Ovarian reserve test: what are the normal values?

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The study of the ovarian reserve can be done through different tests. The most common tests to measure the ovarian reserve are:

  • The recount of antral follicles by ultrasound
  • The assessment of basal endocrine markers such as FSH, estradiol, AMH or Inhibin B
  • Dynamic tests that study the ovarian response to certain drugs

In this article we will explain the main methods that are applied to know the ovarian reserve of a woman at a certain moment of her reproductive life.

Below you have an index with all the points that we will discuss in this article.

Index

Ovarian reserve test: What are the normal values?

Antral follicle count by ultrasound

The follicles are the ovarian structures where the ovules mature. In each menstrual cycle, a set of follicles starts the path of maturation, but only one of them will be able to reach the last stage and release a mature ovum in what we know as ovulation.

The stages through which the ovarian follicles pass are:

  • Primordial follicle
  • Primary follicle
  • Secondary or preantral follicle
  • Tertiary or antral follicle
  • Pre-ovulatory follicle or Graff follicle
Development of ovarian follicles

The antrum, which is the structure that is formed by the accumulation of fluid inside the follicle, allows the visualization of this in the ultrasound. Thus, by transvaginal ultrasound we can count the number of follicles in the antral phase (diameter between 2 and 9 mm).

This count gives us very valuable information about how the ovarian follicular reserve is.

To make a good assessment, it is advisable to perform this test in the follicular phase of the woman's ovarian cycle, that is, between the 3rd and 5th day of the cycle.

It is considered that the feminine cycle begins the day when menstruation falls.

This marker is one of the most accepted in assisted reproduction. In IVF cycles it even has a more predictive value than the basal values ??of the FSH hormone, which we will see below.

Ovarian volume is another ultrasound marker that can also provide information about the state of the ovary and its effect on fertility.

Like the number of follicles, the ovarian volume decreases with age. In fact, it goes from measuring 4.9 ml in the fertile stage to measuring 2.2 ml in the postmenopause.



Follicular reserve endocrine markers

The ovarian cycle of the woman is controlled by hormones (endocrine system). Therefore, the analysis of the values ??of certain hormones involved in the development and maturation of the ovules can be helpful when studying the ovarian reserve to analyze the status of a woman's fertility.

The main hormones that are measured are:



Follicle-stimulating hormone (FSH)

As the woman's age increases, her ovarian reserve decreases and the value of FSH (follicle stimulating hormone) increases.

FSH levels should be measured between the 3rd and 5th day of the menstrual cycle. A level of FSH above 10 mIU / ml indicates a low ovarian reserve.

You can read more about the follicle-stimulating hormone in this article: What is FSH?

Antimüllerian hormone (AMH)

AMH is a glycoprotein that is expressed in women from puberty until they reach menopause. Its levels decrease as the woman's age increases.

Unlike the FSH, the AMH can be measured at any time during the cycle and, for many, it better reflects the ovarian reserve. In fact, it is one of the preferred analyzes to study the egg reserve of women. Also, it is a good measure of the patient's response to fertility treatments and their possibility of pregnancy.

Analysis of antimüllerian hormone

AMH levels between 0.7 and 3.5 ng / ml are considered normal. Levels below 0.7 ng / ml are associated with a decreased ovarian reserve.

It is used as an additional test when the results of FSH are inconclusive. If you want more information about it, you can read this article: What is the function of the anti-Müllerian hormone?

Inhibin B

The inhibin B concentration is inversely proportional to the FSH values. Its serum determination is a good indicator of the functioning of the follicles and the ovarian reserve.

A value of inhibin B less than 35-40 pg / ml is an indicator of poor prognosis, since it reveals alterations in the ovarian reserve and a poor response to in vitro fertilization treatments (IVF).

Estradiol

The measurement of estradiol is also done in the first days of the menstrual cycle (between the 3rd and 5th day). Most of the estradiol is secreted by the preovulatory follicles of the woman.

Normal values ??of estradiol at the beginning of the cycle are less than 40 pg / ml. The fact of having a low ovarian reserve with high values ??of estradiol at the beginning of the menstrual cycle has been related. In any case, the value of estradiol is not one of the best markers for the study of ovarian reserve.

