Ovarian Reserve Testing

Before a woman can start to undergo infertility treatment, it is necessary for her receive different female infertility tests. While there are a variety of tests that can be administered, perhaps the most important female infertility test is ovarian reserve testing.

What Is It?
Ovarian reserve testing (ORT) is done to assess the function and quality of the ovaries. However, this is not the same as testing to see whether you are ovulating or not. It is possible to be regularly ovulating but have poor quality ovaries. By doing ORT, your fertility doctors can gain a better idea of how likely you are to get pregnant and which fertility treatments may be best for you.

Results from ORT fall into two categories: normal or poor. Receiving a diagnosis of normal ovarian reserve does not guarantee that you will become pregnant. It simply indicates that your ovaries appear to be working properly. However, a poor ovarian reserve is a good indication that pregnancy is unlikely to occur or that it will be exceptionally difficult to conceive.

Obviously, receiving a poor ovarian reserve result can be particularly upsetting to a couple as it means that their chances of conceiving are extremely limited. It is perfectly normal to have an emotional reaction to this news, whether it is anger, frustration, denial or even depression. However, it is important to remember that, by having ORT done, you can move forward in your quest to have a child with the knowledge that certain forms of infertility treatments and fertility drugs may not be helpful. This allows you to focus on those treatments which may offer some benefits to you or alternatives, like adoption.

Types of Ovarian Reserve Tests
There are a variety of tests that can be done to assess a woman’s ovarian reserve. While no test can be 100% accurate, some tests are more reliable than others. Tests that can give your specialist an idea of how your ovaries are working include the Day 3 FSH test and Day 3 Estradiol test. However, these tests give limited results.

More accurate and more commonly used tests for ovarian reserve testing include the clomid challenge test (CCT), ovarian volume assessment, and antral follicle count.

Clomid Challenge Test
This test is often viewed as the most accurate form of ORT. Like the Day 3 FSH test, CCT also measures FSH levels. However, rather than doing it just once during your cycle, it measures your levels twice. Because this test is more in-depth, women who have a normal Day 3 FSH test may be shown to have poor ovarian reserve through CCT.

The procedure for the test is fairly simply. On Day 2 or Day 3 of your menstrual cycle, you give a blood sample to have your FSH as well as estradiol levels measured. Starting on Day 5 of your cycle and continuing for five days, you take 100mg of clomid daily. On Day 10 or Day 11 of your menstrual cycle, you return to your fertility specialist to give another blood sample. Again, the FSH and estradiol levels are measured. Finding elevated levels of FSH on either Day 3 or Day10 of your cycle suggests that your ovarian reserve is poor.

Although a normal FSH level won’t ensure that you get pregnant, women who receive a poor result are more likely to:

  • Respond unsuccessfully to gonadotropins (injectable fertility drugs)
  • Have fewer eggs to retrieve during IVF
  • Have lower pregnancy rates in IVF as well as IUI
  • Miscarry
  • Have embryos with chromosome abnormalities

Ovarian Volume Assessment
For this test, your fertility specialist will use a transvaginal ultrasound to determine the volume of your ovaries. This is done by measuring the length, width and depth of each ovary. Because women’s ovaries become smaller as they age, the smaller a woman’s ovaries are found to be, the older she is in "reproductive age". For example, a 35-year-old woman whose ovarian volume is equal to 5mL would have a reproductive age of 40 (or ovarian quality equal to a woman who is 40-years-old). However, if the same 35-year-old woman had ovaries that measured 7mL, her reproductive age would be 30.

Not surprisingly, women with smaller ovaries tend to have a poorer response to infertility drugs compared to those women with larger ovaries. Having small ovaries may also have an impact on how successful IVF treatment will be for you.

Antral Follicle Count
This type of female fertility testing counts the number of egg follicles at the start of your menstrual cycle. The fewer follicles you are found to have, the more likely you are to have a decreased ovarian reserve. This type of ORT is an excellent way of determining a woman’s chance of success (or lack there of) with IVF.

In general, women found to have fewer than five egg follicles will likely not respond well to fertility medications and will have too few mature eggs for retrieval thereby making them unsuitable candidates for IVF. Women whose follicle count falls between 5 and 11 should discuss with their specialist whether or not it is worthwhile to undergo IVF. This is still a fairly reduced number of follicles although IVF may be successful for some.

If your follicle count is found to be between 12 and 30, then IVF is likely to be successful for you. Women who have more than 30 follicles developing are generally considered to be good candidates for IVF. However, the high number of follicles could indicate the presence of polycystic ovaries as well as the possibility of over stimulating your ovaries through the use of fertility medication. There may also be some egg quality issues that need to be looked into.


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