Ovarian Reserve Tests (ORT)

The female reproductive system consists of internal as well as external organs. The reproductive process begins with the release of the egg. Ovaries of the female reproductive system are the organs that produce the egg which when released travels down the fallopian tubes to get fertilized by the sperm. Any abnormality in the ovaries directly affects the fertility rate and can be the main cause of infertility.

The ovaries have three main functions:

• Every female is born with a limited number of eggs to last for a lifetime and the ovaries protect these eggs and on reaching menarche, the ovaries begin to release these eggs.

• female reproductive hormones estrogen and progesterone are also produced by the ovaries. The development of female characteristics is due to these hormones.

• One or more eggs are released by the ovaries with each menstrual cycle. The ovaries contain follicles. Once the egg is stimulated by hormones, the follicle moves to the walls of the ovaries where the egg and the follicle grow and mature.

It is known that ovaries produce the hormone estrogen which is responsible for the menstrual cycle from the age of menarche to menopause. As age progresses, the ovaries also age and very few eggs are released until no more eggs are left, and that is when a woman’s menstrual cycle stops and she attains menopause. Menopause generally occurs after the age of 40. So, if you are younger and your ovaries are not able to produce or release eggs, it is very obvious that your periods will cease. This condition may seem similar to menopause; however, this may be due to premature ovarian failure. Premature ovarian failure, also known as premature ovarian insufficiency refers to a condition where the ovaries are unable to function normally before the age of 40 causing the menstrual cycles to stop and attain menopause much earlier than the normal age.

Some causes of premature ovarian failure are:

• Idiopathic (unknown causes) – Sometimes, it would be difficult to delineate the cause and this is when your doctor might suggest further diagnostic testing.

• Iatrogenic – chemotherapy and radiation therapy – These can cause toxin-induced ovarian failure by damaging the genetic material of the cells. However, other toxins such as tobacco, certain chemicals, viruses, and pesticides can also trigger POF.

• Infectious – Certain microbial and viral infections also seem to contribute to premature ovarian failure.

• Chromosomal abnormalities – Some chromosomal defects such as Turner syndrome and fragile X syndrome have been associated with POF.

• Autoimmune disease – A condition, although very rare, in which the body’s immune system produces antibodies against the ovarian tissue. This can harm the follicle that contains the egg and damage the egg.

• Blood test and pregnancy test – The primary step to identify if you are having POF is a blood test to check if your ovaries are producing estrogen and if FSH and LH (hormones) are produced by the pituitary gland. If there is an elevation in the pituitary hormones and no production of estrogen, clearly this could be an indicator that you might be having POF. A pregnancy test could also be done checking for weekly serum FSH and estradiol levels for a period of 2 to 4 weeks. If FSH levels are high and estrogen levels are low, it could be indicative of POF.

• Genetic testing – If there is a family history of POF, genetic testing to detect POF may also be indicated.

• Transvaginal ultrasound – A procedure to closely examine the ovaries. If only a few follicles are visible and the size of the ovaries is small, there could be POF.

Depending on the levels of serum FSH and clinical findings, POF can be classified into the following types:

• Occult – Normal FSH levels and unexplained infertility.

• Overt – Elevated FSH and irregular menstrual cycle.

• Biochemical – Unexplained infertility and elevated basal serum FSH.

• Premature menopause – Amenorrhea and permanent infertility.

Since infertility is very concerning in women with POF, timely care and appropriate treatment can reverse the condition and increase your chance of conceiving. Consult a fertility specialist to guide you through the treatment process.