Reduced ovarian reserve

In many cases, the age of a woman is used as a basis for calculating how much time is left to have a baby.The age is surely helpful, however, it is only one parameter. Some women at the age of 41 are still highly fertile whilst others reach menopause as early as their 30ies.
Hence, we need the possibility to determine a woman’s „reproductive age“. The combination between the chronological age of a woman and the individual “age of an ovary” respectively “the ovarian reserve” becomes more and more important. There are already several tests that can help estimate the ovarian reserve:

FSH level on day 3

The follicle stimulating hormone (FSH) is an important hormone for the development of the ovarian follicle. It is especially crucial in the beginning of the monthly cycle in order to trigger the development of the follicle.

Eventually, the ovarian reserve of egg cells is depleted due to the continuous monthly cycle. The more follicles which have been used, the stronger the increase in the FSH levels at the beginning of the month.

Read more about FSH levels

FSH levels on day 1 – 4:

  • below 10: normal FSH levels. A positive response to hormonal treatment is to be expected.
  • 10 to 15: limited ovarian reserves. Diminished response to the hormonal treatment can occur; the rate of successful manipulations is already lower.
  • 15 to 20: very limited ovarian reserves: the response to hormonal treatment is extremely limited; the pregnancy and birth rate are strongly decreased.
  • above 20: depleted ovarian reserves: response to treatment minimal to non-existent. Hormonal treatment is not recommended anymore.

Important: Ovarian reserves correspond to the worst FSH levels. There is no sense, after measuring an FSH level of 18 units, to wait for a cycle of 9 in order to then begin the treatment. Regrettably, an FSH level below 10 does not mean that the treatment will be successful. Especially with advanced age the pregnancy rate is limited independently of FSH levels.

The Anti-Müllerian-Hormone (AMH)

The Anti-Müllerian hormone (AMH) is produced in the granulosa cells. These cells build the follicle in which the ovum matures. This hormone is produced mainly by the earlier stages of the follicle which have not been used up. Therefore, an evaluation of this hormone can be used to estimate the ovarian reserves. This hormone can be measured regardless of a particular cycle day.

The number of follicles is determined from birth onwards and decreases throughout life. The levels of AMH correspond to the amount of still available follicles and decrease with each passing year.

Borderline: if the AMH level decreases under 1 ng/ml (7 pmol/l), the ovarian reserve is limited.

Antral follicle count

Antral follicles can be identified, measured and counted at the beginning of the monthly cycle via an ultrasound of the ovaries. They are 2-8 millimeters in size.

Read more about the antral follicle count

  • 0 to 7: if there is only a maximum of seven antral follicles on both ovaries, this is an indication of strongly reduced fertility.
  • 8 to 11: first signs of reduced ovarian reserves
  • 12 to 14: there is no need to worry, however fertility may be reduced in foreseeable time
  • 15 and more: excellent ovarian reserves, no reduction of fertility can be detected

For an estimation of the antral follicle count a simple ultrasound examination through the vagina is sufficient.

Ovarian volume

The ovaries diminish slowly in size with the usage of ovarian follicles. This decrease of the ovarian volume can be used in combination with other tests (Antral Follicle Counts, Anti-Müller hormone, FSH day 3) in order to estimate the ovarian reserves.

The examination is simple and is conducted, as with the antral follicle count, via ultrasound at the beginning of the monthly cycle.