Ovarian Reserve Testing



The general purpose of ovarian reserve testing is to assess the quantity and quality of the remaining oocytes in an attempt to predict reproductive potential. Ovarian reserve testing should be performed in women older than 35 years who have not conceived after 6 months of attempting pregnancy (or women less than 35 who have not conceived after 1 year) and women at higher risk of diminished ovarian reserve, such as those with a history of cancer or other medical condition treated with gonadotoxic therapy and/or pelvic irradiation, or women who have had ovarian surgery for endometriomas.

Available tests for ovarian reserve include biochemical markers, i.e., FSH, estradiol, AMH, and inhibin B and ovarian ultrasound imaging, i.e., antral follicle count and ovarian volume. For general obstetrician-gynecologists, the most appropriate ovarian reserve screening tests to use in practice are basal FSH plus estradiol levels or anti-Müllerian hormone (AMH) levels. An antral follicle count (AFC) may also be useful if there is an indication to perform transvaginal ultrasonography. These screening tests are better predictors of oocyte yield from ovarian stimulation during in vitro fertilization (IVF) than rate of pregnancy. Low ovarian response to stimulation, usually defined as fewer than three to five developing follicles during an IVF cycle, is an indicator of a poor reproductive outcome. It is important to recognize, however, that a poor result from ovarian reserve testing does not signify an absolute inability to conceive and should not be the sole criteria considered to limit or deny access to infertility treatment. Although these tests are used to assess oocyte quantity and quality, the best surrogate marker for oocyte quality is age. At this time, ovarian reserve testing results cannot be extrapolated to predict the likelihood of spontaneous conception.


Follicle Stimulate Hormone Ovarian Stimulation Ovarian Reserve Ovarian Response Antral Follicle Count 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Ovarian reserve

A description of the quantity and quality of the oocytes left in the ovary

Anti-Müllerian hormone

A glycopeptide that is produced predominantly by granulosa cells whose expression is highest in secondary, preantral, and small antral follicles

Antral follicle count

An ultrasound observation of the number of visible ovarian follicles (2–10 mm mean diameter) in the early follicular phase (cycle days 2–5)


