Why is Ovarian Reserve Test done?

Ovarian Reserve test is done to find out what is the capacity of a woman’s ovary to produce healthy eggs in each cycle that would lead to conception. Ovarian Reserve can be viewed as the reproductive potential as a function of the number and quality of remaining oocytes.

Women are born with all the eggs that they will ever half. This bank of egg forming cells in the ovaries are called "primordial follicles". Each primordial follicle contains an immature egg that has the potential to develop and ovulate in the future.

Their count starts to fall right from the foetal stages till Menopause. After Menopause there are no eggs remaining. This count is highest in the growing foetus. By the time the baby is born a good portion of this bank is depleted. What remains of this pool of egg forming cells further declines significantly by the time she reaches puberty (70-80%). By the time the woman reaches reproductive age, the size of her remaining pool of primordial follicles is viewed as her Ovarian Reserve and would determine her reproductive potential for the future. The ovarian Reserve will keep declining as the woman ages. There is a sharp decline after 35 years of age.

This Ovarian Reserve varies from woman to woman based on her respective genetic fingerprint. Some women will have low bank of primordial follicles to start with, will have a poor Ovarian Reserve when she reaches reproductive age. Such women should not wait long and start a family in their 20s.

It is well known that both the quantity and quality of ovarian follicles significantly decrease as a woman advances in age and that many women who postpone maternity may be infertile at the time they are willing to become pregnant.

For women with infertility problems, it therefore becomes extremely important to test their Ovarian Reserve in the pre–treatment evaluations as the result of this test would help the doctors to decide the treatment options.

The ovarian Reserve tests predict three related but distinctly different outcomes:-

  • Oocyte quality
  • Oocyte quantity
  • Fecundity

Age is considered one of the single most important factor in determining quality and quantity of ovarian reserve. In a Young woman with low ovarian reserve it may still be possible to conceive if her egg quality is good. On the other hand an older women with good ovarian reserve may have trouble conceiving due to poor quality of eggs.

Why does the ovarian reserve diminish?

The Ovarian Reserve diminishes with age due to atresia of the pool of oocytes which is a part of normal physiological process, the extent of this drop varies from person to person and is mostly influenced genetically. But other causes where rapid depletion happens may be due to:-

  • systemic chemotherapy
  • pelvic irradiation
  • genetic abnormalities — Turner Syndrome
  • Lifestyle - cigarette smoking

The goal for ovarian Reserve testing is to add more prognostic information to the counselling and planning the process so as to help the couple to choose the right treatment options.

But it should be emphasised, that these tests are not infallible.

How is Ovarian Reserve Tested?

Ovarian reserve can be tested by two types of tests:

1) BIOCHEMICAL
  • AMH
  • FSH
  • ESTRADIOL
  • INHIBIN B
  • PROVOCATIVE TESTS - CCCT
2) IMAGING TESTS OR TRANSVAGINAL ULTRASOUND
  • ANTRAL FOLLICLE COUNT
  • OVARIAN VOLUME