Ovarian reserve

Ovarian reserve is a term that is used to determine the capacity of the ovary to provide egg cells that are capable of fertilization resulting in a healthy and successful pregnancy.

[2] The ovary is generally thought of as an egg bank from which the woman draws during her reproductive life.

[4] Also, elevated androgen levels during prenatal development have an adverse effect on the early establishment of the ovarian reserve.

One additional contributory mechanism for the decline in the ovarian reserve with age appears to be a decreased gene expression of proteins involved in DNA repair by homologous recombination such as BRCA1, MRE11, Rad51 and ATM.

[5] Homologous recombinational repair of DNA double-strand breaks mediated by BRCA1 and ATM weakens with age in oocytes of humans and other species.

[6] Women who are 35 years or older who have attempted to get pregnant unsuccessfully for 6 months should undergo testing for ovarian reserve.

Although FSH and more recently Inhibin B have been shown to have some correlation with ovarian reserve, it is now well established that anti-Müllerian Hormone or AMH is more useful biochemical test.

High levels however can be present in women with Polycystic Ovarian Syndrome which compromises female fertility and therefore a combination of AMH and a transvaginal ultrasound to count the number of antral follicles is probably the best way to assess ovarian reserve and future fertility.