The Role of Ovarian Reserve Testing in Fertility

Fertility is one of the most crucial aspects of a woman’s reproductive health, and a key factor in determining a woman’s ability to conceive naturally is her ovarian reserve. Ovarian reserve refers to the quantity and quality of eggs a woman has at a given time, which naturally declines as she ages. Understanding a woman's ovarian reserve can help assess her fertility potential and guide fertility treatment decisions. Ovarian reserve testing has, therefore, become an essential tool for women who are trying to conceive, particularly those experiencing fertility challenges, delaying childbirth, or considering assisted reproductive technologies like in vitro fertilization (IVF).

This article explores the role of ovarian reserve testing in fertility, the types of tests involved, its significance, and how the results influence treatment decisions for couples trying to conceive.

Ovarian reserve refers to the number of eggs (oocytes) a woman has in her ovaries at a specific point in her life. Unlike men, who produce sperm continuously throughout their lives, women are born with a finite number of eggs. At birth, females have approximately 1 to 2 million eggs, but this number decreases steadily with age. By puberty, the egg count is reduced to around 300,000 to 400,000, and during the reproductive years, only about 400 to 500 eggs are released through ovulation.

As women age, not only does the number of eggs decline, but egg quality diminishes as well. This decline becomes more pronounced after the age of 35 and accelerates in the late 30s and early 40s. By the time a woman reaches menopause, her ovarian reserve is virtually depleted. Understanding the status of a woman’s ovarian reserve is vital for fertility planning and determining the likelihood of natural conception or the success of fertility treatments.

Ovarian reserve testing serves multiple purposes in fertility evaluation and treatment. Some of the key reasons why ovarian reserve testing is important include:

Several tests can help assess a woman’s ovarian reserve. These tests measure hormone levels, egg count, and overall ovarian function to provide a clear picture of a woman’s reproductive capacity. The most commonly used ovarian reserve tests include:

The AMH test is one of the most reliable and widely used tests to evaluate ovarian reserve. Anti-Müllerian Hormone (AMH) is produced by the small, developing follicles in the ovaries, and its levels correspond to the number of eggs remaining.

Antral Follicle Count (AFC) is a transvaginal ultrasound test that measures the number of small, resting follicles (antral follicles) in the ovaries. These follicles contain immature eggs, and their count reflects the ovarian reserve.

The FSH test measures the levels of follicle-stimulating hormone (FSH) in the blood. FSH is responsible for stimulating the growth of follicles in the ovaries. When ovarian reserve is low, FSH levels increase as the body works harder to stimulate the ovaries.

The estradiol test measures the levels of estradiol (a form of estrogen) in the blood. Estradiol is produced by the developing follicles in the ovaries and works in conjunction with FSH.

The CCCT involves measuring FSH levels before and after administering clomiphene citrate, a medication that stimulates the ovaries. The test helps evaluate ovarian response and reserve.

Ovarian reserve test results provide critical insights into a woman’s fertility status. However, no single test can offer a complete picture of ovarian function. Fertility specialists typically combine multiple tests (e.g., AMH, AFC, and FSH) to assess ovarian reserve accurately.

It’s important to note that ovarian reserve tests cannot predict egg quality, which is another crucial factor for successful conception.

Ovarian reserve testing is an essential aspect of fertility assessment, particularly for women who are planning to conceive, struggling with infertility, or considering fertility preservation. Understanding a woman’s ovarian reserve—the quantity and quality of eggs remaining in her ovaries—enables fertility specialists to make informed decisions about treatment options.

As women age, ovarian reserve declines naturally, affecting both the chances of natural conception and the success rates of assisted reproductive techniques like in vitro fertilization (IVF). Early identification of diminished ovarian reserve can help women take proactive steps to preserve or enhance their fertility. In this article, we will explore ovarian reserve testing, what it means for fertility, and the treatment options available to women with low ovarian reserve.

