The Importance of Ovarian Reserve Testing
What is ovarian reserve and why does it matter? Simply put, it’s the number and quality of your eggs, and how well your follicles function. Both are critical to becoming pregnant.
Should you get your ovarian reserve tested? The answer is a resounding yes for anyone who is having trouble getting pregnant. There are a number of non-invasive tests you can have to determine your ovarian reserve. While there’s no way to reverse diminished ovarian reserve, there are many fertility treatment options your doctor can offer you.
Ovarian Reserve Basics
Women are born with all the eggs they will ever have. When a woman starts puberty, around age 12 for most women, she has about 200,000 eggs. By the time she reaches menopause, at about 50 years old, all of her eggs are gone or nonfunctional. If ovulation proceeded steadily from puberty to menopause–without being interrupted by birth control pills or pregnancy–the majority of women would ovulate approximately 500 eggs.
The eggs that aren’t ovulated all die naturally via a process called atresia. At this time, there aren’t any treatments to improve ovarian reserve or restore egg numbers. Ovarian reserve is primarily determined by genetics, however some external factors such as prior ovarian surgery, some chemotherapy agents, pelvic radiation, and smoking can speed egg loss.
Ovarian Reserve Testing
There are many non-invasive tests that can be performed to determine your ovarian reserve, a few are mentioned below. Your doctor at SIRM-NJ will advise you as to which is right for you.
- Day 3 FSH: The pituitary is the area of the brain that produces follicle stimulating hormone (FSH). When ovarian function starts declining FSH values increase in an attempt to stimulate the ovary to mature eggs. Normal FSH values are below 10. If yours is above 10 on cycle day 2 or 3, it may indicate a decline in your ovarian reserve.
- AMH: The cells surrounding the egg produce a hormone called anti-mullerian hormone (AMH). A blood measurement of this hormone can also give us an idea of remaining egg quality. High quality eggs give us measurement of AMH over 2. AMH can be done on any day of the menstrual cycle.
- Clomid Challenge Test (Clomiphene Citrate Challenge Test): An extension of the Day 3 FSH test, this blood test measures levels of the hormone obtained on day 2 or 3 of your cycle. The test involves taking 100 mg of clomiphene citrate orally per day on cycle days 5 through 9. Your FSH is checked again on day 10, if it’s higher than 10 on either day 3 or day 10 it’s generally considered abnormal.
- Resting (Antral) Follicle Count: A transvaginal ultrasound is performed to count the number of resting/unstimulated ovarian follicles at the start of your period. It’s important to know what’s going on with your follicles as fertility medications may be less effective for those with a low number of resting follicles.
- Ovarian Volume: Ovarian volume may start to decline as ovarian function does. A transvaginal ultrasound is used to do a 3D study of ovarian volume.
PCOS & Ovarian Reserve Testing
September is National PCOS Awareness Month and I would be remiss in not mentioning the relationship between PCOS and ovarian reserve testing. Polycystic Ovarian Syndrome (PCOS) is a condition that can significantly affect a woman’s ability to have children. Women with PCOS typically experience missed or irregular periods along with small ovarian cysts. They may also have high levels of androgens, hormones that are typically thought of as male hormones despite the fact that women also produce them.
The cause of PCOS isn’t known and there is no single test that can be used to determine if you have PCOS. Common symptoms include:
- Hirsutism (increased hair growth on the face, back, stomach, chest, thumbs, or toes
- Ovarian cysts
- Irregular menstrual periods
- Anxiety or depression
- Male-pattern baldness or thinning hair
- Skin tags (excess flaps of skin in the neck area or underarms)
- Sleep apnea
- Pelvic pain
- Acne and/or oily skin
- Weight gain or obesity
- Thick dark brown or black patches of skin on the thighs, arms, neck, or breasts
AMH is also helpful in diagnosing PCOD, as levels of AMH tend to be exaggerated in this condition.