The ovarian reserve is the ovaries’ capacity to produce eggs after stimulation. The ovarian reserve is linked to a woman’s age, remaining stable until the age of 35 and gradually decreasing from then on. The ovarian reserve will depend on each individual case, which is why it must be tested in all women with sterility problems.

Factors that affect ovarian reserve

What does ovarian reserve depend on?

A woman’s ovarian reserve is genetic. All follicles that a woman uses during her reproductive years are produced during embryonic development.

During the first phase of the ovarian cycle, several follicles are recruited, so eventually one is selected that causes ovulation. The remaining recruited follicles are lost and thus the ovarian reserve gradually decreases until menopause begins.

There are circumstances that can reduce a woman’s ovarian reserve. Particular attention should be paid to any type of ovarian surgery and the use of certain medications, such as chemotherapy drugs. For this reason, a conservative approach to ovarian surgery is recommended and should be avoided if possible. In the case of chemotherapy, it is recommended to freeze eggs if possible, since in many cases these treatments completely destroy the ovarian reserve and stop any possibility of achieving pregnancy with their own eggs.

How does age affect ovarian reserve?

Age is the most important factor related to ovarian reserve, which remains stable until the age of 35 and gradually decreases from there. It is always important to test a woman’s ovarian reserve regardless of her age, as we can find young women with low ovarian reserves and women over 40 years of age with normal ovarian reserves.

Markers for ovarian reserves

Anti-Müllerian hormone (AMH)

AMH is a hormone produced in the ovary that represents the amount of follicles available. It allows us to evaluate both the low ovarian reserve and the risk of overstimulation during treatment. It has the advantage that it can be determined at any time during the cycle.

Antral follicle counting by ultrasound

The antral follicle count is performed at the beginning of the cycle and shows us the follicles that are ready to respond to hormone stimulation in this cycle. Its advantage is that it can be easily performed by ultrasound during the consultation.

FSH and basal estradiol

FSH and basal estradiol evaluation is always performed at the beginning of the cycle and both hormones must be determined to evaluate ovarian reserve. Its disadvantage is that it must be performed at a certain point during the cycle. Although their values may vary between cycles, the prognosis is determined by the highest FSH level.

Hormone stimulation of the ovaries

The results of the tests for ovarian reserve must be considered indicative and examined as part of the patient’s clinical history. Despite these ovarian reserve markers, the most reliable way to determine them is to subject the ovaries to hormone stimulation.