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Prediction of Fertility Potential in Women
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Ovarian Reserve refers to a woman’s current supply of eggs, and is considered as a reliable indicator of reproductive potential. In general, the greater the number of remaining eggs, the better the chance for conception. As a woman ages, her fertility potential gradually declines due to the declining egg quality and numbers.
There is no doubt about the fact that the ability to achieve a live birth decreases in all women as they grow older. However, the precise age when a woman can no longer conceive varies among individuals. Roughly one-third of couples in which the female partner is aged 35 or older will have problems with fertility. Tests for determining the ovarian reserve (or fertility potential) are part of the initial evaluation for infertility patients of any age. The main tests include:
 Day 3 Levels of FSH and Estradiol
Clomiphene Citrate Challenge Test
Antral Follicle Count
Response to Gonadotropins
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Day 3 Levels of FSH and Estradiol |
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Reproductive hormones such as FSH, LH, and estradiol are measured on day 3 of the menstrual cycle. An elevated FSH level (>10) may be indicative of impending ovarian failure or reduced ovarian reserve. In general, women with elevated levels of FSH and/or estradiol on cycle day 3 have reduced chances of live birth with both ovulation induction and in vitro fertilization (IVF) compared to other women of the same age.
Several laboratory methods are currently used to measure blood levels of FSH and estradiol, and each method results in different measurement levels. It is not advisable to compare the hormone levels if they are measured at different laboratories or by different laboratory techniques. It is important that normal and abnormal test values be based on the pregnancy rates achieved by women studied at a particular center using the same laboratory methods. |
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Clomiphene Citrate Challenge Test |
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The clomiphene citrate challenge test (CCCT) provides an additional assessment of ovarian reserve. The patient is orally administered 100 milligram of clomiphene citrate on menstrual cycle days 5-9. Her FSH and estradiol levels are measured on cycle day 3, and and her FSH is measured again on day 10. Abnormally elevated blood levels of FSH on either cycle day 3 or day 10 are associated with reduced pregnancy rates with both ovulation induction therapy and IVF. |
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Antral Follicle Count |
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Antral follicles are small follicles (about 2-8 mm in diameter) that we can measure and count with ultrasound. They are also referred to as resting follicles. A transvaginal ultrasound, performed in the early part of the menstrual cycle, assesses and counts these small structures. The number of these follicles reflects underlying egg supply and response to gonadotropins. As women age, they have less eggs (primordial follicles) remaining, therefore they have less antral follicles visible on ultrasound. This test is more accurate if done by a physician or ultrasonographer experienced in working with fertility evaluations. |
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Response to Gonadotropins |
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Gonadotropins are concentrated mixtures of FSH and LH (or FSH alone) which are given as injections to stimulate the ovary to produce multiple eggs in preparation for various fertility therapies. The amount of gonadotropins required to induce egg development increases with increasing chronological age. Patients requiring large amounts of gonadotropins to induce egg development generally have lower pregnancy rates with both ovulation induction therapy and Assisted Reproductive Technology (ART). |
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Ovarian Reserve tests predict a woman’s response to fertility treatment and her likelihood of success compared to other women of the same age. In younger women, abnormal test results suggest that fertility potential is declining, but they cannot definitively identify who will or who will not conceive. What is noteworthy is that some younger women with normal test results have difficulty conceiving. Women older than 40 years with abnormal test results have poor chances of achieving pregnancy naturally and after ovulation induction. Such women can be considered for the use of donor eggs or embryos because the chances of pregnancy are primarily related to the quality of the donated eggs. The test results may vary from cycle to cycle. However, any single abnormal test generally indicates diminished fertility potential. |
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