- Ovarian reserve is the number as well as quality of the remaining eggs in both ovaries at a given age.

- Egg quality directly affects embryo development & the ‘take home baby ‘rate.

- Ovarian Reserve Test ( ORT ) helps to determine the chances of natural conception as well as with treatment.

It is very important to identify women with low ovarian reserve so that they can take important decisions regarding their own fertility in a timely manner.

Following are the risk factors for Decreased ovarian reserve :

• Family history of early menopause

• Ovarian surgery especially for endometrioma.

• Surgical removal of part of ovary ( for cystectomy) or removal of one whole ovary ( Oophorectomy )

• Cancer survivors after pelvic surgery , chemotherapy or radiotherapy

• Smoking

• Ovarian inflammation -endometriosis & pelvic infection etc.

• Unexplained infertility

• Poor response in previous IVF cycle

• Known case of certain genetic conditions like Turner syndrome & mutation carriers like Fragile X /FMR1 /BRCA -1

Ovarian reserve should be tested in following conditions also :

• Planning fertility preservation

• Candidate for IVF

• Planning to delay pregnancy for personal reasons

Ovarian reserve can be determined with Ovarian Reserve Test ( ORT ):

• USG for Antral Follicle Count (AFC scan) – Good for number of eggs.

• Blood test for determination of Anti Mullerian Hormone ( AMH ) – Good for number of eggs & quality to some extent.

• Blood test to assess function of ‘Hypothalamic -Pituitary -Ovarian axis’ – Follicle Stimulating Hormone (FSH,) Luteinising Hormone (LH) & Estradiol.

Caution while interpreting result of ORT :

• None of above test can predict the chance of pregnancy with 100 % accuracy.

• Most important factor determining chance of conception is quality of oocyte which cannot be assessed precisely with any available test.

• A woman with good ovarian reserve may face difficulty in having a healthy baby due to issues in sperm quality or implantation issues.

• Woman with low AMH & AFC also can conceive with individualised treatment protocol.

• Women with low ovarian reserve should consult a fertility specialist to discuss their treatment choices.