Ovarian Reserve Testing
As women age, the number of viable eggs in the ovaries slowly decreases. Ovarian reserve testing helps to determine the health of the ovarian reserve and provides a general sense of the supply of remaining eggs. It is important to remember that ovarian reserve testing provides an estimate of the quantity of eggs. While a low ovarian reserve is generally correlated with a decrease in fertility, it does not indicate that the woman is infertile. Low ovarian reserve is, however, an indication that fertility treatments such as IVF have a lower chance of succeeding.
There are several ways in which ovarian reserve can be determined. A simple blood test can be used to measure follicle stimulating hormone (FSH) or anti-Müllerian hormone (AMH). Additionally, a transvaginal ultrasound may be used to visualize remaining developing follicles. The clomiphene challenge test (CCT) is useful in that it simultaneously evaluates ovarian reserve and the body's ability to respond to chemical fertility treatment.
Why would this apply to me? Should I have my Ovarian Reserve tested?
Almost all women that are having difficulty conceiving will undergo routine ovarian reserve testing. Although low ovarian reserve is a condition that generally affects women over 35, younger women may be at risk as well. Certainly all women that are pursuing treatment such as IVF or medicated IUI should be evaluated.
What can I expect?
Both FSH and AMH testing are done through a simple blood test. FSH testing is generally performed on cycle day 3 when estrogen levels in the body are low. This is important because estrogen works as a negative feedback mechanism for FSH production. Thus, for an FSH test to be meaningful, estrogen must be checked at the same time. Although there is some disagreement about normal values, FSH on day three should be below 10 mIU/ml. Levels of FSH between 10-15 mIU/ml are often considered borderline, with levels above 15mIU/ml indicating poor ovarian reserve.
AMH testing is more flexible and can be performed throughout the cycle. AMH levels are generally more stable, leading some doctors to prefer this test as a clinically useful indicator of ovarian reserve. Normal levels of this hormone decrease through life, but for women of reproductive age normal levels should be 1-10 ng/mL. Below 1 ng/mL indicates poor ovarian reserve.
In some cases, especially in women with PCOS, a transvaginal ultrasound will be performed to assess ovarian volume and presence of developing follicles. In this case a small ultrasound device is inserted into the vagina and emits sound waves into the abdominal cavity, allowing you doctor to visualize the ovaries. Again, there is some disagreement about how many developing (antral) follicles are normal, but most sources agree that normal values are 10 or more.
Clomiphene citrate testing (CCT) is a bit more complicated. During this procedure, a drug, clomiphene, is administered to the patient over cycle days 5-9 which causes the body to produce FSH which in turn stimulates the ovaries to produce more follicles. In a healthy, fertile woman, the recruitment of these follicles would result in an increase in estrogen production, which would cause FSH to decrease as part of the body's natural hormone feedback cycle. In women with poor ovarian reserve, normal follicle recruitment doesn't occur, and FSH levels remain high. This test is quite useful as it not only helps to measure ovarian reserve, but also indicates how well the ovaries respond to fertility drugs. Normal levels for the CCT are determined by testing the FSH on both day 3 and day 10. As with FSH testing, values below 10mIU/ml are considered normal.
What risks are associated?
While most testing procedures are generally risk free, there are more risks associated with CCT, as a potent fertility drug is being administered. Risks of using clomiphene are: visual disturbances which may be prolonged, ovarian hyperstimulation syndrome (OHSS), abdominal discomfort, metabolic disorders, multiple pregnancy, and increased risk of spontaneous abortion and congenital abnormalities if you do become pregnant. You should always ask your doctor about any other potential risks or side effects.
What costs are associated?
Costs for ovarian reserve testing will vary greatly from clinic to clinic. Some clinics offer testing for as little as $150, but others may charge in excess of $500 depending on which tests are used. Insurance may cover some testing, especially if fertility services are part of your plan. To find out more about costs, contact a qualified Ob-Gyn or REI in your area.
I had poor test results, what can I do about it?
If you're concerned about the results of your ovarian reserve testing, or if you'd like to learn how our programs can affect ovarian reserve or performance, and what options are available to you, schedule your risk free consult today.