One way is through scan assessment to see the number of follicles in both of the ovaries. This is a test to see how many follicles we have in both of the ovaries in terms of the follicles we can work with during the next two or three month and these are the group of follicles that the body will use to select the dominant one every month. This is the first indication of how fertile a woman is and usually we are satisfied when we can see 10 to 15 follicles in both of the ovaries. But of course the number of visible follicles has to do with the deposit of the ovaries. The deposit of the ovaries has to do with the follicles that are less than 6 millimeters. Follicles that we can not visualise over the scan are less than 4 millimeters usually. So these follicles are producing the Anti-Müllerian hormone.
This is why another test in order to give us a more complete view on how fertile a woman is, is the Anti-Müllerian hormone because this hormone can show us how many follicles remain and we cannot visualise them over the scan. So it’s the hormone produced from these little follicles and there is another test which can complete the antral follicle count. One other test is the baseline FSH which we would usually perform between day 2 to 4 of the cycle and it is not a good predictor according to the evidence that we have. The best predictor seems to be the AMH and the antral follicle count and of course the FSH can have more fluctuations than the other 2 tests. This is why most of the inclinations don’t rely on the FSH in order to have a prediction about the outcome of the fertility treatment. The level of FSH that is considered to be related to poor egg quality is more than ten, when we measure it from day 2 to 4 of the cycle, but as I have mentioned before it is not a good predictor of the outcome of fertility treatment anymore.
Ovarian reserve is a facility assessment so it’s tested by a blood test and that blood test measures the amount of ovarian hormone, Anti-Mullerian hormone, in the blood and then that test comes back and it has a reference range for your age and that way we’re able to tell whether it’s high or low. The higher the number, the better but it should always be done in conjunction with other tests – not just on its own but also with an ultrasound scan as well, to be able to count the number of follicles on each ovary and if that’s low as well, it gives the doctors a much better idea but like I said, fertility isn’t black and white – there’s lots of shades of grey, so I will see women have got low AMH but they still going to produce some eggs during IVF.
Way of measuring our ovarian reserve is by three different ways or three different topics: one is our AMH level which will speak more about quantity than quality but of course it includes both. There’s another way by doing an Antral Follicle Count which is a scan and translational scan to count the number of a small oocytes that a patient can have in her ovaries and the other one is by her age, of course women older than 35 years old will be of worse prognosis.
Ovarian reserve is tested in many different ways. The two best measures of ovarian reserve is the Antimüllerian hormone which is a hormone that reflects the number of eggs that we have in storage. Another method is the antral follicle count which is measuring the follicles on an ultrasound scan which again represents the number of eggs within the ovaries. Another non-medical way of measuring the ovarian reserve, with of course a less accuracy, is the age: simply the age of a woman is likely to predict the ovarian reserve that she will have. From all the tests to date the best insight we can have is from the AMH the antral follicle count and the combination of the age.
