Monday, 13 April 2020

Vol.4 April 2020 - Tests for Ovarian Reserve of Oocytes


Testing for the reserve of oocytes (eggs) in the ovaries is a key part of fertility investigations. The test result can dictate and direct the type of treatment required and the urgency with which treatment should be conducted.
A woman is born with a set number of eggs in her ovaries to last the woman’s reproductive lifespan. As the years go by, the number of eggs in the ovaries decline in quantity and quality. This is the reason for the decline in a woman’s fecundity with increasing age. Menopause occurs when there is depletion of eggs in the ovaries.
Tests include:

1) Blood test for Follicle Stimulating hormone (FSH) level.
The test has to be done in the early follicular phase i.e. on days 2 to 5 of menstrual cycle. A high FSH level indicates low ovarian reserve. A very high result indicates depletion of eggs and may indicate the menopause.

2) Blood test for AntiMullerian Hormone (AMH).
AMH measurement is at present the best test to assess ovarian reserve. Unlike FSH test, AMH blood test can be done at any time of the menstrual cycle. A low AMH concentration indicates low ovarian reserve.

3) Antral Follicle Count (AFC)
AFC is assessed by ultrasound scan in the early follicular phase pretty much like FSH blood test. A low AFC count indicates low ovarian reserve.

There are other causes of diminished ovarian reserve apart from increasing age. These include, lifestyle habits such as smoking, excessive alcohol consumption, obesity and drug abuse. Others include genetic factors, immune factors, and previous surgical excision of ovarian tissue which can occur during removal of ovarian cysts.
Ovulation induction and indeed assisted conception treatments are less likely to be successful in women with low ovarian reserve. At present there is no proven effective treatment to boost egg production (quantity and quality) in women with low reserve. The use of androgens, in particular DHEA tablets, is recommended by some practitioners but it remains controversial, there are no large enough studies to confirm its effectiveness. For most women with very low ovarian reserve, the use of donor eggs provides the best option for a successful treatment outcome.

J. Adeghe
Consultant – Gynaecology & Reproductive Medicine

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