| Egg quantity and quality tends to decline significantly | | | | quantity - and therefore, also the relative chances for |
| in the middle and late 30s and faster in the early 40s. | | | | success with infertility treatment. |
| Also, egg quantity and quality in an individual woman | | | | Response to stimulation and antral follicle counts are |
| can be average for her age, better than average, or | | | | important predictors of outcome, and are discussed |
| worse than average. | | | | in detail elsewhere. |
| It would be nice to have a reliable test to determine | | | | Anti-Mullerian hormone levels, AMH |
| how many eggs remain and how good the eggs are | | | | Blood levels of the hormone AMH are often used by |
| in an individual woman at a point in time. We do have | | | | fertility specialists as part of the evaluation of ovarian |
| some screening tests, however, they are not | | | | reserve. |
| perfect. | | | | Provocative tests of ovarian reserve |
| - These tests are often referred to as tests of | | | | We can also challenge the ovaries with drugs |
| "ovarian reserve". | | | | (hormones) and assess whether they have |
| - We are testing whether there is a good supply | | | | responded appropriately in order to distinguish |
| (reserve) of eggs remaining in the ovaries. | | | | women with good ovarian reserve from women with |
| Do ovarian reserve tests check egg quantity, quality, | | | | diminished reserve. |
| or both? | | | | For example, the exogenous FSH ovarian reserve |
| - Ovarian reserve testing can tell us quite a lot about | | | | test involves giving an FSH injection on day 3 of the |
| the remaining quantity of eggs a woman has, but it | | | | cycle and testing both the baseline FSH and baseline |
| tells us little about the quality of those eggs. | | | | and 24 hour post-injection estradiol to see if a normal |
| - Age is the best "test" that we have at this time | | | | response has resulted. |
| for egg quality. | | | | If the estradiol response is poor, ovarian reserve and |
| Day 3 FSH (follicle stimulating hormone) and estradiol | | | | egg quantity are also likely to be poor. The woman is |
| (E2) test | | | | also less likely to be a "normal responder" to |
| By measuring a baseline FSH on day 3 of the cycle, | | | | gonadotropin stimulation. |
| we sometimes get an indication that the women is | | | | In vitro fertilization |
| closer to menopause and has relatively less "ovarian | | | | This is a treatment for infertility, but at the same |
| reserve". Another way of saying this is that if the | | | | time it can give us much useful information about egg |
| day 3 FSH is elevated, egg quantity is reduced from | | | | and embryo quality. By careful examination of the |
| what is expected. | | | | eggs and embryos during the in vitro incubation |
| Clomiphene challenge test | | | | process we sometimes get clues about why |
| A clomiphene challenge test is a dynamic type of | | | | pregnancy has not occurred previously. |
| test that can discover some cases of poor ovarian | | | | For example, the eggs may demonstrate poor |
| reserve that are still showing a normal day 3 FSH. It | | | | morphology, or may have problems with maturation, |
| is discussed on the day 3 FSH page. | | | | or with fertilization, proper cleavage, etc. |
| Response of the ovaries to ovarian stimulation with | | | | Treatment options for women with reduced ovarian |
| injectable gonadotropins (FSH) | | | | reserve: |
| This is not really a "test" that we do to help us | | | | - In vitro fertilization |
| determine egg quantity and quality - it is part of a | | | | - Lupron "flare" protocol for ovarian stimulation in low |
| treatment for infertility. However, the response of | | | | responders |
| the ovaries when the woman takes injectable FSH | | | | - In vitro fertilization with assisted hatching |
| for stimulation is often very predictive of the egg | | | | - In vitro fertilization with donor eggs. |