Ovarian Reserve, FSH Levels, and Pregnancy Rates

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Average pregnancy rates decline gradually with age and do so more sharply after age 37. This is significant when one considers that menopause, a time when the ovaries no longer contain eggs, occurs on average at age 51. Therefore, for many patients’ fertility begins to decline 15-20 years or more before menopause. The actual degree and rate of decline varies for each patient.

As fertility declines, the incidence of miscarriage also rises. Estimates for miscarriage rates are 10-20% under 35 years, 15-30% for 35-39 years, and about 35-60% for over 40 years.

How Can Ovarian Reserve Be Estimated?

Ovarian reserve is commonly measured using blood tests that measure hormone levels, such as Follicle Stimulating Hormone (FSH), Estradiol, and Antimüllerian hormone (AMH). Ovarian reserve can also be measured via an antral follicle count, which uses a transvaginal ultrasound to count the number of follicles in the ovary. Antral follicles are where eggs develop, therefore the number of follicles are an excellent indication of how many eggs may respond to the patient undergoing IVF medications.

Who should be tested?

We advise testing for a diminished ovarian reserve for patients:

• Age 35 or above
• Experiencing unexplained infertility
• Have a single ovary
• Have a family history of early menopause
• Or have undergone chemotherapy or pelvic irradiation

What are the reproductive options for patients with diminished ovarian reserve?

There are several courses of action, however the primary choices are to continue to attempt conception using the patient’s eggs or to suggest using donor egg IVF.