  1. 1.
    Committee on Gynecologic Practice. Committee opinion no. 618: ovarian reserve testing. Obstet Gynecol. 2015; 125(1): 268–73.Google Scholar
  2. 2.
    Faddy MJ, et al. Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause. Hum Reprod. 1992;7(10):1342–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Gnoth C, et al. Time to pregnancy: results of the German prospective study and impact on the management of infertility. Hum Reprod. 2003;18(9):1959–66.CrossRefPubMedGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention, A.S.f.R.M., Society for Assisted Reproductive Technology. Assisted reproducrtive technology fertility clinic success rates report. Atlanta: Department of Health and Human Services; 2010. p. 2014.Google Scholar
  5. 5.
    Brodin T, et al. Menstrual cycle length is an age-independent marker of female fertility: results from 6271 treatment cycles of in vitro fertilization. Fertil Steril. 2008;90(5):1656–61.CrossRefPubMedGoogle Scholar
  6. 6.
    Esposito MA, Coutifaris C, Barnhart KT. A moderately elevated day 3 FSH concentration has limited predictive value, especially in younger women. Hum Reprod. 2002;17(1):118–23.CrossRefPubMedGoogle Scholar
  7. 7.
    Roberts JE, et al. Taking a basal follicle-stimulating hormone history is essential before initiating in vitro fertilization. Fertil Steril. 2005;83(1):37–41.CrossRefPubMedGoogle Scholar
  8. 8.
    Abdalla H, Thum MY. Repeated testing of basal FSH levels has no predictive value for IVF outcome in women with elevated basal FSH. Hum Reprod. 2006;21(1):171–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Broekmans FJ, et al. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12(6):685–718.CrossRefPubMedGoogle Scholar
  10. 10.
    Sowers MR, et al. Anti-mullerian hormone and inhibin B in the definition of ovarian aging and the menopause transition. J Clin Endocrinol Metab. 2008;93(9):3478–83.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Tsepelidis S, et al. Stable serum levels of anti-Mullerian hormone during the menstrual cycle: a prospective study in normo-ovulatory women. Hum Reprod. 2007;22(7):1837–40.CrossRefPubMedGoogle Scholar
  12. 12.
    Bentzen JG, et al. Maternal menopause as a predictor of anti-Mullerian hormone level and antral follicle count in daughters during reproductive age. Hum Reprod. 2013;28(1):247–55.CrossRefPubMedGoogle Scholar
  13. 13.
    Nelson SM, Yates RW, Fleming R. Serum anti-Mullerian hormone and FSH: prediction of live birth and extremes of response in stimulated cycles--implications for individualization of therapy. Hum Reprod. 2007;22(9):2414–21.CrossRefPubMedGoogle Scholar
  14. 14.
    Toner JP, Seifer DB. Why we may abandon basal follicle-stimulating hormone testing: a sea change in determining ovarian reserve using antimullerian hormone. Fertil Steril. 2013;99(7):1825–30.CrossRefPubMedGoogle Scholar
  15. 15.
    Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril. 2015;103(3):e9–e17.CrossRefGoogle Scholar
  16. 16.
    McIlveen M, Skull JD, Ledger WL. Evaluation of the utility of multiple endocrine and ultrasound measures of ovarian reserve in the prediction of cycle cancellation in a high-risk IVF population. Hum Reprod. 2007;22(3):778–85.CrossRefPubMedGoogle Scholar
  17. 17.
    Muttukrishna S, et al. Inhibin B and anti-Mullerian hormone: markers of ovarian response in IVF/ICSI patients? BJOG. 2004;111(11):1248–53.CrossRefPubMedGoogle Scholar
  18. 18.
    Peigne M, Decanter C. Serum AMH level as a marker of acute and long-term effects of chemotherapy on the ovarian follicular content: a systematic review. Reprod Biol Endocrinol. 2014;12:26.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Nelson SM. Biomarkers of ovarian response: current and future applications. Fertil Steril. 2013;99(4):963–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Broer SL, et al. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach. Hum Reprod Update. 2013;19(1):26–36.CrossRefPubMedGoogle Scholar
  21. 21.
    La Marca A, et al. Anti-Mullerian hormone-based prediction model for a live birth in assisted reproduction. Reprod Biomed Online. 2011;22(4):341–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Lee TH, et al. Impact of female age and male infertility on ovarian reserve markers to predict outcome of assisted reproduction technology cycles. Reprod Biol Endocrinol. 2009;7:100.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Lukaszuk K, et al. Use of ovarian reserve parameters for predicting live births in women undergoing in vitro fertilization. Eur J Obstet Gynecol Reprod Biol. 2013;168(2):173–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Brodin T, et al. Antimullerian hormone levels are strongly associated with live-birth rates after assisted reproduction. J Clin Endocrinol Metab. 2013;98(3):1107–14.CrossRefPubMedGoogle Scholar
  25. 25.
    Dolleman M, et al. The relationship between anti-Mullerian hormone in women receiving fertility assessments and age at menopause in subfertile women: evidence from large population studies. J Clin Endocrinol Metab. 2013;98(5):1946–53.CrossRefPubMedGoogle Scholar
  26. 26.
    Kwee J, et al. Intercycle variability of ovarian reserve tests: results of a prospective randomized study. Hum Reprod. 2004;19(3):590–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Hendriks DJ, et al. The clomiphene citrate challenge test for the prediction of poor ovarian response and nonpregnancy in patients undergoing in vitro fertilization: a systematic review. Fertil Steril. 2006;86(4):807–18.CrossRefPubMedGoogle Scholar
  28. 28.
    Hendriks DJ, et al. Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: a meta-analysis and comparison with basal follicle-stimulating hormone level. Fertil Steril. 2005;83(2):291–301.CrossRefPubMedGoogle Scholar
  29. 29.
    Jayaprakasan K, et al. A prospective, comparative analysis of anti-Mullerian hormone, inhibin-B, and three-dimensional ultrasound determinants of ovarian reserve in the prediction of poor response to controlled ovarian stimulation. Fertil Steril. 2010;93(3):855–64.CrossRefPubMedGoogle Scholar
  30. 30.
    Steiner AZ. Biomarkers of ovarian reserve as predictors of reproductive potential. Semin Reprod Med. 2013;31(6):437–42.CrossRefPubMedGoogle Scholar
  31. 31.
    Scott Jr RT, et al. Intercycle variability of day 3 follicle-stimulating hormone levels and its effect on stimulation quality in in vitro fertilization. Fertil Steril. 1990;54(2):297–302.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and GynecologyOregon Health and Science UniversityPortlandUSA

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