Ovarian Reserve Testing
Ovarian reserve testing is of crucial importance, because effective treatment of diminished ovarian reserve (DOR) starts with timely diagnosis. Timely diagnosis of this condition is more important than for other conditions, as once the ovarian reserve begins declining, it continues to decline with time. The sooner diminished ovarian reserve can be diagnosed, the sooner effective treatment can begin, and the sooner the treatment starts, the better the pregnancy chances are.
About Low Functional Ovarian Reserve
Ovarian Reserve Testing through Blood Tests
CHR can diagnose DOR relatively easily through follicle stimulating hormone (FSH) test and anti-Müllerian hormone (AMH) test. High FSH levels and low AMH levels indicate diminished ovarian reserve and the need for aggressive fertility treatment. FSH needs to be tested on day 2 or 3 of a woman’s menstrual cycle, but AMH can be tested on any day, as AMH levels remain steady throughout a cycle.
Interpreting Ovarian Reserve Test Results
While anyone can perform ovarian reserve testing via FSH test and AMH test, what’s important is the interpretation of these ovarian reserve test results. Traditionally, physicians have used universal cut-off values to determine who has diminished ovarian reserve and who doesn’t. The problem with that approach is that it ignores the natural, age-related change in FSH and AMH levels. This means that older women will have higher FSH and lower AMH than younger women and vice versa. This is why CHR physicians determined the age-specific “normal” FSH level and AMH level and use these age-specific levels to gauge each patient’s ovarian reserve.
Especially for younger women who may have premature ovarian aging (POA), it is crucial that their FSH and AMH levels are measured against age-specific FSH levels and AMH levels, rather than universal cut-off values. Otherwise, physicians may miss POA diagnosis, leading to inappropriate treatment and/or delays in POA treatment.
CHR Doesn’t Rely on Ovarian Reserve Ultrasound Testing
Some reproductive endocrinologists, especially physicians in Europe, utilize antral follicle count (AFC) to evaluate a patient’s ovarian reserve. AFCs refer to the number of antral follicles in the ovaries visible on ultrasound. This ovarian reserve ultrasound testing is not a test CHR physicians rely on heavily, because we have found that the AFC evaluations vary greatly between physicians and blood test results like FSH and AMH are much more objective and reliable when it comes to testing ovarian reserve.
After Ovarian Reserve Testing: DOR Treatment
Following diagnosis of DOR via ovarian reserve testing, we recommend that patients proceed to treatment as quickly as possible to maximize their pregnancy chances. Time is of the essence when it comes to fertility treatments for women with DOR, because once the decline sets in, it’ll continue to decline, along with pregnancy prospects. The sooner low ovarian reserve treatments can start, the better the pregnancy chances are.
As the center of last resort for women with DOR, CHR meets many women who have postponed treatment for DOR while "waiting for the FSH levels to come down" or while undergoing endless tests at other fertility centers. Unfortunately, without treatment, the chances of pregnancy after 40 can only get worse with time.
The same time-sensitivity applies to women with POA, whose ovarian reserve can deteriorate quickly. Not a day passes when we don't hear patients say, "Doctor, I wish I'd known about your center years ago, when I was doing such and such..."
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.