All you needed to know about Ovarian Reserve and its Testing

The science of fertility is complicated–and it’s about time that it gets mainstream attention. At IndoNippon IVF, we’re dedicating our lives to decoding this science – analyzing peer reviewed studies with reproductive endocrinologists (fertility doctors), OB/GYNs, lab clinicians, and reproductive psychologists while accelerating fertility research of our own. All women deserve to know how fertility science is progressing and how to use it to take inform decisions, as well as they also deserve to understand the limitations of ovarian reserve testing. Our first step to making the right fertility information more available and personal is to make this testing more accessible for women–much earlier in life.

What is Ovarian Reserve Testing?

There are simple hormone blood tests–specifically AMH and FSH  – that can measure ovarian reserve (or, how many eggs we have left). These hormone levels can give us a better sense of our fertility timeline, egg freezing and In Vitro Fertilization (IVF) outcomes, future red flags, and menopause onset, than just age.

AMH, or Anti Mullerian Hormone, is a hormone produced by cells inside our follicles (the little sacs that hold our eggs) that serves as a proxy for the amount of eggs we have left. The level of AMH our follicles create reflects the number of eggs we have “waiting in the wings.” FSH or Follicle-Stimulating Hormone, supports maturation of the follicle. If the body needs high levels of FSH to kick-start this maturation, it may be a sign of low ovarian reserve.

These tests have traditionally been used by reproductive endocrinologists to understand potential outcomes for egg freezing and IVF and to determine how much the ovaries need to be stimulated to collect eggs for each procedure. When we have broader access to this testing we have more data for decision-making.

What can Ovarian Reserve Testing tell us?

Most women need more information than just “can I get pregnant right now?” When tracked over time, this testing helps us understand our fertility timelines – which are as unique as our metabolisms. Ovarian reserve testing is also valuable in understanding when we’ll reach menopause and in assessing egg freezing and IVF outcomes. Let’s break these down:

  • Menopause onset: AMH can help us understand the likelihood of reaching menopause earlier than average. Doctors use high levels of FSH over a long period of time (along with the end of a period and other clinical factors) to confirm menopause and AMH levels are highly correlated with menopause timing. Studies also show that AMH is a better predictor of the age we’ll hit menopause than the age our mothers hit menopause. If we have a lower ovarian reserve than average we could hit menopause earlier than the average age of 51. It’s important to note, however, the effects of menopause may start around 35. AMH can help us understand the likelihood of reaching menopause earlier than average and therefore understand that window.
  • PCOS: AMH testing can also play a role in detecting other reproductive issues like PCOS–a hormonal disorder that can cause irregular cycles and other symptoms. PCOS is associated with high AMH and can have major implications for fertility if left untreated. This testing can help us detect it earlier.
  • IVF and Egg freezing: Egg count is directly correlated with success in egg freezing and IVF. Today, with almost 1:6 couples having trouble getting pregnant and women waiting until later in life to have kids, more women than ever are debating whether or not egg freezing is right for them. Outcomes with these procedures are tied directly to the amount and quality of eggs that a doctor can collect on any given cycle of treatment and AMH and FSH can help us understand the expected number of eggs that can be retrieved. Women with higher ovarian reserve are more likely to produce more eggs for collection.
  • Tracking and identifying red flags: They can also help us screen for red flags that can have serious implications for fertility.

Premature Ovarian Failure (POF) , also known as Primary Ovarian Insufficiency (POI), the early loss of ovarian function, affects 1 in 100 women. POF or POI occurs when a woman’s reserve of eggs are depleted at an early age (usually before 40) or when her ovaries are dysfunctional. Both these factors could lead to premature menopause and infertility. It’s important to note that some women with POF (POI) may still ovulate.

FSH and, increasingly, AMH are used to diagnose POF. AMH is a particularly useful marker for POF because it is secreted by developing follicles, and thus levels of AMH correspond proportionally to ovarian reserve. Low AMH is a red flag for POF because it could indicate that one has fewer eggs than average. A simple AMH blood test can help identify if someone is at risk for POF earlier in life. AMH levels can also predict the chances of a live birth for women with POF.

Both POF and DOR, Diminished Ovarian Reserve, can greatly impact the likelihood of a healthy pregnancy, egg freezing and IVF outcomes, and can have implications for bone, heart and sexual health throughout a woman’s lifetime. Early detection is essential for proactive treatment and planning.

Ovarian Reserve Testing is a great first step, but the bottom line is: we need more research that tracks healthy women throughout their lives in order to understand every nuance of fertility. Such hormone testing procedure provides valuable data points that can help us understand how our fertility changes over time.

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