The progressive decline in female reproductive potential with increasing age has been well documented. It is generally accepted that this diminution relates principally to changes in oocyte quality. Women, with a depleted oocyte supply to the point that few oocytes remain that are capable of producing an offspring are said to have diminished ovarian reserve. While the progressive course of this diminution in reproductive efficiency is undeniable, the time in life when women go through the transition from fertile to infertile varies dramatically.
Evaluation of ovarian reserve has been the focus of much clinical research over the past several years. Assessment of ovarian reserve is valuable for determining stimulation protocols and predicting ART outcome. Many tests have been evaluated to predict cycle outcome. Although age is associated with ovarian reserve and responsiveness, age alone is a weak predictor of IVF success.
Various hormonal markers have also been used to predict ovarian response. Cycle day 3 serum levels of FSH, LH, and E2 and challenge tests have been studied. Cycle day 3 serum basal FSH level has been shown to be a better predictor than age alone in women undergoing IVF. Although hormonal determinations have inter- and intra-cycle variability, these variations in basal FSH values are not associated with changes in ovarian response to gonadotropins or pregnancy outcomes.
Despite their increasing acceptance in clinical practice, the tests have a variety of shortcomings, including a lack of predictive value of a normal result. Investigators therefore continue the search for other markers to identify patients whose ovarian reserve is insufficient for conception.
Evaluation of ovarian reserve has been the focus of much clinical research over the past several years. Assessment of ovarian reserve is valuable for determining stimulation protocols and predicting ART outcome. Many tests have been evaluated to predict cycle outcome. Although age is associated with ovarian reserve and responsiveness, age alone is a weak predictor of IVF success.