The evaluation of ovarian reserve is, along with other factors, important in determining a woman’s reproductive capacity. This evaluation should be performed routinely in the same way as a clinical interview to determine which contraception is most appropriate for the patient or the examination for early detection of cervical cancer during a general gynecological visit.
At our centre, we encourage both patients and professionals to routinely assess their ovarian reserve and not wait until they are trying to get pregnant to begin this assessment. In this way, we can prevent some of the fertility problems in the future for these patients, who in many cases postpone motherhood without being aware of their decreased reproductive capacity.
What is it?
Ovarian reserve refers to the ovary’s capacity to produce eggs, which fertilize and generate embryos. This capacity decreases progressively with the woman’s age. Therefore, the older the woman, the lower the number of her eggs and their quality, and the greater the number of abnormalities in her chromosomes (genetic material). In this way, the probability of having children decreases, increasing in turn the percentage of miscarriages. Although this decrease in ovarian reserve is progressive during the woman’s life, it is true that it generally becomes more pronounced after the age of 35, with another important turning point after the age of 40, with the possibility of having a healthy child in women over 45 years of age becoming less than 1%, even if the patient continues to have regular cycles.
How is it evaluated?
In most cases, the assessment of ovarian reserve is done in the context of a gynecological visit. Generally, after the clinical interview, we rely on two tests to estimate the capacity of the ovaries to perform their function:
– Gynecological ultrasound: preferably at the beginning of the menstrual cycle, a transvaginal ultrasound is used to count the antral follicles of the ovaries. These are the follicles that are a few millimeters in size (2-10 mm) and are recruited by the ovaries in each cycle. These are follicles that could potentially produce oocytes or eggs if stimulated with hormones.
– Blood hormone analysis: basal hormone (ideally performed on day 3 of the cycle) where the value of FSH (Follicle Stimulating Hormone), LH (Luteinizing Hormone) and Estradiol is quantified. An abnormally high FSH value can be a sign of ovarian aging, an alteration in the percentage of other hormones can also be suggestive of problems in the normal cycle, PCOS (Polycystic Ovary Syndrome) or ovarian failure. Another interesting analysis is that of the Anti-Mullerian hormone or AMH. This hormone is secreted by the cells of the ovarian follicle and is one of the best reflections of the ovarian reserve. The lower the stock of oocytes, the lower the AMH levels. There are also studies in which low AMH levels are directly related to poor oocyte quality.
These tests, together with different factors such as age, medical history and physical examination of the woman, can give us an approximate idea ofthe woman’s reproductive capacity.
It should be noted that obtaining valuesthat indicate a good ovarian reserve does not guarantee pregnancy, since other factors also come into play in this matter, such as the fallopian tubes, the uterus and its endometrium, as well as the characteristics of the semen.
What to do in case of problems?
If altered results are detected in the ovarian reserve tests, it is advisable to go to a specialist in Human Reproduction, who can provide better guidance on the case in order to know all the alternatives according to whether or not the woman wants to become pregnant. There are numerous techniques that can help in different cases to achieve pregnancy in the present or future. These may include, among others, Fertility Preservation, Artificial Insemination, In Vitro Fertilization, ICSI or Egg Donation.
Please do not hesitate to tell us about your case or come in for an assessment of your ovarian reserve.