In the treatment of infertility, a number of tests are used to determine a woman’s fertility.
help is sought. One of the most important markers of a woman’s fertility potential is the ovary.
(ovarian) reserve. The purpose of ovarian reserve evaluation is to assess the
to be able to identify patients and guide them in the right way and if they want pregnancy
is to prevent a delay. The AMH level is also one of the best tests of egg reserve.
What is ovarian reserve?
Ovarian reserve refers to the number of follicles (eggs) in a person’s ovaries and, in part
Who is tested for ovarian reserve?
Women over 35 years of age who cannot conceive despite 6 months of regular unprotected sexual intercourse
or those with a family history of early menopause, some genetic disorders affecting the ovaries
diseases, endometriosis patients, patients with ovarian removal (oophorectomy),
in patients undergoing ovarian surgery (such as ovarian cyst), chemotherapy and radiotherapy
It is appropriate to evaluate ovarian (ovarian) reserve in smokers.
Is ovarian reserve related to age?
The number of follicles (eggs) in a woman’s ovary and the quality of the eggs are the most important determinants.
The important factor is the age of the person. Women’s eggs develop in the womb and last a lifetime.
they carry these eggs. When a woman is born, she has about 1-2 million eggs,
After childbirth, these eggs do not multiply, but rather become fewer and fewer with age. Every menstrual cycle
one egg matures and is released from the ovary. Sometimes more than one is released. Menopause
Towards the end of menopause, the eggs start to run out. Too few eggs in a menopausal woman
What are other factors that reduce ovarian reserve?
Endometriosis (chocolate cysts) can affect ovarian reserve. Pregnancy
If desired, surgery of endometriosis (chocolate cyst), especially in the ovary, with ovarian (
ovarian (ovarian) reserve will decrease, so surgical treatment should be avoided as much as possible before pregnancy.
should be avoided and medication should be tried.
Radiotherapy and chemotherapies: Due to the effects of chemotherapy and radiotherapy on the ovaries
the option of egg freezing can be considered beforehand.
Ovarian surgeries: Operations to remove ovarian cysts or operations to remove the ovary for cancer, etc.
Ovarian reserve will also decrease in operations where the ovary is removed due to cancer, etc.
Especially cyst operations should be performed with maximum care to protect the eggs.
is important in terms of ovarian reserve.
What are the tests that show ovarian reserve?
There is no test that shows ovarian reserve one hundred percent. Our most important parameter is age
However, the tests that best reflect ovarian (ovarian) reserve are the AMH test and
is antral follicle counting by ultrasound.
•AMH (Anti-Müllerian Hormone) Test
AMH (anti-müllerian hormone) is a hormone found in the ovary, each containing an egg
is a hormone produced by the follicles that host it. AMH level, ovarian
(ovarian) egg reserve is one of the best markers of egg reserve. AMH is the same marker
decrease much earlier than the increase, so that the ovarian reserve may be reduced earlier and
is a sensitive marker. AMH is similar to other ovarian hormone tests (inhibin B and
It is also more closely associated with ovarian reserve than estradiol.
The AMH test is a blood test and is performed at any time during the menstrual cycle.
can be done.
In women, AMH levels gradually decrease as the amount of eggs decreases with age.
decreases and is monitored at levels too low to be detected in menopause.
In women under 35 years of age, low AMH levels may indicate early menopause.
is a stimulating condition. Patients in this situation should not be alarmed if they want to get pregnant,
should get pregnant with proper planning under the supervision of a physician or, if necessary, undergo treatment.
they must start.
In patients with polycystic ovary syndrome, a large number of small eggs that fail to mature
AMH levels may be above normal due to the presence of AMH cells. Some
AMH is also elevated in ovarian tumors.
AMH level also determines the response to treatment in patients for whom IVF (in vitro fertilization) is planned.
is also a useful marker for prediction. If the AMH value is below normal, the egg
reserve is low, fewer eggs can be collected and IVF in these patients
the chances of getting pregnant with treatment are lower. But even very low AMH levels,
As with other tests, it does not indicate that conception is not possible. High AMH level
indicates a risk for problems related to ovarian overstimulation, in vitro fertilization
The doses of medication used in treatment are adjusted accordingly.
In IVF treatment, the AMH test is a valuable guide for the course of treatment.
The collection of a sufficient number of eggs is important for the success of IVF treatment.
AMH <0.5 ng/mL: ovarian reserve is very reduced, the chance of pregnancy is lower.
AMH <1.0 ng/mL: ovarian reserve is reduced, limited number of eggs can be collected.
AMH between 1.0 -3.5 ng/mL: sufficient number of eggs can be collected.
AMH >3.5 ng/mL: a large number of eggs can be collected.
Basal FSH (Follicle Stimulating Hormone) and Estradiol
Basal FSH and estradiol are measured in the blood on days 2-4 of menstruation. FSH values are measured every menstrual
cycle, so a single FSH value is not reliable.
If FSH levels are consistently high (>10-20 IU/L), this indicates that the ovarian
reserve is diminished. Likewise, high estradiol (>60-80
pg/mL) indicates decreased ovarian reserve.
Since high estradiol will decrease FSH level with negative feedback, basal FSH
The value must be seen together with estradiol.
-Antral Follicle Count
Transvaginal ultrasound on days 2-4 of the menstrual cycle, 2-10 mm in diameter
follicles are counted. Since the number of antral follicles does not vary much from cycle to cycle
is a reliable test and is directly proportional to the patient’s number of remaining follicles (ovarian reserve).
is assumed to be.
Ovarian volume decreases with age and can be measured by ultrasound. Ovarian volume
its value in demonstrating reserve is lower than antral follicle count
Inhibin B is a hormone secreted from preantral and antral follicles. For this reason
The value of inhibin B in the blood also decreases with age. Inhibin B levels decrease between cycles
Since it varies, it is nowadays recognized that ovarian reserve
is not used in the evaluation.
-Clomiphene Citrate Challenge Test (CCCT)
Variability of hormone values (FSH, estradiol, inhibin B) used in this test
the test can be derived from basal FSH (follicle stimulating hormone) measurement or antral follicle
is not more sensitive than the census and requires additional medication.
CCCT (clomiphene) is now routinely used to assess ovarian reserve.
Citrate Challenge Test) is not used.
Home fertility tests
These kits measure FSH (follicle stimulating hormone) in urine on day 3 of menstruation
is not recommended. It is not recommended that the patient be evaluated by a professional.
There is a risk of misdirection.
I have low ovarian reserve, can I get pregnant?
Although these ovarian reserve tests can determine when fertility will end
Although it cannot be predicted, women with very low test values should try to avoid losing the chance of pregnancy.
should not postpone their plans too long; if they are unable to conceive, they should seek infertility research and in vitro fertilization.
treatment should be started. As a result, it is recommended to treat patients with low ovarian reserve.
patients have a chance of becoming pregnant, even if their chances are reduced.
Women with a family history of early menopause have earlier ovarian reserves.
can become exhausted. While a normal woman has difficulty conceiving after the age of 40, this
For patients, this process can start 5-10 years earlier. These women become mothers at a young age
is the right option.
Before surgery, radiotherapy, chemotherapy procedures where ovarian (ovarian) reserve will decrease
egg freezing can be considered.
Today, there are studies showing that stem cells are also present in the ovaries. These
research is ongoing for the production of new eggs from cells and ovarian reserve
for women who have been reduced in the number of pregnancies they can conceive.