What is Ovarian Reserve and why is it important for Fertility Testing?

Ovarian reserve is the term used to describe the ability of a woman’s ovaries to produce eggs that will ultimately produce a baby.  Age is an important determinant of ovarian reserve, but ovarian reserve can be severely affected even in younger women. This decline in ovarian reserve can occur due to surgery, smoking, cancer treatments, or simply a woman’s genetic make-up.  To assess a woman’s ability to achieve a pregnancy, ovarian reserve tests help to measure important components of the reproductive system.

While there are many tests that evaluate ovarian reserve, there is no clear measure that applies to all women at every age.  These tests should be considered as a part of a larger assessment that incorporates the patient’s age, response to previous treatment, and other factors.  I typically review many factors when assessing a woman’s health and chances of achieving a pregnancy.

There are now many different treatments available for infertility.  However, a woman’s  options for treatment become more limited as she ages and ovarian function declines. Some problems can be corrected surgically.  Conservative hormonal therapies (such as clomiphene citrate or gonadotropins combined with intrauterine insemination) can be effective for younger women (usually under age 40), but these options are typically less effective in older women.

In Vitro Fertilization (IVF) was first introduced more than 30 years ago and continues to be the most effective therapy for women who hope to conceive using their own eggs.  However, the live birth rate with IVF drops off considerably in women after age 40. Unfortunately, there is no treatment currently available that can restore or improve a woman’s egg quality (ovarian reserve).  For that reason, women should be treated with the most effective options as early in their reproductive years as possible to have the very best chance of success.

While pregnancy rates are low for women with abnormal ovarian reserve who try to become pregnant using their own oocytes, these women can consider other options such as oocyte donation. With oocyte donation, a woman with normal ovarian reserve donates her eggs to be used to help a couple achieve a pregnancy. This treatment option can make it possible for women to experience pregnancy and childbirth regardless of her ovarian function.  Oocyte donation results have relatively high success rates for women treated during her reproductive years, regardless of age. This again demonstrates the important role that egg quality plays in helping women to achieve a successful pregnancy at any age.

While there have been many important advances in our ability to treat infertility, the reality is that a woman’s chance of achieving a pregnancy that results in a live birth will decline with age.  In addition, there is a great deal of variability in the time that individual women experience this inevitable decline in fertility.  For this reason, the evaluation of ovarian reserve is important for all women having difficulty conceiving.  Some treatments can help women to improve their chances of success, but no treatment can stop or reverse the aging process.  While oocyte donation is often an effective option, a woman will have her best chances of success when fertility problems are discovered and treated as early as possible.

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