Determination of ovarian reserve

Ovarian reserve is the quantity and quality of remaining oocytes in a woman’s ovaries. It is an important indicator of fertility potential, as a higher ovarian reserve generally provides a higher chance of conception. Gynecologists and reproductive specialists at the "Dobrobut" Medical Center, with extensive experience, carry out all necessary tests using modern equipment. The assessment of ovarian reserve can provide valuable information about a woman’s reproductive health.

Signs of Decreased Ovarian Reserve

Decreased ovarian reserve means a reduction in the number and quality of remaining eggs in a woman’s ovaries. It can decrease with age or due to various factors such as genetics, lifestyle, health conditions, or the use of certain medications.

Signs of decreased reproductive potential may include:

• Irregular menstrual cycle: changes in cycle duration, often becoming shorter and less stable.
• Decreased fertility: difficulties in conception despite regular sexual activity without contraception.
• Elevated follicle-stimulating hormone (FSH) level: higher levels of FSH on the third day of the menstrual cycle indicate that the ovaries are responding poorly to stimulation.
• Low anti-Müllerian hormone (AMH) level: AMH levels decrease as ovarian reserve diminishes.
• Problems with the ovaries or diseases of the female reproductive system, such as endometriosis, pelvic infections, or ovarian surgeries.

What Affects Ovarian Reserve

Ovarian reserve can be affected by various factors, including:

• Age: over time, the ovarian reserve naturally decreases, especially after age 35.
• Hereditary factors.
• Certain types of treatment: chemotherapy, radiation therapy, or surgeries affecting the reproductive organs.
• Lifestyle: smoking, excessive alcohol consumption, and poor nutrition can negatively impact ovarian health.
• Health conditions: the presence of chronic disorders such as polycystic ovary syndrome (PCOS) or autoimmune diseases.

How Ovarian Reserve is Determined

Ovarian reserve can be determined through various laboratory and instrumental studies ordered by a physician:

• Blood tests:
  • Anti-Müllerian hormone (AMH) test – measures hormonal levels which reflect the number of growing follicles in the ovaries.
  • Measurement of follicle-stimulating hormone (FSH) levels: conducted on the third day of the menstrual cycle — the higher the levels, the lower the ovarian reserve.
  • Estradiol: assessed alongside FSH to provide a clearer picture of ovarian function.
• Antral Follicle Count (AFC) – an ultrasound examination conducted at the beginning of the menstrual cycle to count the number of visible follicles in the ovaries.

The reproductive potential assessment package at the "Dobrobut" Medical Center includes a consultation with a reproductive specialist, pelvic ultrasound, and blood tests for AMH.

Based on the survey results, considering the ultrasound and anti-Müllerian hormone (AMH) levels, the reproductive specialist evaluates reproductive potential and gives recommendations regarding the timing for pregnancy planning. Duration of the procedure: 2 days.

Indications:

• Screening assessment of ovarian reserve;
• Delaying pregnancy until a later reproductive period;
• Absence of pregnancy over 6 months;
• Previous surgical interventions on the ovaries;
• Previous chemotherapy;
• Family history of premature ovarian insufficiency on the maternal side.

How to Properly Assess the Results of Ovarian Reserve Determination

The interpretation of ovarian reserve tests is conducted by a reproductive specialist or gynecologist. For accurate diagnosis, it is necessary to assess the results of all conducted studies. Indicators of decreased reserve include:

• AMH of less than 1.0 ng/ml;
• FSH levels above 10 mIU/mL on the third day of the cycle;
• Low count (typically less than 5-7) of antral follicles in the ovary.

It is important to relate the results to the woman’s age, clinical signs, medical history, and reproductive goals, as the norm of ovarian reserve depends on many factors.

How the Procedure for Determining Ovarian Reserve Takes Place

The steps for assessing ovarian reserve are:

1. Initial consultation: discussing symptoms, reviewing medical history, and clarifying reproductive plans with the doctor.
2. Timing for tests: FSH and estradiol tests are scheduled on the 3rd day of the menstrual cycle; anti-Müllerian hormone can be checked at any time; follicle counting is conducted via transvaginal ultrasound at the beginning of the menstrual cycle.
3. Blood tests and ultrasound interpretation by a specialist.
4. Follow-up consultation: assessment of results and discussion with the doctor about possible next steps or treatment methods.

Advantages of the Procedure

Assessing ovarian reserve provides numerous benefits:

• Provides important information for making informed reproductive choices;
• Early detection of decreased ovarian reserve allows for proactive pregnancy planning;
• Helps personalize infertility treatment methods, such as IVF, by evaluating ovarian response potential;
• Highlights major health issues that may affect ovarian function;
• Reduces anxiety related to fertility by providing a clear understanding of reproductive health.

Overall, determining ovarian reserve is an important step in assessing fertility and planning for future reproductive options. Despite its simplicity, this procedure provides invaluable information to both patients and specialists, enabling effective solutions to infertility issues.