What does a fertility assessment include, and what does an ovarian reserve check show and not show? The place and limits of the tests per ASRM's view.
A fertility assessment is a process in which your fertility status is reviewed through history, examination, hormone measurements and ultrasound; the ovarian reserve check is only one part of this process. Ovarian reserve gives an idea of the number of eggs remaining in the ovary; it does not show egg quality. According to the current medical view, reserve indicators do not on their own say whether you will become pregnant. For this reason the results are not just a single number; they are information that must be read together with your age and history. Below you can find what the assessment covers, what the tests show and do not show, and what routes exist after the result.
For whom is a fertility assessment considered?
A fertility assessment is a review, brought together, of the factors that may affect your likelihood of becoming pregnant. It is not a single test or a single number; it is made up of history, examination and the investigations considered necessary.
An assessment may be requested if your attempts to conceive have not given a result for some time; the timing varies from person to person. If you have not yet started trying but are planning a pregnancy, you can also talk with your doctor about which investigations are meaningful for you. Reasons such as a change in your menstrual pattern or a history of the tubes, the uterus or endometriosis can also be grounds for asking for an assessment; each has its own diagnostic and treatment approach.
What is done in the assessment?
Your menstrual pattern, your earlier pregnancies, your medical and surgical history and your lifestyle are discussed; an examination is done if thought necessary.
Your ovulation and menstrual pattern are assessed. For ovarian reserve, AMH is measured in your blood and the antral follicles (the small developing sacs in the ovary) are counted by ultrasound; in some situations basal FSH and oestradiol are also requested. Your doctor decides which test is needed and when it will be done.
Ovarian reserve gives no information about the patency of your tubes, the structure of your uterus or your ovulation pattern; these are assessed with separate investigations. The assessment of your male partner is also part of the process; the assessment is not limited to you alone.
What does an ovarian reserve test show, and what does it not show?
Ovarian reserve expresses the number of eggs remaining in the ovary and is a subject separate from egg quality. That is, reserve indicators shed light on the question "how many eggs are left"; they do not tell how healthy your eggs are.
AMH measurement and antral follicle count by ultrasound are accepted as the most sensitive and reliable methods that show reserve; in experienced centres the antral follicle count is regarded as a reasonable alternative to AMH. These indicators predict well the response of your ovary to treatment and the number of eggs that can be obtained. But they remain weak in predicting egg quality, pregnancy and live birth. Whether a result will be counted as low or high is interpreted by your doctor together with your age and history.
How are the results interpreted, and what is the role of age?
These indicators predict your reproductive potential poorly independently of age; your age, on the other hand, predicts your reproductive success far more strongly. For this reason your result is read not on its own but together with your age and history.
A finding of reduced reserve does not mean that you cannot become pregnant. A normal result does not offer assurance for pregnancy either. Apart from the reserve test, factors such as ovulation, the tubes, the uterus and the male factor are assessed separately.
Is a reserve test necessary for every woman whose fertility has not been tested?
No. Reserve indicators should not be used as a general "fertility test" in people who are not infertile or whose fertility has not yet been tested. In this case it is recommended that your decisions rest on your reproductive plans and your age rather than on the tests. Unnecessary anxiety may arise in a person whose result comes out low, and a false sense of assurance in one whose result comes out normal. For this reason it is good to talk with your doctor, before requesting the test, about what you want to learn and which decision the result will influence.
What routes are followed after the result?
Your result is assessed together with your doctor. Monitoring regarding your plan for pregnancy may be done; if necessary, an assessment of IVF treatment or counselling on preserving your fertility may be considered. The result alone does not determine which is suitable for you.
What questions can you ask your doctor?
- Which tests (blood, ultrasound) are meaningful for me, and which are not necessary?
- When do the tests need to be done?
- How are the results interpreted together with my age and history?
- Does the result need to be repeated?
- According to the result, which options can be discussed, and in which areas is additional investigation needed?
Frequently Asked Questions
Is a fertility assessment a single test?
No. A fertility assessment is a process made up of history, examination and the investigations considered necessary; it is not a single test or a single number.
Are ovarian reserve and egg quality the same thing?
No. Ovarian reserve expresses the number of eggs remaining in the ovary; egg quality is a separate subject. Reserve indicators shed light on the question "how many eggs are left", and do not tell how healthy the eggs are.
Does reduced ovarian reserve mean I cannot become pregnant?
No. A finding of reduced reserve does not mean that you cannot become pregnant.
Does a normal reserve result guarantee pregnancy?
No. A normal result offers no assurance for pregnancy either. Apart from the reserve test, factors such as ovulation, the tubes, the uterus and the male factor are assessed separately.
My reserve test is normal but I cannot get pregnant; what could be the reason?
Reserve indicators add nothing significant on top of the age-based estimate in predicting spontaneous pregnancy; AMH also predicts IVF pregnancy and live birth poorly. A normal result does not mean that there is no other reason for your not conceiving. Factors such as ovulation, the tubes, the uterus and your partner's sperm characteristics also need to be assessed; you can talk with your doctor about this.
Does an ovarian reserve test show the patency of the tubes or the structure of the uterus?
No. Ovarian reserve gives no information about the patency of the tubes, the structure of the uterus or the pattern of ovulation; these are assessed with separate investigations.
Is only the woman examined in the assessment process?
No. The assessment of the male partner is also part of the process.
Are the same tests done for everyone?
No. Your doctor decides which test is needed and when it will be done; hormone tests and ultrasound are planned according to the findings of the consultation and examination.
Does the test result affect access to IVF treatment?
It is recommended that reserve indicators not be used to deny you access to infertility treatment. A very low AMH value can be used to inform you about the egg yield expected from treatment; but it does not form grounds for refusing IVF. That is, the result is not the only criterion that determines whether treatment will be given.
Is an FSH measurement alone enough?
A high basal FSH value suggests that reserve has fallen, but a normal value does not show that reserve is preserved; the result of a single measurement may also vary from day to day. For this reason FSH is assessed not alone but together with indicators such as AMH and the antral follicle count. Among the older methods, it is recommended that the clomiphene citrate challenge test is no longer used.
Are reserve tests used as a general fertility test in women whose fertility has not been tested?
No. Reserve indicators should not be used as a general "fertility test" in people who are not infertile or whose fertility has not yet been tested; it is recommended that decisions rest on reproductive plans and age rather than on the tests.
Is the decision to freeze eggs made by looking at the test result?
It is recommended that reserve indicators not be used on their own to encourage planned egg freezing; this decision needs to rest on your reproductive plans and your age. For people considering egg freezing because of age-related loss of fertility, it is recommended that success rates, risks and costs be explained in detail and that suitability be determined according to the person.
After the result, is IVF treatment the only route?
No. The result is assessed together with your doctor; monitoring regarding your plan for pregnancy may be done and, if necessary, an assessment of IVF treatment or counselling on preserving fertility may be considered. The result alone does not determine which is suitable.
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