A new approach to ovarian reserve testing

Abstract

Objective-To critically examine ovarian reserve testing prior to assisted reproduction. Design-A PUBMED computer search to identify relevant literature. Setting-Multiple sites Interventions-Testing for ovarian reserve Main Outcome Measures-IVF and pregnancy outcomesResult(s)-The prevalence of ovarian insufficiency varies significantly for women aged 30-45 years. Generalization or averaging of threshold values across different aged women leads to very poor sensitivity, specificity, and positive predictive value for all tests of ovarian reserve. Because of the changing prevalence of ovarian insufficiency, there is no single, suitable threshold value for any screening test of ovarian reserve. Our analysis supports dividing impaired ovarian reserve into two groups: age-dependent ovarian aging (physiologic) and premature (non-physiologic) reductions in the oocyte pool. Interpretation of any screening test used requires that age is considered as a variable. To guide clinical interpretation of test results, we suggest using a nomogram of FSH values versus expected delivery rate-per-cycle-start with ART for a given age. Conclusions(s)-Proper interpretation of screening tests for ovarian insufficiency in couplesconsidering ART is important since the presence of impaired ovarian reserve is associated with a low likelihood of pregnancy. The condition of premature (non-physiologic) ovarian insufficiency warrants additional research. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. More than 100 years ago, population studies clearly documented a decrease in fertility with increasing age (1). In today's culture of widely available birth control and workforce equality, women often delay child-bearing to pursue a career. As a result, the childbearing age for women has been delayed from the 20's to the 30's and even into the early 40s (2). This societal shift has resulted in an increase in the number of women who are interested in fertility and have regular cycles, but who are subfertile due to a reduction in their oocyte (egg) supply. Recognition of the profound adverse effect of a reduction in oocyte supply on fertility led to the concept of ovarian reserve and the moniker of 'Diminished Ovarian Reserve' (DOR (5,13,14). NIH Public AccessThe pathophysiology associated with the age-related reduction in fertility (1) is a reduction in the oocyte pool accompanied by an increase in FSH due to reduced feedback from estrogen and inhibins (15). There are also reduced levels of hormones such as anti-Mullerian hormone (AMH) (16). Theoretically, in some women the reduction in the oocyte po...

Elevated day 3 FSH/LH ratio: a marker to predict IVF outcome in young and older women

“…It has been suggested that diminished ovarian reserve in younger women may be more reflective of quantity, rather than quality of oocytes [4,14,15]. Abdalla et al [14] demonstrated that although younger cycling patients with high FSH had significantly lower number of oocytes collected and lower number of available and transferred embryos, their pregnancy rate was significantly higher than older women with normal FSH.…”

“…They may continue to be otherwise asymptomatic for several more years and they have been classified as "early ovarian ageing" [2]. It is necessary to distinguish this separate group of patients from the physiologic ovarian ageing for proper interpretation of ovarian reserve screening tests and altering stimulation regimens [4].…”

Relative expression of genes encoding SMAD signal transduction factors in human granulosa cells is correlated with oocyte quality

“…These have included: early-follicular-phase blood values of FSH and estradiol, antral follicle counts (AFCs); inhibin B levels in serum and follicular fluid, and anti-Müllerian hormone (AMH) levels [42,43]. Although some studies have demonstrated these factors to be associated with oocyte quantity [44,45], some but not all have been associated with oocyte quality and fertilization potential [44,45].…”

Genetic associations with diminished ovarian reserve: a systematic review of the literature

“…It is expected that her risk of DOR varies directly with increasing age. Therefore, we regard the age-related type of DOR as physiologic DOR [20]. Other causes of DOR, such as autoimmune and idiopathic, will be superimposed on this physiologic DOR and may thus be considered pathologic DOR, because they reflect abnormal ovarian aging [20].…”

“…Therefore, we regard the age-related type of DOR as physiologic DOR [20]. Other causes of DOR, such as autoimmune and idiopathic, will be superimposed on this physiologic DOR and may thus be considered pathologic DOR, because they reflect abnormal ovarian aging [20]. Stated differently, pathologic DOR reflects a process that accelerates the normal physiologic decline in ovarian function with age.…”