Assessing Ovarian Reserve
As a woman ages, the chances of pregnancy decline. This is mainly related to decreasing egg quantity and quality. Ovarian reserve testing uses a combination of blood work and ultrasound to determine the number of eggs a woman has left. The test results can help predict how likely a woman is to get pregnant from in vitro fertilization (IVF), a type of fertility treatment.
Blood work and ultrasound
Ovarian reserve testing includes several different types of assessments. Blood work is performed to look at follicle-stimulating hormone (FSH) levels, anti-müllerian hormone (AMH), and estradiol. A vaginal ultrasound is also done to assess antral follicle count (AFC), the number of eggs left in the ovaries. Taken together, the results of the test can provide an overall snapshot of a woman’s current fertility. Asking the right questions before proceeding with ovarian reserve testing is essential.
1. When is the test performed?
Most fertility clinics will recommend that the patient call on the first day of the menstrual cycle, or when the period starts so that scheduling can be coordinated. Estradiol, FSH, and the vaginal ultrasound to assess AFC are typically done between days 2-5 of the menstrual cycle. The AMH test can be performed at any time but is often done on the same day for convenience.
2. What happens during the test?
For the blood work component, the woman will be asked to visit a lab where the phlebotomist will draw enough blood to run all 3 tests. Patients should be well hydrated and have a small snack before heading to the lab. The ultrasound is done in the doctor’s office and should not cause any pain. The entire test takes 1 hour at most, and results should be available soon after.
3. What do the results show?
The results of ovarian reserve testing show a woman’s current response to fertility treatment. Although 1 or 2 of the values may be lower than expected, remember that the tests aim to provide an overall assessment based on all the information collected. The doctor will consider the blood test values and ultrasound findings to determine current fertility and response to assisted reproductive technology (ART) treatments.
An important caveat
Nowadays, ovarian reserve testing is widely done. However, patients should know that the purpose of this test is to evaluate a woman’s potential response to fertility treatments such as IVF, not general pregnancy potential. The results can offer insight into how likely the patient is to get pregnant from fertility treatment compared with other women the same age. Low ovarian reserve results suggest that fertility potential has declined, but many women with abnormal results can go on to get pregnant naturally.
Older age, fewer eggs
Fertility declines over time, but IVF and other ART treatments can help women get pregnant at an older age. Measuring hormone blood levels and performing an ultrasound can help determine a woman’s current egg count before starting fertility treatment. The information the test provides helps determine whether IVF success is possible with the patient’s eggs or whether an alternative route, such as an egg donor, should be considered.
