What is Ovarian Reserve?

A woman’s ovarian reserve is the measure of her remaining store of unreleased eggs.  Think of it like a basket that is filled up before you are born. You take an egg out every month or so, and eventually the basket will become empty. Unfortunately, unlike that basket, there’s no easy way for doctors to count just how many eggs a woman has left.

There are testings, that can give an idea of remaining ovarian reserve, and having this measure is important to treating fertility problems. So, what kind of tests can measure this reserve? And what might the results mean to someone who’s trying for a baby?

Testing AMH 

Anti-Mullerian Hormone (AMH) is a hormone associated with ovarian reserve. The test for AMH levels in the blood is used to determine if a woman will respond positively to IVF treatments. AMH levels between 1.5 and 4 ng/ml are usually considered normal. However, there is not yet a universally accepted standard. Generally, a higher amount of AMH indicates a greater ovarian reserve.

Antral Follicle Count

Ovaries contain follicles, where eggs develop before being released during ovulation. An antral follicle is a “resting” follicle that contains a premature egg. Early in the menstrual cycle, these follicles can be counted by ultrasound, and this count helps estimate ovarian reserve. Eight or more antral follicles is considered average to high.

Testing FSH 

Follicle stimulating hormone (FSH) causes those antral follicles to mature, eventually releasing their eggs. The test for FSH is often called a “day 3 FSH” test because it is performed on the third day of the menstrual cycle when FSH levels are at their lowest. This is the “baseline” level, and if it is higher than normal – up to 9 – that means the woman’s body is working harder to make follicles mature. This indicates a lower ovarian reserve.

Limitations

None of these tests is perfect. In particular, none of them can predict egg quality, which is as important to fertility as egg quantity. Also, there’s no one sure-fire way to determine ovarian reserve. But the results of multiple tests taken together can give a more complete picture.

If you are exploring fertility treatment options, and particularly if you are 35 or older, talk to your doctor about testing your ovarian reserve.


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