What is ovarian reserve and why does it matter? Simply put, it’s testing to assess your fertility potential. Should you get your ovarian reserve tested? The answer is a resounding yes for anyone who is having trouble getting pregnant or anyone with risk for factors for which could potentially lead to a decrease in the number of eggs such as family history of early menopause, history of ovarian surgery or chemo/radiation therapy. There are a number of non-invasive tests you can have to determine your ovarian reserve. While there’s no way to reverse diminished ovarian reserve, there are many fertility treatment options your doctor can offer you. Read on for more information about ovarian reserve testing from Melvin Thornton, MD of CT Fertility in Trumbull, CT.
Ovarian Reserve Basics
Women are born with all the eggs they will ever have. When a woman starts puberty, around age 12 for most women, she has about 200,000 eggs. By the time she reaches menopause, at about 50 years old, all of her eggs are gone. If ovulation proceeded steadily from puberty to menopause–without being interrupted by birth control pills or pregnancy–the majority of women would ovulate approximately 500 eggs.
The eggs that aren’t ovulated all die naturally via a process called atresia. The most dramatic decrease in egg numbers occurs in women over the age of 35 years old. At this time, there aren’t any treatments to improve ovarian reserve or restore egg numbers. Ovarian reserve is primarily determined by genetics, however some external factors such as prior ovarian surgery, some chemotherapy agents, pelvic radiation, and smoking can speed egg loss. In regards to egg quality your age will determine your egg quality. The younger you are the better your egg quality will be.
Ovarian Reserve Testing
There are many non-invasive tests that can be performed to determine your ovarian reserve, a few are mentioned below. Your doctor at CT Fertility will advise you as to which is right for you.
- Anti-Mullerian Hormone (AMH) is produced by cells in developing eggs, aka follicles and is related to the number of eggs. Measuring AMH can provide useful information when it comes time to decide the best course of fertility treatment, and it’s also helpful in diagnosing PCOS.
- Day 3 FSH: The pituitary is the area of the brain that produces follicle stimulating hormone (FSH). When ovarian function starts declining FSH values increase in an attempt to stimulate the ovary to mature eggs. Normal FSH values are below 10. If yours is above 10 on cycle day 2 or 3, it may indicate a decline in your ovarian reserve.
- Clomid Challenge Test (Clomiphene Citrate Challenge Test): An extension of the Day 3 FSH test, this blood test measures levels of the hormone obtained on day 2 or 3 of your cycle. The test involves taking 100 mg of clomiphene citrate orally per day on cycle days 5 through 9. Your FSH is checked again on day 10, if it’s higher than 10 on either day 3 or day 10 it’s generally considered abnormal.
- Resting (Antral) Follicle Count: A transvaginal ultrasound is performed to count the number of resting/unstimulated ovarian follicles at the start of your period. It’s important to know what’s going on with your follicles as fertility medications may be less effective for those with a low number of resting follicles.
- Ovarian Volume: Ovarian volume may start to decline as ovarian function does. A transvaginal ultrasound is used to do a 3D study of ovarian volume.
PCOS & Ovarian Reserve Testing
September is National PCOS Awareness Month and I would be remiss in not mentioning the relationship between PCOS and ovarian reserve testing. Polycystic Ovarian Syndrome (PCOS) is a condition that can significantly affect a woman’s ability to have children. Women with PCOS typically experience missed or irregular periods, signs of androgen excess such hirsutism and acne along with small ovarian cysts. They may also have high levels of androgens, hormones that are typically thought of as male hormones despite the fact that women also produce them.
The cause of PCOS isn’t known. Some of the common symptoms include:
- Hirsutism (increased hair growth on the face, back, stomach, chest, thumbs, or toes
- Ovarian cysts
- Irregular menstrual periods
- Male-pattern baldness or thinning hair
- Acne and/or oily skin
- Weight gain or obesity
- Thick dark brown or black patches of skin on the thighs, arms, neck, or breasts
Anti-Mullerian Hormone (AMH) is produced by cells in developing eggs, aka follicles. As the follicles mature into eggs, they stop producing AMH. Measuring AMH can provide useful information when it comes time to decide the best course of fertility treatment, and it’s helpful in diagnosing PCOS.
If you’re having trouble getting pregnant, ovarian reserve testing is an important tool in finding your most successful path to parenthood. Schedule an appointment today to learn more about which fertility treatment options may be best for you. Contact Melvin Thornton, MD of CT Fertility at 203-373-1200 to set up your initial consultation.