Ovarian reserve fertility tests - evaluation of egg quantity and quality
Page author Richard Sherbahn MD
Female age is a very important consideration when estimating the probability for conception because it is a strong determinant of egg quality.
- A 45 year old can have good quality eggs (for her age) and still be fertile, although this is rare
- At the other extreme, a 25 year old can have very poor quality eggs and be infertile
- These are extreme examples. The point is that egg quantity and quality declines - beginning in the early 30s and faster in the late 30's and early 40s.
- Egg quantity and quality in a woman can be average for her age, better than average, or worse than average
It would be nice to have a reliable test to determine how many eggs remain and how good the eggs are in an individual woman at a point in time. We have some screening tests but they are not perfect.
- These tests are often referred to as tests of "ovarian reserve"
- We are testing the supply (or reserve) of eggs remaining in the ovaries
Do ovarian reserve tests check egg quantity, quality, or both?
- Ovarian reserve testing can tell us quite a lot about the remaining quantity of eggs a woman has, but it tells us little about the quality of those eggs.
- Age is the best "test" that we have at this time for egg quality
Antral follicle count test
Counting the number of 2-9mm diameter antral follicles that can be seen with transvaginal ultrasound gives us a good idea about a woman's ovarian reserve.
Day 3 FSH (follicle stimulating hormone) and estradiol (E2) test
By measuring a baseline FSH on day 3 of the cycle, we sometimes get an indication that the women is closer to menopause and has relatively less "ovarian reserve". In other words, if the day 3 FSH is elevated the egg quantity is reduced.
Clomiphene challenge test
A clomiphene challenge test is a dynamic type of test that can discover some cases of poor ovarian reserve that are still showing a normal day 3 FSH. This test is discussed on the day 3 FSH page.
Anti-Mullerian hormone levels, AMH
Blood levels of the hormone AMH are often used by fertility specialists and gynecologists as part of the evaluation of ovarian reserve.
Response of the ovaries to ovarian stimulation with injectable gonadotropins (FSH)
This is not really a "test" that we do to help us determine egg quantity and quality - it is part of a treatment for infertility. However, the response of the ovaries when the woman takes injectable FSH for stimulation is often very predictive of the egg quantity - and therefore, also the relative chances for success with infertility treatment.
In vitro fertilization
This is a treatment for infertility, but at the same time it can give us much useful information about egg and embryo quality. By careful examination of the eggs and embryos during the in vitro incubation process we sometimes get clues about why pregnancy has not occurred previously.
For example, the eggs may demonstrate poor morphology, or may have problems with maturation, or with fertilization, proper cleavage, etc.
Treatment options for women with reduced ovarian reserve: