Who Needs Ovarian Reserve?
- Women over 35 years of age
- Smoking
- Previous ovarian surgery
- One ovary having
- Unexplained infertility
- Failure in previous infertility treatments
- Family history of early menopause
- Stage 3-4 endometriosis
- Chemotherapy, radiotherapy history
Tests Used for Evaluation of Ovarian Reserve
Basal serum FSH, E2 level: Serum E2 value measured on the 2nd-3rd day of menstruation < 80 pg/mL, FSH value of 5-10 mIU/mL indicates sufficient ovarian reserve. While FSH values between 10-15 mIU/mL indicate that the reserve is limited, FSH above this and E2 values > 80 pg/mL are associated with poor reproductive results.
Prolactin, TSH: Prolactin ovulation disorders, ejaculation from the breast and pituitary adenoma. TSH should be requested in patients with complaints of ovulation disorders or thyroid disease. Prolactin and TSH do not need to be requested in routine basal hormone evaluation, but in this case, forms that do not cause significant complaints can be skipped.
Clomiphene Citrate Challenge Test: After checking FSH and E2 levels on the 3rd day of menstruation, the 5th-9th day. 100 mg/day clomiphene citrate is administered between days. The aim is that clomiphene citrate increases the release of E2 by stimulating follicle development in the ovaries, and the increased E2 suppresses FSH. FSH level is repeated on the 10th day. An FSH level > 15 mIU/mL indicates that the ovarian reserve is insufficient. The fact that the FSH value is higher than normal on the 3rd day means that 85% of women, regardless of age, will respond poorly to ovulation treatments.
Antral Follicle Number: In the 3rd day evaluation with transvaginal ultrasonography, there are 4-10 cells with a diameter of 2-10 mm in the ovaries. Detection of menstrual antral follicles means that the ovarian reserve is good. If the number of antral follicles is < 4 (Grade I), the response to ovulation treatments is inadequate; if the number of antral follicles is between 4 and 6 (Grade II), the response to ovulation treatments is generally inadequate; if the number of antral follicles is between 7 and 10 (Grade III), the response to ovulation treatments is good. If the number is > 10 pieces (Grade IV), pol It is compatible with cystic ovary. Detection of ovarian cysts, endometriomas and polycystic ovaries during ultrasound examination has diagnostic value regarding infertility and also determines treatment planning.
Anti-Müllerian Hormone (AMH): AMH is released from the granulosa cells of preantral and early antral follicles, in the early period. It takes part in egg development. Serum levels give information about the ovarian pool. With increasing age, serum levels decrease due to the decrease in the follicle pool in the ovary and become undetectable in serum with menopause. Although there is no consensus on the appropriate threshold value, it is thought that ovarian reserve is good at values above 0.5 ng/mL, and at values below it, the follicle pool in the ovaries decreases. Values below 0.15 ng/mL are associated with a very poor response to in vitro treatment. Apart from determining the ovarian reserve, AMH can be used as a screening test in high-risk groups (familial early menopause, previous ovarian surgery, severe endometriosis, long and high dose smoking).
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