Ovarian reserves include the current quantity of oocytes in the ovary and are clinically linked with ovarian response to stimulation. Determining ovarian reserves makes each woman aware of her chances of achieving pregnancy and helps to plan childbirth more effectively.
Ovary Reproductive Age
Women reach their fertility peak between the ages of 20 and 30 and their ovarian functions cease around the age of 50. Occasionally organ and system physiological functions may decline earlier. Certain diseases, such as malignancies, may also lead to reproductive system declines. The ovary is an organ that loses almost all of its reproductive and endocrinal function in the menopause. Studies show that one in ten women experience menopause before the age of 45, while in one in a hundred the menstrual cycle may stop before the age of 40.
Ovarian Reserve Testing
Determining Basal FHS Serum Levels
Follicle-stimulating hormone (FSH) basal values, which are easily determined, offer a good forecasting indicator of the likelihood of pregnancy in a natural or stimulated cycle. FSH serum levels above 12.5mIU/ml are linked with poor ovarian response to stimulation.
Determining Basal Values of Serum Inhibin B Levels
Inhibin В is a hormone secreted by the granulosa cells of so-called antral follicles in the ovary. Advancing reproductive age in women is linked with reduction in Inhibin В serum values. Inhibin B also participates in polycystic ovary syndrome (PCOS) pathophysiology.
Clomiphene Citrate Challenge Test (СССТ)
This test is based on the possibility of restoring the reproductive system after clomiphene citrate (CC) application. FSH values below 10IU/ml are normal, with values of 10 to 12IU/ml being borderline and values above 12IU/ml abnormal.
GnRH Agonist Challenge Test (GAST)
This test assesses estradiol (Е2) changes on the third day after applying GnRH agonist on the second day of the menstrual cycle. The results depend on hypophyseal production of gonadotropins and ovarian response to stimulation.
Gonadotropin Stimulating Ovarian Reserve Test (EFORT)
This test is based on the application of gonadotropins and on estradiol (Е2) dynamics as a function of ovarian response. Women whose Е2 rises by more than 30pg/ml have adequate ovarian response, while those whose Е2 levels are lower than 30 pg/ml do not.
Basal Serum Levels of Anti-Müllerian Hormone
Anti-Müllerian hormone (АМН) is produced by granulosa cells in preantral and lesser antral follicles and its levels may be established in the serum. АМН may be used as a marker of ovarian age. We may view ovarian structures as having a sound reserve where hormone values exceed 2ng/ml. Results between 1 and 2ng/ml show a trend to declining ovarian function. AMH values under 1ng/ml indicate significantly declining ovarian reserves.
- Testing the number of antral follicles (АFC) ultrasonically produces objective information on the ovarian reserve. The test is conducted at an early follicle phase (between the second and fourth day of the cycle), detecting follicles measuring between 2 and 10mm in both ovaries. Where the average number of antral follicles is under five, the ovarian reserve is significantly reduced.
- Determining the mean ovarian diameter (MOD). This is conducted in the early follicular phase (between the second and fourth days of the cycle). Values of mean ovarian diameter below 20.6mm indicate a greater probability of reduced ovarian reserves.