Assessment of Ovarian Reserve

Abstract

The enormous rate of atresia of ovarian follicles will leave 10,000–25,000 at age 36 years with ovulatory potential and the rate of loss accelerates even further up to the age of menopause. The assessment of ovarian reserve is important as a guide for counseling patients regarding prognosis for pregnancy if used judiciously, roughly predict the age of menopause, help determine the protocol for ovarian stimulation. In practical terms, methods for the assessment of ovarian reserve are female age, serum concentrations of FSH and oestradiol estimated on day 2–4 of the menstrual cycle, antral follicle count (AFC), serum concentrations of anti-Mullerian hormone (AMH). Female age is an independent predictor of ovarian reserve. Although wide variations are seen, female age has the advantage of being indisputable and, particularly when used with a further parameter, is probably the most valuable predictor of ovarian reserve and prognosis for live birth. Day 3 FSH levels vary from cycle to cycle and are unreliable particularly in those <40 years old. The advantage of the antral follicle count is that it is a direct measure of the cohort of follicles available and capable of responding to stimulation. However, good ultrasound equipment is necessary and large intra-observer differences have been noted. The concentration of AMH in serum is a good indicator of the size of the ovarian antral follicle pool and consequently a good predictor of the ovarian response to stimulation. It is now widely used in counseling patients and determining the protocol for ovarian stimulation.