A doctor may recommend ovarian reserve testing if a person has difficulty conceiving. These tests can provide an overall picture of a person’s fertility and help guide an individual’s decisions.
Doctors recommend testing for people over 35 who have not fallen pregnant within 6 months of trying to conceive, people with PCOS, and those preparing to undergo IVF or egg freezing.
Some commonly used tests are in the form of simple blood tests. Others require an ultrasound to closely examine a person’s ovaries.
Read on to learn more about ovarian reserve testing, the different types of tests, the limitations, and more.
Ovarian reserve testing aims to measure how many eggs a person has.
Females are born with a finite number of eggs, known as the ovarian reserve, and this number decreases gradually throughout life. Egg quality also decreases as people age, so the likelihood of falling pregnant gradually lowers throughout a person’s life.
If someone is having difficulty getting pregnant, their doctor may recommend ovarian reserve testing to asses how many eggs they have left.
There is a range of tests used. Some of the most common ones include:
- antimüllerian hormone (AMH)
- follicle-stimulating hormone (FSH)
- antral follicle count
These tests, explained in more detail below, can provide useful data that can inform a person’s decision on when to start trying to conceive. However, they cannot definitively tell how many eggs or fertile years a person has.
A doctor may recommend ovarian reserve testing to people who:
- are over 35 years of age and have not been able to conceive for 6 months or more
- are under 35 years of age and have not been able to conceive for 12 months or more
- want to know how long they can delay pregnancy
- have fertility conditions such as polycystic ovary syndrome (PCOS)
- are planning to go through IVF, egg freezing, or both
Historically, doctors have used ovarian reserve testing to predict outcomes in people undergoing IVF. However, healthcare professionals are using them more often in the general population to assess fertility.
Research has shown that AMH is the best predictor of menopause timing, so AMH testing can help a person know how much time they have left before menopause. While testing cannot provide definitive information regarding the number of eggs a person has, it can give people an overall picture of their fertility.
This can help people who are planning to delay pregnancy, and those with conditions such as PCOS, make informed decisions regarding their fertility.
There is a
Antimüllerian hormone (AMH)
AMH is a hormone that the ovarian follicles produce, which are small sacs of fluid in the ovaries. AMH levels link to the number of eggs a person has.
To test AMH, a healthcare professional will draw blood and send it to a lab for testing. They can perform this test at any point in the menstrual cycle. AMH testing is generally considered one of the more reliable ways to evaluate ovarian reserve.
Follicle-stimulating hormone (FSH)
FSH is a hormone produced in the pituitary gland and correlates to the age of a person’s ovaries. It helps to regulate a person’s menstrual cycle and the production of eggs.
As FSH levels can vary significantly throughout a person’s menstrual cycle, a healthcare professional will usually draw blood for this test on day 3 of the cycle.
While it can provide valuable information, its constantly changing levels make it somewhat unreliable. Doctors usually prefer AMH and AFC tests when checking ovarian reserve.
Antral follicle count (AFC)
AFC measures the number of ovarian follicles up to 10 millimeters. Generally speaking, the more follicles, the larger the ovarian reserve.
To perform this test, a healthcare professional use a transvaginal ultrasound. They will use a small probe inserted into the vagina to look closely at the ovaries.
Like FSH, estradiol is a hormone that fluctuates throughout the menstrual l cycle.
Healthcare professionals usually do these two tests at the same time on day 3 of the cycle via a simple blood test.
While it is not as effective as some other tests, elevated estradiol levels may indicate a diminished ovarian reserve. Doctors usually use this test in combination with other tests to get an overall picture of fertility.
Clomiphene Citrate Challenge Test (CCCT)
A CCCT measures FSH and estradiol both before and after clomiphene exposure. Clomiphene is a medication that inhibits the effect of estradiol on the hypothalamus. Measuring both levels before and after exposure can give doctors valuable information.
To perform this test, a healthcare professional will draw blood on day 3 of the menstrual cycle, prescribe 100 milligrams of clomiphene to be taken on days 5 through 9, and draw blood again on day 10.
Although fertility testing can provide valuable information about the number and quality of a person’s eggs, it cannot provide a definitive answer as to how many eggs a person has, when they will be able to get pregnant, if they will be able to get pregnant, and at what age they will no longer be able to get pregnant. In addition, fertility tests do not provide reliable information on the egg’s quality.
Instead, people should use this information as a general overview of a person’s fertility. This is particularly true if the individual is
Individuals should talk with a healthcare professional about their fertility and family planning goals to determine which tests will provide valuable information to achieve those goals.
Ovarian reserve testing can give a person and their medical team valuable insight into a person’s fertility. Typically, doctors recommend testing for people over 35 who have not fallen pregnant, people with PCOS, and those preparing to undergo IVF or egg freezing.
Some commonly used tests include AMH, AFC, and estradiol. While these tests can be useful, they provide general information rather than definitive answers regarding a person’s fertility. A person should discuss with a doctor which tests may be best for them.