Strategies for ascertaining ovarian reserve among women suspected of subfertility

Abstract

"Ovarian reserve" describes the native oocyte endowment and is closely associated with reproductive potential. As a diagnostic entity, ovarian reserve screening developed from clinical experience with the advanced reproductive technologies--particularly in vitro fertilization. Diminished ovarian reserve generally presages a poor response to any fertility treatment, and sharply limits the possibility of successful pregnancy. Screening for ovarian reserve is a fundamental component of the initial infertility evaluation, since it is a key determinant of what, if any, treatment should be offered. Methods of clinical ascertainment of ovarian reserve may be classified in two groups: passive and provocative testing. Both approaches seek to provide information regarding oocyte quality and quantity, which then may be used to direct specific therapeutic interventions. This monograph presents basic elements of ovarian reserve testing as currently practiced, and provides insights into the interpretation and limitations of these assessments.