An ovarian reserve test provides insight into a woman’s remaining egg supply and potential reproductive lifespan. It helps understand how an individual’s egg count compares to others of the same age.
What is Ovarian Reserve?
Ovarian reserve refers to the quantity and quality of eggs remaining within the ovaries. Women are born with a finite number of eggs, stored in tiny fluid-filled sacs called follicles. This egg supply naturally declines throughout a woman’s life, significantly decreasing from fetal development to puberty. The decline in egg count accelerates as a woman ages, particularly after 35, influencing her fertility potential.
Understanding the Test
Assessing ovarian reserve typically involves a combination of blood tests and a transvaginal ultrasound. These tests provide different perspectives on the remaining egg supply.
One key blood test measures Anti-Müllerian Hormone (AMH). AMH is produced by the granulosa cells of small, developing follicles within the ovaries. Higher AMH levels generally correspond to a larger number of eggs, indicating a higher ovarian reserve. This test can be performed at any point in the menstrual cycle, as AMH levels remain relatively consistent.
Another blood test measures Follicle-Stimulating Hormone (FSH), often alongside estradiol (E2). FSH is a hormone released by the brain’s pituitary gland that stimulates the ovaries to mature eggs. These tests are typically conducted on day 2 or 3 of the menstrual cycle to provide an accurate baseline. An elevated FSH level can signal that the brain is working harder to stimulate the ovaries, suggesting a decreased egg supply.
The Antral Follicle Count (AFC) is determined through a transvaginal ultrasound. This ultrasound visually counts the number of small, fluid-filled sacs (antral follicles) in the ovaries, each containing an immature egg. AFC provides a direct estimate of the number of eggs that might respond to fertility medication and is often performed during the early part of the menstrual cycle.
Interpreting Your Results
Interpreting ovarian reserve test results involves considering each marker in context, often alongside a woman’s age and overall health. No single test definitively predicts the ability to conceive, but they collectively offer valuable insights.
For AMH, a higher level generally suggests a larger ovarian reserve, while lower levels indicate a diminished supply. Normal AMH levels for women of reproductive age often fall between 1.0 and 4.0 ng/mL. Levels below 1.0 ng/mL are typically considered low, indicating a limited ovarian reserve. Very high AMH levels can sometimes be associated with conditions like Polycystic Ovary Syndrome (PCOS).
FSH levels are interpreted in relation to the menstrual cycle day and age. An FSH level below 10 mIU/mL on day 2 or 3 of the cycle is generally considered normal, with lower levels indicating better ovarian function. Levels consistently above 10 mIU/mL suggest a reduced ovarian reserve, as the pituitary gland compensates for declining ovarian function. Elevated estradiol levels alongside high FSH can also indicate diminished ovarian reserve, as estradiol normally helps regulate FSH.
Regarding AFC, a count between 10 and 20 follicles is typically considered normal, suggesting a good ovarian reserve. A low AFC, generally less than 10, indicates a decreased ovarian reserve and may predict a poorer response to fertility treatments. A high AFC can sometimes be seen in women with PCOS. While AFC is a strong indicator of egg quantity, it does not assess egg quality, which is primarily influenced by age.
Implications for Fertility Planning
Ovarian reserve test results provide a snapshot of egg quantity, which can influence fertility planning and treatment decisions. These tests do not guarantee pregnancy or predict the exact timing of menopause, but they do offer a clearer picture of reproductive potential.
If test results indicate a normal or good ovarian reserve, this can be reassuring, but it does not eliminate other factors that might affect conception. For those with reduced or low ovarian reserve, the results may suggest a need to consider conceiving sooner. Such findings can also guide discussions about fertility treatments like in vitro fertilization (IVF) or options such as egg freezing. For instance, a lower ovarian reserve might mean fewer eggs retrieved during an IVF cycle, potentially requiring higher medication doses.
Conversely, a high ovarian reserve might indicate a strong response to stimulation, possibly yielding more eggs for IVF or egg freezing. However, very high levels might also increase the risk of ovarian hyperstimulation syndrome (OHSS) during treatment. Ultimately, these test results are a piece of the larger fertility puzzle, and consulting with a fertility specialist is important for personalized advice and planning.