Your Guide to Ovarian Reserve: What it means and why it matters

Your Guide to Ovarian Reserve: What it means and why it matters

Featuring Dr Devora Lieberman, NSW Medical Director and Sydney CBD fertility specialist.

For many individuals considering their fertility options, assessing ovarian reserve, or the quantity of your remaining eggs, is a crucial step in making informed treatment decisions. Whether you’re having difficulty conceiving or want to consider freezing your eggs, assessing your ovarian reserve can provide valuable insights.

In this article, Dr Devora Lieberman will explore the methods available for evaluating ovarian reserve and highlight how they can better inform your decision-making.


What is your ovarian reserve?

Ovarian reserve refers to the quantity of an individual’s eggs (ova) that are stored in the ovaries. It’s a critical factor in a woman’s fertility and reproductive potential.

Understanding your ovarian reserve is essential when making decisions about family planning, fertility treatments, and assisted reproductive technologies as it can help plan for potential fertility treatments, if needed.


In what ways can we assess your ovarian reserve?

Assessment of ovarian reserve can assist in decision-making regarding fertility treatment and/or egg freezing and in managing expectations about the likelihood of success.

There are two ways to determine egg reserve:

  • Anti-Mullerian hormone (AMH) level test

An AMH test is a simple blood test that can be done at any time of the menstrual cycle. This test measures the concentration of Anti-Mullerian hormone, which is produced by the small follicles in the ovary that have not yet begun to develop into. These early-developing follicles are called antral and pre-antral follicles. As a result, the AMH level is reflective of the number of eggs (oocytes) remaining, decreasing in line with the age-related decline in follicle numbers. However, AMH levels do not measure the quality of the eggs, critical for successful outcomes.

A lower-than-expected ovarian reserve result may indicate that you need to consider your options for growing your family sooner, that further assisted fertility methods should be considered, or that you may require a larger dose of medication to stimulate follicle growth in IVF or egg freezing. Alternatively, a high ovarian reserve level may indicate polycystic ovaries.

  • Ultrasound imaging of the ovaries to evaluate the antral follicle count (AFC).

The AFC assessment involves a transvaginal ultrasound examination typically conducted on days five to nine of the menstrual cycle. During this procedure, ultrasound imaging is used to assess the total number of antral follicles present in both ovaries. Antral follicles are small, fluid-filled sacs that contain immature eggs. The count of these follicles serves as an indicator of your ovarian reserve.

Although AMH and AFC are markers of egg quantity, they do not reflect oocyte quality or predict the chance of conception or of having a live birth. As of yet, there are no biomarkers of egg quality.


The role of ovarian reserve assessment

This assessment can provide crucial insights into your reproductive potential and guide your decisions on family planning and fertility treatments. Here, we explore some of the key roles that ovarian reserve assessment plays in your fertility journey:

  • Fertility Counselling: Assessing ovarian reserve can also be an essential component of fertility counselling.  Your fertility specialist will often order an AMH test as a first step on your journey. They can use this information to understand your unique fertility situation better and explore your options.
  • Fertility Treatment Planning: Knowing your AMH and AFC levels can guide your treatment plan if you decide to proceed with fertility treatment. It helps optimise medication dosages and predict the likelihood of a successful response to ovarian stimulation.
  • Egg Freezing: If you’re considering freezing your eggs for future use, knowing your ovarian reserve can help determine the number of eggs that can be retrieved and preserved. This information ensures that you have a realistic expectation of the outcome.


Next steps

Assessing your ovarian reserve through AMH and AFC tests is a valuable step in your fertility journey. While these tests provide insights into egg quantity and your potential response to treatment, it is essential to note they do not reveal information about egg quality or guarantee success.

Remember that fertility is a complex and multifaceted journey, and while assessing ovarian reserve is a crucial aspect, it’s only one piece of the puzzle. Discussing the results of these tests with your fertility specialist to develop a personalised fertility plan that aligns with your goals and expectations is crucial.


To book an appointment or learn more about Dr Devora Lieberman, visit her profile.

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