Ovarian reserve tests - evaluation of egg quantity and quality

Female age is very important in consideration of probability for conception because it is very much related to egg quality.
A 45 year old can have good quality eggs (for her age) and still be fertile, although this is quite uncommon. At the other extreme, a 25 year old can have very poor quality eggs and be infertile - unless she uses donor eggs. These are extreme examples, but the point is that egg quantity and quality tends to decline significantly in the 30s and faster in the early 40s, but egg quantity and quality in an individual woman can be average for her age, better than average, or worse than average.

It would be nice to have a reliable test to determine how many eggs remain and how good the eggs are in an individual woman at a point in time. We do have some screening tests, however, they are far from perfect. These tests are often referred to as tests of "ovarian reserve". In other words, does the woman have a good number (reserve) of good quality eggs remaining in her ovaries?

Day 3 FSH (follicle stimulating hormone) and estradiol (E2) test

By measuring a baseline FSH on day 3 of the cycle, we can sometimes get an indication that the women is closer to menopause and has relatively less "ovarian reserve". Another way of saying this is that if the baseline FSH is elevated the egg quantity is reduced from what is expected.

Clomiphene challenge test

A clomiphene challenge test is a dynamic type of test that can discover some cases of poor ovarian reserve that are still showing a normal day 3 FSH. It is discussed on the day 3 FSH page.

Response of the ovaries to ovarian stimulation with injectable gonadotropins (FSH)

This is not really a "test" that we do to help us determine egg quantity and quality - it is part of a treatment for infertility. However, the response of the ovaries when the woman takes injectable FSH for stimulation is often very predictive of the egg quantity - and therefore, also the relative chances for success with infertility treatment.

Response to stimulation and antral follicle counts are important predictors of outcome, and are discussed in detail on another page.

Other provocative tests of ovarian reserve

We can also challenge the ovaries with drugs (hormones) and assess whether they have responded appropriately in order to distinguish women with good ovarian reserve from women with diminished reserve.

For example, the exogenous FSH ovarian reserve test involves giving an FSH injection on day 3 of the cycle and testing both the baseline FSH and baseline and 24 hour post-injection estradiol to see if a normal response has resulted.

If the estradiol response is poor, ovarian reserve and egg quantity are also likely to be poor. The woman is also less likely to be a "normal responder" to gonadotropin stimulation.

In vitro fertilization

This is a treatment for infertility, but at the same time it can give us much useful information about egg and embryo quality . By careful examination of the eggs and embryos during the in vitro incubation process we sometimes get clues about why pregnancy has not occurred previously.

For example, the eggs may demonstrate poor morphology, or may have problems with maturation, or with fertilization, proper cleavage, etc...

Treatment options for women with reduced ovarian reserve

In vitro fertilization

Lupron "flare" protocol for ovarian stimulation in low responders

In vitro fertilization with assisted hatching

In vitro fertilization with coculture

In vitro fertilization with donor eggs