Dynamic tests

The response of the ovary to the stimulation of drugs such as clomiphene citrate (CC) or GnRH analogues is evaluated.

Clomiphene citrate test stimulates the ovary with clomiphene citrate for 5 days, usually after the third or fifth day of the cycle. The response of the ovary is then assessed by ultrasound and hormonal controls. An abnormal result of the test, such as very high FSH, indicates a poor prognosis in relation to pregnancy.Test of GnRH analogues are measured changes in serum estradiol between the second and third day after administering an analogue agonist of the GnRH. In a normal result (good ovarian reserve), the basal levels of estradiol appear high due to the medication administered.

Ovarian reserve and fertility

One of the main causes of female infertility is age, as the ovarian reserve decreases with increasing age of the woman, especially after 37 years.

Decrease in ovarian reserve with age

The reduction in the number of antral follicles observed in the ultrasound, as well as a change in the values ??of female hormones (estradiol, FSH, antimülleriana hormone and inhibin) are the main indications that fertility has decreased.

The results obtained through the aforementioned tests help to predict, to a large extent, the ability of women to achieve a pregnancy naturally.

These tests are also a great help to know, with enough reliability, the probability of success of fertility treatment, since they help to obtain information about the response of the patient to the treatment of ovarian stimulation applied in the majority of assisted reproduction techniques ( eg artificial insemination and in vitro fertilization)

When the examination of the ovarian reserve shows a very low number of ovules, also associated with the decrease in quality, it is usually recommended to resort to the donation of ovules to achieve pregnancy. In this link you can find detailed information on this: What does egg donation consist of?

We must bear in mind that this type of test gives an idea of ??the status of a woman's ovarian reserve at a certain point in her reproductive life, but does not indicate 100% the probability of pregnancy.

It is essential to combine this type of evidence with other studies of female fertility that help to assess with greater certainty the reproductive potential of each woman before indicating the need for a specific treatment of assisted reproduction.

Prices

Fertility studies for women cost around ? 120-450 depending on the tests that are included.

In the most basic, a vaginal ultrasound is performed to assess the ovarian reserve and observe the uterus. Others also include hormonal analysis to see how the ovary works and the possible imbalances of the menstrual cycle.

The determination of antimülleriana hormone is considered a separate analytical and, therefore, it makes the study of fertility expensive if requested.

Assisted Reproduction ORG collaborates with several clinics to offer you the best price in fertility studies. In addition, you can request a first visit to inform you without obligation and then decide if you want to carry out the study.

Some of these discounts also include the hormone AMH. You have them below: Discounts in female fertility studies.

Questions from users

What do I have to do to know my ovarian reservation?

To know the ovarian reserve you must go to a fertility and assisted reproduction specialist to make a detailed study of the ovarian reserve. To analyze your egg reserve, it will mainly do an ultrasound (to count the antral follicles) and a blood test (to measure the hormones that we have cited in the section Follicular endocrine bookmarks within this article).

Can I be a mother if I have a decreased ovarian reserve?

Yes, it may be difficult to achieve natural pregnancy, but assisted reproduction offers several solutions. Among them, we found in vitro fertilization with a previous cycle of ovarian stimulation.

On the other hand, in the most serious cases in which the ovarian reserve is very low, egg donation is perhaps the most appropriate reproductive solution.

Is it recommended to make an artificial insemination if I have low ovarian reserve?

Generally, artificial insemination is not recommended when the woman has a low number of ovules, since the chances of success are low. The usual thing is to perform an IVF, although it will depend on the results obtained in the assessment of the ovarian reserve in each case.

Recommended reading

We have commented on some of the main hormones indicative of ovarian reserve. If you want to know other hormones related to female fertility and their normal values, I recommend you consult this article: Normal values ??of female sex hormones.

As we have seen, the ovarian reserve test is one of the main tests to analyze the fertility of women. However, there are others that can complement the study of the ovarian reserve. Do you want to know what they are? Discover them here: Fertility tests female.

Finally, I recommend reading this article to know in more detail what is the ovarian reserve and its influence on fertility: What do we understand by 'ovarian reserve'?


embryo donation in Malaga(Spain)

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