Ovarian Reserve Testing

What is ovarian reserve testing?

Ovarian reserve testing is a test healthcare providers use to evaluate your fertility potential. This means the results are interpreted as a comparison to people the same age as you. Ovarian reserve testing uses a blood test and a vaginal ultrasound to estimate your egg count. You’re born with all the eggs you’ll ever have in your life and you don’t make more during your lifetime. This is called your ovarian reserve. Your ovarian reserve naturally declines as you age. The results of ovarian testing help predict how well you’d respond to fertility treatment like IVF (in vitro fertilization).

It’s important to know that ovarian reserve tests can’t tell you with certainty how fertile you are, meaning it’s not able to predict if you’re able to get pregnant on your own. Your healthcare provider uses the results to determine the next steps in your treatment.

When should I have ovarian reserve testing?

Your healthcare provider may recommend ovarian reserve testing if:

• You have a health condition that may have affected your egg count, like cancer.
• You’re planning to start fertility treatments like IVF.

How do you know if your ovarian reserve is low?

The only way to know if you have a low ovarian reserve is to have a fertility evaluation from your healthcare provider.

How does ovarian reserve testing work?

Ovarian reserve testing is a predictor of fertility treatment success. It doesn’t predict egg quality (or the health of your eggs) or tell your provider how many eggs you have.

Ovarian reserve testing involves measuring follicle-stimulating hormone (FSH) and anti-mullerian hormone (AMH) with a blood test. A transvaginal ultrasound measures antral follicle count (AFC).

Follicle-stimulating hormone (FSH)

FSH is a hormone that controls the growth of eggs in your ovaries. Your pituitary gland (located in your brain) releases FSH to make a follicle grow in your ovary. A follicle is a small, fluid-filled sac that contains your eggs. These follicles release estrogen, which tells your pituitary gland to make more or less FSH. Your provider will measure FSH levels around the third day of your menstrual cycle.

Anti-mullerian hormone (AMH)

AMH is a hormone produced by the follicles in your ovaries. Your follicles contain your eggs, which means the higher the AMH level, the more eggs you’re estimated to have. AMH levels decrease with age because your egg count also decreases with age. Unlike FSH, AMH can be measured at any point in your cycle. AMH levels less than 1 nanogram per milliliter (ng/mL) may mean your supply is declining, it but doesn’t predict your ability to get pregnant.

Antral follicle count (AFC)

AFC is the portion of ovarian reserve testing performed by transvaginal ultrasound. It’s a way for your provider to count the number of follicles in your ovaries. Your follicles are where your eggs develop. Your provider will typically count your follicles in the first four days of your menstrual cycle.

It’s important to know that your healthcare provider uses your test results as just one data point among many others to gauge your fertility.

What factors affect ovarian reserve?

Many factors affect ovarian reserve. Your age is generally the biggest factor.

You’re born with all the eggs you’ll ever have. Some people are born with more eggs than others. By the time you start menstruating as a teenager, you’ve already lost millions of eggs. During a typical menstrual cycle, several eggs will grow in an attempt to be the dominant, mature egg that gets released during ovulation. So, even though your body releases one egg each month, it loses thousands of eggs per year.

The other factor healthcare providers consider is egg quality. Egg quality refers to the health of your egg.

Other factors that could cause your egg count to decrease are:

• History of ovarian surgery or an issue with one or both ovaries.
• Chemotherapy or radiation therapy.
• History of severe pelvic infections.
• Family history of early menopause.

Are there any risks of ovarian reserve testing?

No, there aren’t any risks to ovarian reserve testing. It’s a safe test that involves drawing blood from a vein in your arm and performing a transvaginal ultrasound.

What are the limitations of ovarian reserve testing?

Ovarian reserve testing provides insight into how you’d respond to fertility treatment, but it doesn’t tell the entire story. While ovarian reserve testing can be an indicator of egg count, it doesn’t tell your provider how healthy those eggs are. For example, a person could have normal ovarian reserves, but lower-quality eggs that don’t fertilize during IVF cycles. Once a person reaches 35, studies show egg quality also starts to decline.

There are other factors that affect fertility that are unrelated to egg count or quality. Healthcare providers perform ovarian reserve testing as a part of fertility testing to help them get a sense of your overall fertility.

When will I get my results?

Your healthcare provider typically has results from your testing within a week of the test being done. They’ll work with you on a treatment plan based on results from ovarian reserve testing and any other fertility tests you’ve had.

What do the results of ovarian reserve testing mean?

Your ovarian reserve testing results help predict your fertility potential and how well you’d respond to fertility treatment. It doesn’t tell you when you’ll conceive or exactly how many eggs you have left, but it can suggest if your egg supply is lower than other people your age.

No single fertility test can predict your ability to get pregnant or respond to fertility treatment. Results of all of your fertility tests, including ovarian reserve testing, are analyzed together. Your healthcare provider uses all of your test results to make a treatment plan that’s right for you.

How accurate are ovarian reserve tests?

Fertility testing is diagnostic and can’t predict exactly how many eggs you have, how long you have to conceive with your eggs or how long you have before you enter menopause. However, it’s the most accurate tool healthcare providers have at the moment.

When it comes to IVF treatment, ovarian reserve testing is important because your egg count and response to hormone medication are related to the success of ovarian stimulation.

What is a good number for ovarian reserve?

Normal ovarian reserve levels can vary between labs and healthcare providers, so you shouldn’t interpret or compare results without your provider’s help. It’s hard to assign a good score for an ovarian reserve test because each test measures something different. Instead, your provider will look at the result of each blood test and your ultrasound to determine if your ovarian reserve levels are within a normal range.

Can I increase my ovarian reserve?

No, you can’t increase the number of eggs you have. You’re born with all the eggs you’ll ever produce. But you may be able to impact the quality of your eggs. Lifestyle factors that could affect your egg quality include:

• Eating nutritious foods and taking vitamins.
• Getting enough sleep.
• Quitting smoking and avoiding alcohol.

How do I test my egg quality?

There isn’t a test that checks for egg quality. Ovarian reserve tests estimate the relative number of eggs remaining, but not how good the eggs are. You’ll only know your egg quality once IVF treatment begins.

A note from Cleveland Clinic

Ovarian reserve testing is one tool your healthcare provider may use to predict your response to fertility treatment. Many factors come into play when it comes to fertility treatment and getting pregnant. But there’s no magic formula to predict how successful fertility treatment will be or when your egg count will decline. Your provider can help you make decisions based on your goals for pregnancy. Discuss your concerns with your provider and don’t be afraid to ask questions about fertility testing and what your results mean.