Ovarian Reserve

Ovarian reserve refers to a woman’s fertility potential. Every woman is born with a fixed number of eggs. Both the number and quality of eggs decrease with age. Fertility begins to decline significantly from a woman’s mid 30s, with a corresponding increase in miscarriage and other pregnancy complications.

There are also reasons (other than age) that can cause faster depletion of egg reserve – this includes ovarian cystectomy, history of chemo- or radiotherapy, or family history of premature menopause.

There are several ways available to measure one’s ovarian reserve. This include:

• Blood tests: The most common test performed in anti-mullerian hormone (AMH). AMH is produced by your ovarian follicles, and declines naturally with age. If your AMH is low, you may have low ovarian reserves (low egg count), but it doesn’t mean that your remaining eggs are poor quality. If you are going for in-vitro fertilisation (IVF), however, AMH can be used to decide on the dose you need for ovarian stimulation and predict the number of eggs you will produce (your response).

Some may also look at your follicle stimulating hormone (FSH) levels for further information. FSH is responsible for egg development. If it is high, your ovarian reserve may be low and your response to ovarian stimulation for in-vitro fertilisation (IVF) may be poor.

• Ultrasound scan: A transvaginal scan in the early part of your menstrual cycles counts the number of small follicles  (2-9mm) in your ovary. This is the antral follicle count (AFC), which gives an idea of ovarian reserve and predict your response to ovarian stimulation for in-vitro fertilisation (IVF).

It is important to note that there isn’t a single test of ovarian reserve that can predict a woman’s ability to get pregnant. They can give an idea of declining fertility potential, but does not give an insight to egg quality (which is tied to age – the single biggest determinant in your chances in getting pregnant). These tests however, can help your gynaecologist develop a plan for assisted reproductive techniques for you.