IS OVERIAN RESERVE A GUIDE TO OVARIAN STIMULATION

Ovarian reserve tests started to emerge during the rise of ART in the late 1980s to predict both responsiveness to superovulation drugs and the odds of pregnancy with treatment. They include both biochemical basal and provocative tests and ultrasound imaging of the ovaries.

Most of these measures, however, have poor predictive value, often because they are indirect measures of ovarian reserve or have substantial intracycle or intercycle variability.

The purpose of using ovarian reserve testing as a screening test is to identify infertility patients at risk for DOR, who are more likely to have poor response to gonadotropin stimulation and less likely to achieve pregnancy with ART or ovulation induction.

The ideal ovarian reserve test should be affordable, noninvasive, and rapidly interpretable

It should be able to detect the decline in ovarian reserve at an early enough stage such that timely interventions could be pursued if desired. Lastly, it should have validity, ie, good sensitivity and specificity.

Optimizing specificity sacrifices sensitivity and the ability to identify all women with DOR.

Ovarian reserve tests have limitations and should not be used as sole criteria to deny patients access to ARTor other treatments.

Evidence of DOR does not necessarily mean inability to conceive, only that it may be less likely.

Finally, ovarian reserve testing may be considered as a screening tool in selected populations of women for assisting in their reproductive life planning.

While there is currently no perfect ovarian reserve test, both AFC and AMH level have good predictive value and are superior to day-3 FSH.