A woman is born with all the eggs she will ever have—approximately 1 to 2 million. By the time she reaches puberty, this number drops to around 300,000 to 400,000. With each menstrual cycle, a group of eggs begins to develop, and one egg is typically released during ovulation. Over time, the ovarian reserve declines both in quantity and quality, with a steep decline occurring after the age of 35.

Ovarian reserve testing assesses the current status of a woman’s egg supply. The results provide valuable insights into her fertility potential and help determine the most appropriate treatment plan. While ovarian reserve does not guarantee conception, it can indicate how urgent treatment may be and whether advanced fertility treatments are required.

Fertility specialists use several tests to evaluate ovarian reserve. These tests measure hormone levels and the number of follicles in the ovaries, offering a comprehensive understanding of egg supply.

1. Anti-Müllerian Hormone (AMH) Test

AMH is a hormone produced by the small follicles (antral follicles) in the ovaries. The AMH test is considered one of the most reliable indicators of ovarian reserve.

AFC is an ultrasound-based test that counts the number of small, resting follicles in the ovaries. These follicles contain immature eggs and are a direct indicator of ovarian reserve.

FSH is a hormone produced by the brain to stimulate egg development. When ovarian reserve is low, the body produces more FSH to stimulate the ovaries.

Estradiol is a form of estrogen produced by developing follicles. High estradiol levels can indicate poor ovarian response.

The CCCT measures ovarian reserve by stimulating the ovaries with clomiphene citrate, a fertility drug.

The results of ovarian reserve tests help fertility specialists predict how well a woman may respond to fertility treatments like ovarian stimulation in IVF. However, it’s important to note that ovarian reserve testing does not directly assess egg quality. Even women with a good ovarian reserve may experience challenges due to poor egg quality, particularly as they age.

For women diagnosed with diminished ovarian reserve, various treatment options are available to optimize their chances of conception. Treatment recommendations depend on age, ovarian function, and individual fertility goals.

Egg freezing, or oocyte cryopreservation, is an excellent option for women who wish to delay pregnancy. Eggs are harvested, frozen, and stored for future use when natural fertility may have declined. This is particularly beneficial for women with low ovarian reserve who want to preserve their fertility while eggs are still viable.

IVF is a common treatment for women with low ovarian reserve. The process involves stimulating the ovaries to produce multiple eggs, retrieving them, and fertilizing them in the lab. Fertilized embryos are then transferred to the uterus for implantation.

Egg donation is a viable option for women with extremely low ovarian reserve or poor egg quality. Eggs from a young, healthy donor are fertilized with the partner’s or donor’s sperm and transferred to the intended mother’s uterus. Egg donation offers high success rates, as donor eggs are typically of good quality.

Hormonal treatments, such as supplementation with dehydroepiandrosterone (DHEA) or growth hormone, can improve ovarian response in some women with low ovarian reserve. These treatments aim to enhance the number and quality of eggs produced during fertility cycles.

Ovulation induction involves stimulating the ovaries with medications like clomiphene citrate or gonadotropins to encourage egg development. This treatment is often used in women with low ovarian reserve who still have some remaining egg function.

Lifestyle changes can play a supportive role in improving overall fertility health. Women are advised to:

Early diagnosis and intervention are critical for women with diminished ovarian reserve. Since ovarian reserve declines with age, delaying treatment can significantly reduce the chances of success. Women planning to conceive in the future should consider ovarian reserve testing as part of their fertility evaluation, especially if they:

Ovarian reserve testing plays a critical role in assessing a woman’s fertility potential, guiding treatment decisions, and empowering women to plan for their reproductive future. By providing insights into the remaining egg supply, tests like AMH, AFC, and FSH help women and couples make informed decisions about fertility treatments, egg freezing, or natural conception timelines.

If you are struggling with infertility or planning to delay pregnancy, consulting a fertility specialist for ovarian reserve testing can provide clarity and help you explore the best options for achieving your reproductive goals. With advancements in medical technology, even women with low ovarian reserve have hope through treatments like IVF and egg donation.