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Ovarian reserve tests and female fertility

By Dr. Jesús Alberto Félix Atondo

One of the first tests recommended for women who have wanted to become pregnant for more than a year to have unprotected intercourse is the ovarian reserve test. This data is especially important in women over 35 years of age, since it allows getting a predictive value of the ability to achieve pregnancy.

Today on The Fertility Center blog we will tell you what ovarian reserve tests are, when they should be carried out, what the results mean, their importance in female fertility and if they are determinants of success in achieving pregnancy. Let’s get started!

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What is the ovarian reserve?

Ovarian reserve is a term used to account for the number of eggs a woman has in her ovaries, also the functional capacity of the ovary, as well as the number and quality of oocytes remaining in the ovaries.

Ultrasound with antral follicle count (AFC)

Also known as ultrasound measurement, it is a test performed using a vaginal ultrasound to count the number of antral follicles in each ovary. It is usually performed in the first days of the menstrual cycle and is considered to have normal results when the number of follicles per ovary is greater than 5-7.

Anti-Mullerian Hormone (AMH) Test

It consists of a blood test to measure the AMH protein that is produced in the ovary and is considered normal when it is above 1-1.3 ng/ml. It can be performed on any day of the menstrual cycle and the values it provides are not affected by any external factor.

Follicle-stimulating hormone (FSH) test

It is a blood test that must be performed between the second and fifth day of the menstrual cycle. If it is in a range above 10, it can be interpreted that there is a low ovarian reserve, and if it is below it, it is considered that the reserve is normal.

Women are born with an ovarian complement of around one million oocytes. This amount is reduced during puberty to around 500 thousand ovules. In each menstrual cycle that occurs from this age, around 400 oocytes will reach ovulation, while the rest will degenerate.

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What is an ovarian reserve test?

Ovarian reserve tests are methods to measure the quantity and quality of the eggs. One of the most effective tests consists of combining the chronological age of the patient with an antral follicle count (AFC) through ultrasound and anti-müllerian hormone (AMH).

If the ovarian reserve is good at the time of a test, the chances of achieving pregnancy will be hopeful. However, it is possible that the available eggs are not of good quality, and, in this case, it will be necessary to resort to assisted reproduction treatments such as in vitro fertilization (IVF) to achieve pregnancy.

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At what age is an ovarian reserve test recommended?

The period in which women are most fertile is from 16 to 30 years of age, when they have a good quality and quantity of oocytes. From the age of 35, the ovarian reserve decreases significantly until its complete exhaustion, which usually occurs between the ages of 45 and 55, when the woman begins a new stage: the menopause.

This means that, per se, there is no special age to have an ovarian reserve test. The specialist will be the one who indicates the need to carry out the test in case he suspects that there may be reproductive aging and, therefore, a lesser ability to achieve pregnancy, either by natural means or assisted reproduction methods.

Is an ovarian measurement test key to assisted reproduction treatment?

Yes. Evaluating the ovarian reserve is an essential step in the treatment of female infertility, since it allows a prognosis of response to a possible treatment, calculation of the dose of medication and the need for one or several IVF cycles to achieve success.

The reproductive potential is considered higher when the FSH value is less than 14 mIU/ml and when between 5 and 10 follicles are visualized between the two ovaries. If you have less than 5 follicles, the chances of a natural pregnancy are minimal, but you can still opt for assisted reproduction treatment.

Ovarian reserve and female fertility, what is the relationship?

It is important to clarify that the ovarian reserve is not the only factor or the determinant when analyzing female fertility. The permeability of the fallopian tubes, the state of the uterine cavity, among other data, should also be considered.

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Dr. Jesús Alberto Félix Atondo

Gynecology, Obstetrics and Biology of Human Reproduction Surgeon at the Autonomous University of Guadalajara, specialist Biologist of Human Reproduction by the Mexican Institute of Infertility.

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