Plastic model of a uterus and ovaries with an EVOLVE swirl in background

What is Ovarian Reserve and How is it Tested?

Diagnosis & Treatment September 17, 2024

Are you considering freezing your eggs? Then, you might have heard a thing or two about ovarian reserve testing. But if not, don’t worry — you’ve come to the right place!

Ovarian reserve testing can help set realistic expectations regarding your fertility preservation journey. So, what is an ovarian reserve, and what does testing involve? In this article, we answer these questions and more.

Ovarian reserve refers to the number of eggs you have left. You are born with all the eggs you will have in a lifetime, and this number naturally decreases over time. This is often why the ability to get pregnant decreases with age—and why egg freezing can be a great option.

A good ovarian reserve means more eggs are available, which can lead to greater success with fertility preservation.

Factors Affecting Ovarian Reserve

Several factors can influence your ovarian reserve, including:

  • Age
  • Genetics
  • Medical conditions (Endometriosis and some autoimmune diseases may affect ovarian reserve.)
  • Smoking
  • Cancer treatments
  • Weight
  • Stress
  • Environmental factors

What Is Ovarian Reserve Testing?

An ovarian reserve test assesses your egg quantity. For this, your doctor will likely use a combination of blood tests and ultrasound imaging. Together, these methods offer a comprehensive view of your egg supply.

An ovarian reserve test further helps predict how your ovaries may respond to stimulation, and estimate the number of eggs that could be retrieved. At the same time, it’s important to remember that this testing is just one piece of the bigger picture.

At EVOLVE, we’re here to help you navigate the egg freezing process with compassion and expertise — helping you have the best experience and outcome possible.

How To Test Ovarian Reserve

Testing for your ovarian reserve can take on many forms. The following sections outline what types of blood tests and ultrasounds you can expect during this process.

Ovarian Reserve Blood Tests

Blood tests measure levels of hormones that play essential roles in egg development and ovulation. The main blood tests include Anti-Müllerian Hormone (AMH), Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), and Estradiol Test.

Anti-Müllerian Hormone (AMH)

AMH is produced by the follicles (the structures that house your eggs). This blood test can be done at any point in your menstrual cycle. Generally, higher AMH levels indicate a higher number of eggs remaining.

Follicle Stimulating Hormone (FSH)

This test can help create a more complete picture of your ovarian reserve.

Follicle Stimulating Hormone stimulates your ovaries to produce and mature an egg each month and is typically tested on days 2-5 of your menstrual cycle. Higher FSH levels, especially early in your menstrual cycle, can indicate a diminished ovarian reserve.

Luteinizing Hormone (LH)

LH works alongside FSH to regulate your menstrual cycle and egg production. An LH test, usually done on days 2-5 of your menstrual cycle, can provide additional insights into your ovarian function.

Estradiol Test

Estradiol is a form of estrogen produced by your ovaries. Elevated estradiol levels can suppress FSH and mask an abnormal result. Testing estradiol and FSH provides a more accurate picture of your ovarian reserve.

Ovarian Reserve Ultrasound

In addition to blood tests, an abdominal and transvaginal ultrasound is conducted. This type of ultrasound is also performed throughout the stimulation phase of egg freezing; this ensures your safety and can help adjust any protocols accordingly.

Antral Follicle Count

An antral follicle count is a transvaginal ultrasound that visualizes and counts the number of small, early follicles (antral follicles) in your ovaries at the beginning of your menstrual cycle (usually on days 2-5). Each of these antral follicles contains an immature egg.

In this way, the antral follicle count visually estimates your remaining egg supply and indicates your ovarian reserve. A higher antral follicle count suggests a better response to ovarian stimulation during the egg-freezing process.

Understanding Ovarian Reserve Testing Results

Once you’ve completed your ovarian reserve tests, your fertility specialist will analyze the results. These results can help guide your decision-making process. So, let’s look at what low and high ovarian reserve results may mean for you.

Low or Diminished Ovarian Reserve

A diminished ovarian reserve indicates that your egg supply is decreasing more rapidly than expected for your age. A diminished ovarian reserve may be due to advanced maternal age, genetic predisposition, or certain medical conditions.

Signs of a diminished ovarian reserve may include:

  • Higher FSH levels
  • Lower AMH levels
  • Lower antral follicle count

If your results indicate a diminished ovarian reserve, don’t worry; egg freezing may still be an option. However, your window of opportunity might be smaller than expected. If you have a decreased ovarian reserve, your fertility specialist may advise preserving your fertility sooner rather than later.

High Ovarian Reserve

On the other hand, a high ovarian reserve suggests that you have a more abundant egg supply for your age. This is often characterized by:

  • Lower FSH levels
  • Higher AMH levels
  • Higher antral follicle count

A high ovarian reserve is generally a positive sign for your fertility potential. It suggests that you may have a longer window of opportunity for pregnancy and potentially egg freezing. At the same time, egg quality also declines with age. This means that regardless of egg quantity, the rule of thumb for egg freezing is the sooner, the better.

Ovarian Reserve Testing Cost

Generally, OHIP covers the cost of ovarian reserve testing, with the exception of the AMH test ($125). The AMH test is sometimes covered by private insurance.

Are you curious about your ovarian reserve and egg-freezing options? Our team at EVOLVE is here for you. Talk to an EVOLVE nurse today to learn more.

Conclusion

Ovarian reserve testing provides valuable insights, and fertility treatments can be tailored to meet individual needs. By understanding the complexities of ovarian reserve and fertility treatment options, women can take control of their reproductive health and make informed decisions about their future.

FAQs

What causes low ovarian reserve?

Low ovarian reserve can happen due to various factors. These include age, genetics, lifestyle choices, and medical conditions.

When should you have ovarian reserve testing?

Ovarian reserve testing is recommended for those who are:

  • Over 35 years old and trying to conceive
  • Diagnosed with endometriosis or premature ovarian failure
  • Considering egg freezing to preserve fertility for the future

How to improve ovarian reserve?

You can’t increase your total egg count, but you can maintain the health of your existing eggs by:

  • Maintaining a healthy weight and balanced diet rich in antioxidants and omega-3 fatty acids
  • Quitting smoking and limiting alcohol consumption
  • Managing stress with relaxation techniques, exercise, and self-care

How accurate are ovarian reserve tests?

While ovarian reserve tests are generally reliable indicators, they cannot predict the exact number of eggs you have or your exact outcome during the egg-freezing process.

References:
https://www.sciencedirect.com/topics/medicine-and-dentistry/ovarian-reserve#:~:text=Ovarian%20reserve%20is%20most%20affected,reserve%20%5B10%2C11%5D
https://www.ncbi.nlm.nih.gov/books/NBK279058/
https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/ovarian-reserve-predicting-fertility-potential-in-women/

More Articles