Assessing ovarian reserve

• Female fertility is related to the ovarian reserve. Ovarian reserve declines from before birth until the menopause.
• The rate of embryo implantation decreases while the rate of pregnancy loss increases with age. There is a decline in IVF success rates from around age 35 years.
• A woman’s age is therefore the most readily measured surrogate for ovarian reserve and should be used as an initial predictor of her overall chance of success through natural conception or with IVF

The following can be used to predict the likely ovarian response to gonadotrophin stimulation in IVF:

1. Total antral follicle count measured by TV scan on day 3 of cycle ≤ 4 for a low response and > 16 for a high response
2. Anti-Müllerian hormone of ≤ 5.4 pmol/l for a low response and  ≥ 25.0 pmol/l for a high response
3. FSH > 8.9 IU/l for a low response and < 4 IU/l for a high response

The following should not be used on their own to predict any outcome of fertility treatment:

1. Ovarian volume
2. Ovarian blood flow
3. Inhibin B
4. Oestradiol levels