauloRibeirão PretoBrazil
  2. 2.Department of Obstetrics and GynecologySkåne University HospitalMalmöSweden

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