Ovarian Reserve Testing

Get a greater insight on your fertility

Ovarian reserve denotes the number of good eggs left in a woman’s ovaries. As the age increases the number of antral follicles decline, as a result of which the serum Anti-Mullerian Hormone (AMH) drops.

Several studies reveal that women are blessed with 1 million oocytes (eggs) in their lifetime. But on a typical menstrual cycle, a woman on an average is expected to lose 10-30 eggs every day. On the other hand, the fertility of eggs gradually declines after mid-thirties till menopause, where the ovarian reserve is left with only 100-500 eggs per ovary.

Secondarily, eggs in the ovarian reserve are not of the same quality. In fact, few oocytes in ovaries are not capable of attaining pregnancy. Of these produced ones, not many are genetically normal, as these will either die in embryo or not fertilize with sperm. Ovarian reserve testing identifies potential abnormal reasons for the decrease in such ability to producing healthy eggs.

Other factors affecting fertility can be irregular ovulation or the dramatic change in hormone levels. Many ovary count tests and follicle count tests for regular ovulation are based on the measures of these hormones.

We understand that trying to get pregnant in the late thirties, or after ovarian surgery can be a frustrating scenario. If worried, the simple ovarian fertility test gives an indication of the remaining of oocytes and the possibilities of conceiving. The best test for ovarian reserve is carried out by analyzing several factors affecting the fertility egg count including Age, Follicle Stimulating Hormone (FSH), Antral Follicle Count (AFC), and Anti-Mullerian Hormone (AMH). This egg reserve test is carried on the early days of the ovulation cycle, before the full flow.

Factors affecting the ovarian egg reserve:

Female Age

The age factor in women plays a vital role in calculating the probability of a healthy pregnancy. The modern trend of females wanting to start their family late is increasing the fertility problem. The fertility is expected to decline slowly in the twenties and rapidly in thirties. At forty, there is a significant decrease in the quality and quantity of eggs. But same is not the case for everyone, few couple faces the issue of infertility due to various reason beside age. Although advance treatments for infertility is introduced, women still have to undergo ovary egg count test to figure out the significant factor confining the success.

Anti-Mullerian Hormones (AMH) Test

AMH is considerable for the woman throughout their childbearing period to figure out the number of left-over eggs. AMH is secreted by follicles, and AMH ovarian reserve test is a good practice adopted as a woman’s egg count test. AMH remains constant during the periodic flow, so the blood test for fertility eggs can be taken at any time throughout the month. However, this test is not appropriate for females under birth control pills.

AMH level evaluates the existing fertility status of a woman. Studies have shown that anti-mullerian hormones ovarian test verifies the ovarian egg reserve potentiality and the likelihood of conceiving. AMH declines over the child-bearing years and becomes undetectable after menopause. Generally, the result of AMH is concerned with a gaining situation of polycystic ovarian syndrome (PCOS).

Who can take the Anti-Mullerian Hormones (AMH) test?

Females interested to gain understanding regarding her ovarian reserve screening for future family planning.
A woman trying to conceive not less than six months, searching to understand the condition of their ovarian reserve according to their present age.
A woman approaching for IVF or other fertility tests. It is said that the AMH level in combination with Antral Follicle Count (AFC) & Pelvic Morphology Scan is a good predictor for IVF success.
Women who have faced intense chemotherapy or ovarian surgery and want to find out their fertility success.

Understanding the Anti-Mullerian Hormones (AMH) test result

During the first half of the ovulation cycle blood sample is collected to measure the AMH level. The presented report after the evaluation indicates the Normal, Low, or Raised AMH level.

AMH Level mg/ml	Interpretation	Expected Response to FSH	Cancellation rate with IVF	Pregnancy rate With IVF
>3.0	High, often PCOS	High	Low	Normal
1.0-3.0	Normal	Fair	Low	Normal
0.4-0.9	Low	Low	High	Low
<0.4	Very Low	Extreme low	Very High	Extreme low

High AMH (>0.3) and high FSC have a very low cancellation rate with IVF. In this case the anticipated pregnancy rate is normal with IVF.
Normal AMH (1.0-3.0) and fair FSC have a low cancellation rate with IVF leading to normal pregnancy.
Low AMH (0.4-0.9) and low FSC have a high chance of IVF cancellation with low conceiving rate.
Very low AMH (<0.4) and extreme low FSH has a high possibility of IVF cancellation with an` extreme low conceiving rate.

