Ovarian reserve

Ovarian reserve

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.

What can I do if I have a low ovarian reserve?

Treatment for low ovarian reserve depends on the couple’s medical history, the results of the remaining diagnostic tests and, above all, the woman’s age. In cases of very low ovarian reserve where it is not possible to collect their own eggs, egg donation is the recommended treatment.

Aspects related to the ovarian reserve

You can find below the relevant different aspects related to the ovarian reserve.

Factors that affect the ovarian reserve
What does the ovarian reserve depend on?

A woman’s ovarian reserve is genetically determined. All the follicles a woman will use throughout her reproductive years are produced during embryonic development.

During the first phase of the ovarian cycle, multiple follicles are recruited so that one is finally selected that will cause ovulation. The remaining recruited follicles will be lost and thus the ovarian reserve gradually decreases until menopause begins.

There are circumstances that can decrease a woman’s ovarian reserve. Particular attention should be paid to any type of ovarian surgery and the use of certain medications, such as chemotherapeutic agents. For this reason, a conservative approach to ovarian surgery is recommended and it should be avoided, where possible. In the event of chemotherapy, it is recommended to freeze eggs wherever possible since, in many cases, these treatments end up completely destroying the ovarian reserve and stopping any possibility of achieving a pregnancy with their own eggs.

How does age affect the ovarian reserve?
Age is the most important factor related to the ovarian reserve, remaining stable until the age of 35 and gradually decreasing from then on. 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 the age of 40 with normal ovarian reserves.
Ovarian reserve markers
Anti-Müllerian Hormone (AMH)
AMH is a hormone produced in the ovary and represents the amount of available follicles. It allows us to evaluate both the low ovarian reserve and the risk of hyperstimulation during treatment. It has the advantage of being determined at any time during the cycle.
Antral follicle count by ultrasound
The antral follicle count is performed at the beginning of the cycle and shows us the follicles that are prepared 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 start of the cycle and both hormones need to be determined to evaluate the ovarian reserve. Its disadvantage is that it has to be performed at a certain point during the cycle. Even though their values can vary between cycles, the prognosis will be determined by the highest FSH level.
Hormone stimulation of the ovaries
The results of the tests on the ovarian reserve need to be considered as indicative and must be examined as part of the patient’s clinical history. Despite these ovarian reserve markers, the most reliable way of determining it, is by subjecting the ovaries to hormone stimulation.