Ovarian Reserve Testing: Purpose, Test Details & Results

Purpose of Ovarian Reserve Testing

Understanding ovarian reserve—the quantity and quality of remaining eggs in the ovaries—is a key concern for anyone considering their reproductive future. Ovarian reserve testing (ORT) aims to offer insight into a woman’s fertility potential and guide decisions about family planning, infertility treatments, and even certain medical interventions. Whether you are looking to start a family soon, are dealing with infertility, or want to know more about your reproductive lifespan, understanding the purpose of these tests can help you make informed choices about your health.

Table 1: Key Purposes of Ovarian Reserve Testing

Why Do We Test Ovarian Reserve?

The main driver behind ovarian reserve testing is the natural, age-related decline in the number and quality of eggs. This decline not only affects the chances of getting pregnant but also influences the success of fertility treatments such as IVF. Since women are born with all the eggs they will ever have—and these decrease over time—testing helps estimate how many eggs remain and their likely quality 1 4 6.

Who Benefits from Ovarian Reserve Testing?

• Women considering delaying pregnancy: ORT can provide valuable information about the remaining reproductive window.
• Couples experiencing infertility: Testing can aid in choosing the most effective fertility treatment and counsel on likely outcomes 3 5.
• Women facing medical treatments: Those about to undergo chemotherapy, radiation, or surgery that could impact the ovaries may use ORT to decide on fertility preservation 4 6.
• Women with irregular periods or suspected reproductive disorders: ORT can help diagnose and manage conditions like polycystic ovary syndrome (PCOS) or early menopause 4 6.

What Can Ovarian Reserve Testing Tell Us?

ORT provides estimates about:

• The likely response to fertility medications (poor, normal, or high responder)
• Potential for success with assisted reproductive technologies (ART)
• Remaining reproductive lifespan and time to menopause 4 6 7

However, it is important to note that while ORT can predict the quantity of eggs (the ovarian reserve), it is less reliable in predicting the quality of those eggs or the chances of achieving a live birth. Age remains a critical factor in overall fertility potential 1 5 7.

Ovarian Reserve Testing Details

Ovarian reserve is assessed through a combination of hormonal blood tests and ultrasound imaging. Each test has its own strengths, limitations, and ideal clinical uses. Understanding what these tests measure, how they're performed, and what their results indicate will help demystify the process.

Table 2: Common Ovarian Reserve Tests

Hormonal Blood Tests

Anti-Müllerian Hormone (AMH)

• AMH is produced by granulosa cells of small growing follicles.
• Levels decline with age and closely reflect the number of eggs remaining.
• AMH can be measured at any time in the menstrual cycle and is relatively stable, making it highly convenient 4 6.
• It is the preferred and most reliable biomarker for ovarian reserve testing, with strong predictive value for ovarian response during ART 2 4 6.

Follicle-Stimulating Hormone (FSH)

• FSH is measured on day 3 of the menstrual cycle.
• High FSH suggests diminished ovarian reserve.
• However, FSH levels can fluctuate and may be less reliable than AMH or AFC 1 3 4.

Other Hormones: Estradiol and Inhibin B

• These are sometimes measured alongside FSH to provide additional context.
• Elevated estradiol or low inhibin B may indicate reduced ovarian reserve, but these markers are less specific 1 2 4.

Ultrasound-Based Tests

Antral Follicle Count (AFC)

• A transvaginal ultrasound is used to count the number of small follicles (2-10 mm) in both ovaries, ideally on days 2-5 of the cycle.
• AFC strongly correlates with the actual number of primordial follicles and is considered highly informative 2 4.
• It helps predict ovarian response to stimulation and guides dosing in ART cycles.

Ovarian Volume (OVVOL)

• Measurement of ovary size via ultrasound.
• Has limited predictive value and is rarely used alone 1.

Ovarian Function Challenge Tests

Clomiphene Citrate Challenge Test (CCCT)

• Involves taking clomiphene citrate (a fertility drug) and measuring FSH before and after.
• Used when standard tests are inconclusive.
• Can identify women with diminished ovarian reserve who may otherwise have normal baseline results 1 7 9.

Practical Considerations

• AMH and AFC are preferred for their convenience, reproducibility, and specificity 4 6.
• FSH, estradiol, and inhibin B are supplementary but less accurate.
• No single test is perfect; results should always be interpreted alongside age and clinical context 1 5 8.

Ovarian Reserve Testing Results & Follow-Up

Once ovarian reserve testing results are in, what do they mean for your health, fertility, and next steps? Interpreting these numbers can be complex, as it involves understanding both the limitations and the actionable insights these tests provide.

Table 3: Ovarian Reserve Test Results & Clinical Implications

Interpreting the Results

A normal ovarian reserve indicates a standard probability of response to fertility treatments and an average timeline for natural conception, provided there are no other infertility factors. Low ovarian reserve suggests fewer remaining eggs, which may prompt quicker or more aggressive fertility interventions. High ovarian reserve, often seen in conditions like polycystic ovary syndrome (PCOS), can signal a risk for ovarian hyperstimulation during ART and requires careful management 4 6.

However, these results are not absolute predictors of the ability to conceive. While low reserve is associated with reduced chances for IVF success, it does not rule out natural pregnancy, especially in younger women. Conversely, good reserve does not guarantee pregnancy, as egg quality (which declines with age) remains crucial 1 5 7.

Limitations and Considerations

• Predictive Power: ORTs are better at predicting ovarian response to medication (how many eggs can be retrieved) than predicting live birth or natural pregnancy 1 5 7.
• Age Matters: Age is still the most important factor in fertility; test results must be interpreted in this context 5 7.
• Variability: AMH and AFC are more consistent between cycles, while FSH can vary due to hormonal fluctuations 4 6.
• Laboratory Standards: Different labs may use different assay methods, so results should ideally be interpreted using lab-specific reference ranges 7.

What Happens Next?

Depending on your results:

• Normal/High Reserve: Standard fertility planning, monitoring, or ART protocols are used.
• Low Reserve: Options may include expedited attempts at conception, consideration of egg or embryo freezing, or alternative family building strategies.
• High Reserve/PCOS: ART protocols may be tailored to lower the risk of ovarian hyperstimulation syndrome (OHSS).
• Unclear Results: Further testing or repeat assessments may be required to clarify the situation 1 4 5.

Counseling and Follow-Up

Results from ovarian reserve testing should always be discussed with a fertility specialist or reproductive endocrinologist. Counseling should address not only the test numbers but also personal goals, age, medical history, and emotional needs 4 5 7.

Conclusion

Ovarian reserve testing is a valuable tool in reproductive medicine, offering insight into a woman’s current fertility status and aiding decisions about family planning and fertility treatments. However, it is not a crystal ball—results must be interpreted thoughtfully and in the context of age and broader health.

Key Takeaways:

• Ovarian reserve testing provides estimates of remaining egg supply, guiding fertility planning and treatment 4 6.
• The most reliable tests are AMH and AFC, which outperform FSH and other markers in most situations 2 4 6.
• Results inform treatment protocols but are limited in predicting actual pregnancy outcomes; age remains the most critical factor 1 5 7.
• Test results should always be discussed with a healthcare professional for individualized counseling and next steps 4 5 7.
• Ovarian reserve testing is especially valuable for those considering ART, fertility preservation, or with specific reproductive health concerns 4 6.

Understanding your ovarian reserve is a proactive step toward informed, empowered reproductive health choices.