Penn Fertility Care

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Reproductive Health Information

Tests of Ovarian Function / Ovarian Reserve

What is Ovarian Reserve?

Ovarian reserve refers to the number and quality of eggs in a woman's ovaries. Ovarian reserve naturally declines as women age and approach menopause. Some women experience this decline earlier in life (for unknown reasons) and this is a common cause of infertility.

Studies show that women with better ovarian reserve will tend to have better response to infertility treatments such as ovarian stimulation for IVF and therefore will have more eggs retrieved. In general, having more eggs produced with IVF gives a higher success rate. These tests probably do not reflect egg quality, but having more eggs at the IVF egg retrieval gives us more to work with - so we are more likely to have at least one high quality embryo available for transfer back to the uterus. In addition, these measures of ovarian reserve help us to determine the dosage of medications required to stimulate your ovaries.

Tests for Ovarian Reserve

The following tests are used in combination to assess your ovarian reserve.

  • Follicle Stimulating Hormone (FSH) – FSH is a hormone that is measured by a blood test. Developing egg-containing follicles produce estrogen which signals the brain (hypothalamus) to increase or reduce the amount of FSH produced by the pituitary gland. When only a few follicles are developing, estrogen levels are lower and more FSH is produced. This leads to higher levels of FSH during the early menstrual cycle (day 2-4). FSH levels greater than 10-11 mIU/mL may be a sign of reduced of ovarian reserve.
  • Anti –Mullerian Hormone (AMH) - AMH is a hormone that is measured by a blood test. AMH is produced by follicles in the ovaries and the level reflects the remaining egg supply in the ovaries. With increasing female age, the number of eggs in the ovary decreases. Likewise, the blood AMH levels decrease with age. AMH level less than 1.0 ng/ml may be a sign of reduced of ovarian reserve.
  • Antral Follicle Count (AFC) - AFC is a test that is performed by transvaginal ultrasound. The total number of small (antral) follicles in both ovaries are usually measured during the first few days of the menstrual cycle. The number of ovarian follicles visible on ultrasound decreases with age. Fewer than 10 antral follicles may be a sign of reduced ovarian reserve.