CASE Your patient wants ovarian reserve testing. Is her request reasonable?
A 34-year-old woman, recently married, plans to delay attempting pregnancy for a few years. She requests ovarian reserve testing to inform this timeline.
This is not an unreasonable inquiry, given her age (<35 years), after which there is natural acceleration in the rate of decline in the quality of oocytes. Regardless of the results of testing, attempting pregnancy or pursuing fertility preservation as soon as possible (particularly in patients >35 years) is associated with better outcomes.
A woman is born with all the eggs she will ever have. Oocyte atresia occurs throughout a woman’s lifetime, from 1,000,000 eggs at birth to only 1,000 by the time of menopause.1 A woman’s ovarian reserve reflects the number of oocytes present in the ovaries and is the result of complex interactions of age, genetics, and environmental variables.
Ovarian reserve testing, however, only has been consistently shown to predict ovarian response to stimulation with gonadotropins; these tests might reflect in vitro fertilization (IVF) birth outcomes to a lesser degree, but have not been shown to predict natural fecundability.2,3 Essentially, ovarian reserve testing provides a partial view of reproductive potential.
Ovarian reserve testing also does not reflect an age-related decline in oocyte quality, particularly after age 35.4,5 As such, female age is the principal driver of fertility potential, regardless of oocyte number. A woman with abnormal ovarian reserve tests may benefit from referral to a fertility specialist for counseling that integrates her results, age, and medical history, with the caveat that abnormal results do not necessarily mean she needs assisted reproductive technology (ART) to conceive.
In this article, we review 6 common questions about the ovarian reserve, providing current data to support the answers.
Continue to: #1 What tests are part of an ovarian reserve assessment?