Assessment of ovarian reserve

Decreased ovarian reserve refers to decreased oocyte quality, quantity, or reproductive potential. These techniques can estimate the number of eggs in the ovaries (ovarian reserve) and is useful in the management of infertility. They can guide the choice and amount of medication to be given.

The two most commonly used tests nowadays are anti-Müllerian hormone (AMH) measurement and antral follicle count (AFC).

AMH is produced by granulosa cells in preantral follicles and is constant throughout the cycle. Normal values are between 1,1 – 3,5. If the value is below this, the ovarian reserve is low, if above then the ovarian reserve is high.

Antral follicle count is an ultrasound measurement of the 2 – 10 mm follicles in the ovaries at the beginning of the cycle. This number correlates to the number of eggs. < 7 AFC means low ovarian reserve, > 20 AFC means high ovarian reserve.

Other tests of ovarian reserve include:

FSH/oestradiol ratio on day 3
Inhibit B level
Clomiphene citrate challenge test

The ovarian reserve declines by approximately 5% per year.

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is characterised by oligomenorrhoea, hyperandrogenism, and anovulation. It’s a common disorder, as it affects approx. 10% of women. It’s the most common cause of hyperandrogenism in females.

Symptoms usually begin in adolescence.

Diagnosis and evaluation

We should test for biochemical evidence of hyperandrogenism, by measuring serum androgens. We can also measure an LH:FSH ratio of > 3:1.

Transvaginal ultrasound is essential to look for polycystic ovaries.

The diagnosis is made based on the Rotterdam criteria. According to these criteria, at least two of these three criteria must be present:

Oligo/anovulation
Hyperandrogenism (clinical or on labs)
Polycystic ovaries on ultrasound

After diagnosis, we should screen for diabetic, cardiovascular, and hepatic complications.