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Ovarian Reserve Assessment

Ovarian reserve provides an indication of the number of remaining follicles and the expected response to ovarian stimulation. At Adella Fertility, we will help you understand what your results mean for you personally and which next steps may be appropriate.

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More About Ovarian Reserve Assessment

What Can the Tests Tell Us?

Ovarian reserve assessment helps us estimate the number of remaining follicles and the expected ovarian response to hormonal stimulation. It does not indicate the exact number or quality of the eggs and, on its own, cannot predict whether a natural pregnancy will occur.

Initial Assessment
The initial assessment includes a detailed medical history, testing of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH) and estradiol levels, as well as a transvaginal ultrasound to determine the antral follicle count (AFC).

Considering these findings together helps us obtain more reliable information and avoid drawing conclusions based on a single result.
Additional Assessment
We may recommend additional tests when there are discrepancies between the results, irregular menstrual cycles, a family history of early menopause, or suspected premature ovarian insufficiency (POI).

These tests are selected carefully to avoid unnecessary investigations that would not affect the medical approach.

Every Stage of Reproductive Life Has Its Own Considerations

When Is Ovarian Reserve Assessment Recommended?

  • Ovarian reserve assessment is part of a comprehensive fertility evaluation when pregnancy does not occur after a prolonged period of trying to conceive. The results are considered alongside ovulation, the condition of the uterus and fallopian tubes, and the reproductive health of the partner.

  • After the age of 35, both the number and quality of eggs decline more noticeably. Ovarian reserve assessment can help with timely planning of the next steps, particularly when pregnancy is being postponed or has not occurred after six months of trying to conceive.

  • Before IVF treatment, we assess ovarian reserve to help select an appropriate ovarian stimulation protocol. The results help us estimate the expected number of developing follicles and the risk of a poor or excessive response to medication.

  • AMH levels and the antral follicle count provide an indication of how many eggs may be retrieved following ovarian stimulation. Age remains the main factor affecting egg quality, which is why we discuss the results in the context of each woman’s personal plans and reproductive timeline.

  • Endometriomas and certain ovarian procedures can affect healthy ovarian tissue. Assessing ovarian reserve before treatment or surgery helps us discuss the potential risks and available fertility preservation options.

  • If a mother, sister or another close relative has experienced early menopause or premature ovarian insufficiency, an earlier assessment may be appropriate. Family history does not necessarily determine how your own reproductive health will develop, but it is an important part of the individual evaluation.

How Is Ovarian Reserve Assessed?

Which Tests Provide the Information We Need?

Medical and Reproductive History

We discuss your menstrual cycle, previous pregnancies, how long you have been trying to conceive, any ovarian surgery, endometriosis, cancer treatment, and any family history of early menopause. We also take into account medications that may affect the test results.

AMH Testing

Anti-Müllerian hormone (AMH) is produced by small developing follicles and provides an indication of the quantity of the ovarian reserve. AMH can be measured on any day of the menstrual cycle, but the result does not indicate egg quality and should not be interpreted in isolation.

FSH and Estradiol Testing

Follicle-stimulating hormone (FSH) and estradiol are usually measured at the beginning of the menstrual cycle. They provide information about the interaction between the pituitary gland and the ovaries. Levels can vary from one cycle to another, which is why we interpret them alongside AMH and ultrasound findings.

Antral Follicle Count

Antral follicles are counted by transvaginal ultrasound during the early follicular phase. The antral follicle count (AFC) indicates how many follicles may respond to stimulation during that cycle and is one of the key markers used to assess ovarian reserve.

Ultrasound Assessment of the Ovaries

During the ultrasound examination, we assess the size and structure of the ovaries and look for cysts, endometriomas, or changes related to previous surgery. This information helps us better understand the hormone test results and plan the appropriate next steps.

Interpreting the Results Together

AMH, FSH, estradiol, and the antral follicle count are considered together with age and medical history. If the findings do not correspond, we will explain the possible reasons and, when appropriate, recommend repeat testing or further evaluation.

Developing an Individualised Plan

Once we have reviewed the results, we discuss the appropriate next steps with you. These may include continuing to try to conceive naturally, IVF treatment, monitoring over time, or fertility preservation. A low ovarian reserve does not automatically mean that treatment with donor eggs is necessary.

Precise Hormonal Assessment

Laboratory Tests

AMH, FSH and estradiol measure different aspects of ovarian function. AMH can be tested regardless of the day of the menstrual cycle, while FSH and estradiol are usually assessed during the early follicular phase.

At the Adella Fertility laboratory, results are interpreted according to the testing method used, the patient’s age, menstrual cycle, current medications and ultrasound findings.

Precise Imaging Assessment

Ultrasound Evaluation

Transvaginal ultrasound allows us to count the antral follicles and assess the structure of the ovaries. The examination may also identify endometriomas, cysts and changes related to previous ovarian surgery.

For the most reliable assessment, the ultrasound is usually performed at the beginning of the menstrual cycle by a specialist experienced in reproductive medicine.

Questions

Frequently Asked Questions

  • No. We understand that a low result can be worrying, but it does not rule out the possibility of natural pregnancy. AMH indicates a lower quantitative ovarian reserve and may suggest a reduced response to ovarian stimulation. Age, ovulation, the condition of the fallopian tubes, and the partner’s test results are also important factors.

  • No. AMH primarily provides information about the quantity of the ovarian reserve. Age is the most important indicator of egg quality, but there is currently no test that can directly determine egg quality before an IVF procedure.

  • We understand the desire to find a way to increase ovarian reserve, but there is no proven method that can restore the number of eggs. A healthy lifestyle supports overall and reproductive health. When ovarian reserve is lower, timely assessment and an appropriately selected medical plan are particularly important.

  • Ovarian reserve assessment may be recommended when there are difficulties conceiving, after the age of 35, before IVF treatment or egg freezing, and in cases of endometriosis, previous ovarian surgery, cancer treatment, or a family history of early menopause.

    If you are unsure whether testing is appropriate for you, a consultation with a fertility specialist can help clarify the next steps.

What they say about us

They Know Best

Read the stories of those who have been where you are now.
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4.4 (140)
The clinic is wonderful! The team is made up of professionals who truly know what they are doing. We have our little miracle thanks to Dr Makedonova, and I will be grateful to her for the rest of my life! The nurses are always smiling and helpful, as are the ladies at reception. I would choose Adella again without hesitation!
Yoana Karanlakova
Maria & Christian

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