Assessment of ovarian reserve
Ovarian reserve is defined as the functional potential of the ovary, and reflects the number and quality of the follicles left in the ovary at any given time. There are no definite estimates to measure of the quantitative ovarian reserve in reproductive age. Although recent progresses have been achieved in this field, the ideal test reflecting ovarian reserve has remained the evaluation of the response to ovarian stimulation. Various tests and markers of the ovarian reserve have been reported. Hormonal tests such as follicle stimulating hormone (FSH), estradiol, luteinizing hormone (LH), AMH or inhibin-b and sonographic measurements such as ovarian volume, antral follicular count (AFC), or ovarian blood flow have been proposed. Among these factors AMH which is produced by the granulosa cells of the recruited follicles until they become sensitive to FSH, has been identified as a regulator of recruitment for preventing depletion of the entire primordial follicle pool at once29,30. Serum AMH levels appears to correspond well with AFCs and ovarian response hyperstimulation in in-vitro ferilization. It has been found to decline with age in females and has been suggested as a predictor of ovarian response and menopausal transition. Moreover, AMH is the only marker of ovarian reserve which is menstrual cycle independent and easily measurable although the threshold levels in follicular and luteal phases need to be standardized. The measurement of serum AMH levels is more convenient than ovarian response to hyperstimulation for predicting the ovarian reserve31.