What is ovarian reserve and why does it matter? Simply put, it’s the number of  eggs in the ovaries. Fertility doctors use this information to determine whether a woman’s ovaries are “acting their age.”  This information is critical to becoming pregnant and planning for either fertility treatment or fertility preservation.

Should you get your ovarian reserve tested? The answer is a resounding yes for anyone who is having trouble getting pregnant. There are a number of non-invasive tests you can have to determine your ovarian reserve. While there’s no way to reverse diminished ovarian reserve, there are many fertility treatment options your doctor can offer you. Read on for more information about ovarian reserve testing from Cary L. Dicken, MD of Sher Fertility Institute New York in Manhattan.

Ovarian Reserve Basics
Women are born with all the eggs they will ever have. When a woman starts puberty, around age 12 for most women, she has about 200,000 eggs. By the time she reaches menopause, at about 50 years old, the vast majority of these eggs are gone. If ovulation proceeded steadily from puberty to menopause–without being interrupted by birth control pills or pregnancy–the majority of women would ovulate approximately 500 eggs.

The eggs that aren’t ovulated all die naturally via a process called atresia. At this time, there aren’t any treatments to improve ovarian reserve or restore egg numbers. Ovarian reserve is primarily determined by genetics, however some external factors such as prior ovarian surgery, some chemotherapy agents, pelvic radiation, and smoking can speed egg loss.

Ovarian Reserve Testing
There are many non-invasive tests that can be performed to determine your ovarian reserve, a few are mentioned below. Your doctor at Sher Fertility Institute New York will advise you as to which is right for you.

  • Day 3 FSH: The pituitary is the area of the brain that produces follicle stimulating hormone (FSH). When ovarian function starts declining FSH values increase in an attempt to stimulate the ovary to mature eggs. Normal FSH values are below 10. If yours is above 10 on cycle day 2 or 3, it may indicate a decline in your ovarian reserve.
  • Clomid Challenge Test (Clomiphene Citrate Challenge Test): An extension of the Day 3 FSH test, this blood test measures levels of the hormone obtained on day 2 or 3 of your cycle. The test involves taking 100 mg of clomiphene citrate orally per day on cycle days 5 through 9. Your FSH is checked again on day 10, if it’s higher than 10 on either day 3 or day 10 it’s generally considered abnormal.
  • Resting (Antral) Follicle Count: A transvaginal ultrasound is performed to count the number of resting/unstimulated ovarian follicles at the start of your period. It’s important to know what’s going on with your follicles as fertility medications may be less effective for those with a low number of resting follicles.
  • Ovarian Volume: Ovarian volume may start to decline as ovarian function does. A transvaginal ultrasound is used to do a 3D study of ovarian volume.
  • Antimullerian Hormone (AMH): AMH is a hormone produced by the early eggs, so the higher the AMH level, the more eggs that remain in the ovary.

PCOS & Ovarian Reserve Testing
September is National PCOS Awareness Month and I would be remiss in not mentioning the relationship between PCOS and ovarian reserve testing. Polycystic Ovarian Syndrome (PCOS) is a condition that can affect a woman’s ability to have children. Women with PCOS typically experience missed or irregular periods. They may also have high levels of androgens, hormones that are typically thought of as male hormones despite the fact that women also produce them.

The cause of PCOS isn’t known and there is no single test that can be used to determine if you have PCOS. Typically the diagnosis is one of exclusion – meaning your doctor needs to rule out other medical problems that produce similar symptoms.  Common symptoms of PCOS include:

  • Infertility
  • Hirsutism (increased hair growth on the face, back, stomach, chest, thumbs, or toes)
  • Polycystic appearing ovaries Irregular menstrual periods
  • Male-pattern baldness or thinning hair
  • Skin tags (excess flaps of skin in the neck area or underarms)
  • Sleep apnea
  • Acne and/or oily skin
  • Weight gain or obesity
  • Thick dark brown or black patches of skin on the thighs, arms, neck, or breasts

Anti-Mullerian Hormone (AMH) is produced by cells in early immature eggs. As the follicles mature into eggs, they stop producing AMH. Measuring AMH can provide useful information when it comes time to decide the best course of fertility treatment, and although not part of a PCOS diagnosis it is helpful in predicting how a woman with PCOS may respond to fertility treatment.

If you’re having trouble getting pregnant, ovarian reserve testing is an important tool in finding your most successful path to parenthood. Schedule an appointment today to learn more about which fertility treatment options may be best for you. Contact Cary L. Dicken, MD of Sher Fertility Institute New York in Manhattan at (646) 792-7476 to set up your initial consultation.