Day 3 Follicle-Stimulating Hormone (FSH)

It examines the FSH level present in the blood and urine. It is an important part of the reproductive system, as it is responsible for the development of ovarian follicles. The follicle produces estrogen and progesterone to maintain the menstruation flow in women while in men FSH forms sperms and gonads.

Who can take the Day 3 Follicle-Stimulating Hormone (FSH) test?

The FSH test can be taken by both the genders. It’s a simple egg reserve blood test, which determines the existing status of ovarian reserve. The ovarian baseline test is carried out on the 2, 3 or 4^th day of menstruation cycle.

Day 3 FSH Test for Women

In women, FSH test concentrates on the area such as:

Assessing the reason for the irregular ovulation cycle.
Assessing infertility problems.
Identifying ovarian diseases and pituitary gland disorders.

Day 3 FSH Test for Men

In men, FSH test is performed to:

Evaluate low sperm count.
Analyze gonadal failure and hypogonadism.
Examine testicular dysfunction.

Understanding the Day 3 Follicle-Stimulating Hormone (FSH) result

Day 3 Follicle-Stimulating Hormone (FSH)	Interpretation
Less than 20	Extreme low FSH. No response to stimulation.
16-20	Low FSH. Reduction in embryo quality, low response to stimulation, with a low birth chance.
13-15	Reduced FSH. Fair response to stimulation and embryo quality with IVF. Fair chances of pregnancy.
10-12	Normal FSH. Response to stimulation is slightly reduced, while there are normal chances of pregnancy.
<10	Above normal FSH and ovarian reserve stimulation is good with high chances of pregnancy.

The high FSH result indicates a reduction in the production of good quality eggs for fertilization. With the increasing age of women, fertility starts to decline. The FSH test may be used to figure out the other associated levels of the luteinizing hormone, progesterone, and estradiol. A high FSH level means the chances of getting pregnant are lower with the expected age.

In the case of men high FSH level indicates damage or absence of testicles due to high alcohol consumption or radiation treatments.

Low FSH level denotes the production of low-quality eggs in women and low count sperm generation in men.

Antral Follicle Count (AFC)

Antral follicles are tiny structures- just 2mm to 10mm wide- that can be seen by ultrasound on the early menstrual cycle. These follicles produce a higher number of hormones known as Anti-Mullerian Hormone (AMH), which circulates in the blood.

Antral Follicle Count is a test to check ovarian reserve. It is a transvaginal ultrasound study performed under the observation of fertility experts, who shall count the number of eggs containing follicles in both ovaries. So far AFC is accepted as an accurate mark in assessing the functional ovarian reserve, and for predicting response to gonadotropin stimulation with IVF.

Who can take the Antral Follicle Count (AFC) test?

This egg reserve test is done via transvaginal ultrasound in between the cycle day of 2 and 5. The ultra-sound tech shall monitor closely on the number of follicles at each ovary. For an IVF treatment, 8-15 follicles are considered as an acceptable amount. The physician may advise:

Evaluate ovarian reserves.
Make an analysis of primary ovarian inadequacy.
Diagnose polycystic ovarian syndrome.
Provide a general idea on the present fertility situation in accordance to the age.

Understanding the Antral Follicle Count (AFC) result

Antral Follicle Count	Interpretation	Expected Response to FSH	Anticipated Cancellation with IVF	Anticipated Pregnancy with IVF
<4	Extreme low	Extreme poor	Extreme high	Extreme low
4-6	Low	Poor	High	Low
7-10	Reduced	Reduced	Increased	Decreased
11-30	Normal	Good	Low	Excellent
>30	Good	High risks of hyperstimulation	Low	Fair

A high or very high number of AFC indicates a good stimulation of ovaries with a high chance of pregnancy.
A low to medium range of AFC indicates declining ovarian reserve with unpredictable ovarian stimulation, with less likelihood of conceiving.
A low antral follicle count in between 4-6 indicates low ovarian reserve with a high chance of failure in pregnancy. In IVF, high dose of ovarian stimulation medication is needed.
Female with low AFC is not recommended to use their own eggs for IVF, as their ovarian reserve fails to produce quality eggs.

Ovarian Reserve Testing is a valuable test to plan a healthy fertility, therefore, the ovarian reserve test costing depends on the individual treatment. To establish a better treatment plan, Vatsalya doctors shall examine many factors and start a comprehensive fertility evaluation. To know more about the ovarian reserve, contact us!