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.