Updated on 8 October 2024
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) 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.
How to test your ovarian egg reserve
There are two ways to determine egg reserve:
- Anti-Müllerian 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. These are called antral and pre-antral follicles. As a result, the AMH level reflects of the number of eggs available in that cycle. AMH decreases in line with the age-related decline in follicle numbers.
AMH is often promoted as an ‘egg timer’ test, which is an unfortunate misnomer. It doesn’t predict the age of menopause and tells us nothing about the quality of eggs. AMH tells us where you sit relative to other individuals your age at a given point in time. So, a high level does not mean you’ll have no trouble conceiving in future, and a low level does not mean you will.
A low or high AMH for someone looking at freezing eggs or who is having difficulty conceiving will likely play a role in decision-making. If AMH is high, they may defer egg freezing or continue to try naturally. A high result may also indicate polycystic ovaries. Alternatively, if it’s low, they may decide to freeze eggs, or move to IVF sooner, particularly if they would like more than one child. It may also suggest the for a need higher dose of medication to stimulate follicle growth in IVF or egg freezing. AMH is a reasonable predictor of the number of eggs anticipated in a stimulated cycle, which has implications for the chance of success.
- 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 assesses 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 indicates your ovarian reserve.
It bears repeating that 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 testing
This assessment can provide insights into your reproductive potential in IVF or egg freezing and guide your decisions on family planning and fertility treatments. Some of the key roles that ovarian reserve testing 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 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.
Ovarian Reserve FAQs
What are follicles in ovaries?
Follicles are small sacs in the ovaries that contain immature eggs. Each month during ovulation, a follicle matures and releases an egg, ready for fertilisation.
How many eggs does a woman have?
Women are born with approximately 1 to 2 million eggs. However, the number declines over time, with around 300,000 to 400,000 remaining by puberty. Only about 400 eggs will be ovulated throughout a woman’s reproductive life.
