Ovarian Reserve - Do You Know Your Egg Count?

At birth, a woman’s ovary has millions of eggs but only 30,000 survive till puberty.¹ And, as a woman's age progresses, these numbers continue to decline.¹ However, the good news is that this reservoir of eggs, commonly called ovarian reserve, can be measured easily. Let us learn more about it in detail below. 

What Is Ovarian Reserve And Why Do We Measure It?

Ovarian reserve refers to the number of eggs present in a woman’s ovaries that are capable of fertilization to achieve a successful pregnancy. But, if the quality & quantity of oocytes (eggs) decreases, it is termed as a low ovarian reserve. And, here’s when the ovarian reserve tests can help in providing an estimate of the remaining follicular pool (a small sac that contains egg). ^2,3,4

However, according to studies, it is seen that low ovarian reserve is associated with:³

• poor ovarian response to ovarian stimulation (fewer eggs retrieved during IVF)
• increased cycle cancellation rate and
• decline in pregnancy rate during the IVF treatment

Hence, in many fertility clinics, a woman undergoes ovarian reserve tests as a part of the evaluation before beginning IVF.⁴

Tests To Measure Ovarian Reserve

To measure the ovarian reserve, both biochemical and ultrasound imaging tests are performed such as:²

Biochemical Tests²

• Anti-Mullerian Hormone (AMH) - It is a glycoprotein that is involved in the regulation of follicle development⁵
• Early follicular phase levels of Follicle Stimulating Hormone (FSH) - FSH is a hormone secreted by the pituitary gland that helps regulate the menstrual cycle and stimulates the ovaries to produce eggs⁶
• Early follicular phase levels of Estradiol (E2) - It is a hormone made by the ovaries and crucial to regulate the menstrual cycle⁷
• Early follicular phase levels of Inhibin B - A hormone that can reflect low ovarian reserve⁸

Ultrasonographic Tests^2,4

• Antral Follicle Count (AFC) - Indicates the number of antral follicles (a small sac that contains an immature egg) remaining in the ovary

Out of the above tests, the most commonly used are Follicle Stimulating Hormone (FSH), Estradiol (E2), Anti-Mullerian Hormone (AMH), and Antral Follicle Count (AFC).² Let’s have a look at them in detail!

Follicle Stimulating Hormone (FSH) And Estradiol (E2)

The early follicular phase FSH along with estradiol is an indirect measure of ovarian reserve² and here’s the reason behind it!

Under normal conditions, enough estradiol and inhibin B is produced by the granulosa cells (small cells found inside ovaries). And, this usually takes place at the beginning of a menstrual cycle to keep FSH levels low. But, as the follicular pool (a small sac that contains egg) declines, the early follicular FSH is seen to increase due to low estradiol and inhibin B, which stops FSH production. Hence, a high early follicular phase FSH level indicates Diminished Ovarian Reserve (DOR).² 

So, to get an accurate interpretation of FSH, measuring the estradiol level at the same time is beneficial.²

Antral Follicle Count (AFC) 

Antral Follicle Count (AFC) is the number of antral follicles present in both ovaries and is a reliable predictor of ovarian response in IVF. They usually measure between 2-10 mm and can be monitored using vaginal ultrasound. AFC is useful to evaluate a woman's ovarian reserve as it is stable across menstrual cycles, but has a limited ability to predict pregnancy outcomes.² 

Anti-Mullerian Hormone (AMH)

Anti-Mullerian Hormone (AMH) is produced by the granulosa cells (small cells found inside ovarian follicles) and can indicate the number of growing follicles (tiny fluid-filled sacs that contain an immature egg) that can ovulate. AMH levels decrease with a woman’s advancing age, which strongly correlates with the remaining early antral follicles (a small sac that contains an immature egg). Hence, AMH is said to be one of the most promising screening tests for IVF couples and for women with a high risk of DOR.^2,9,10 

Another reason for AMH being the popular “ovarian reserve test” is that, AMH levels remain stable during the menstrual cycle in both normal and infertile women. It can thus act as a starting point for infertile couples and also help make decisions on the recommended therapy.^2,9

Adding It All Up!

If you’re facing fertility issues, the first step is to identify the root cause of your problem. And, ovarian reserve is one of the first things to consider when assessing your reproductive health. In order to get started and manage your fertility better, you can get your hormones checked. 

To begin with, you can check out LifeCell’s OvaScore kit, which will help you test your Anti-Mullerian Hormone (AMH) level plus 8 other hormones linked to your reproductive health. Additionally, you will also receive physician-reviewed results, a private online dashboard and a virtual consultation with experts!

So, if you still haven’t taken a call on where to get your hormones tested, 

then don’t wait any longer!

Order your OvaScore kit right away!