Testing for ovarian reserve
FSH? and AMH - How best to test for ovarian reserve
It is now well established that AMH and FSH measured in blood can give a clear indication of ovarian reserve. This in turn will give an indication on how easy, challenging or impossible it will be to stimulate the ovaries during an IVF/ICSI cycle.
During the COGI 2011 conference Dr Gleicher advised that, in his experience, he recommends AMH and FSH to both be measured in women over 42, however for younger women measuring AMH is sufficient. He mentioned that, in his clinic, they do not offer IVF for patients who have an AMH below 0.5ng/mL as the results are not high enough to justify the invasiveness of the procedure.
Dr Christian-Maitre warned against results which had been taken more than 1 year previously. In her opinion, the levels can change quickly. She advised that the test is best taken yearly in order to avoid unnecessary IVF.
Can we treat low ovarian reserve?
Dr Gleicher has seen AMH results increase when patients take DHEA supplementation. He also repeated several case studies with a better response of the ovaries to treatment when the woman is taking DHEA. His recent article can be read here
Typically, it will take 2-6 months for this improvement to be clearly seen in blood tests. But he thinks that DHEA may have a positive effect on egg? quality of women with low ovarian reserve.
Ovarian resistance
Dr Fauser warns that in some cases women are diagnosed with “ovarian resistance”. This is a subjective description, as in most cases, they also have a low ovarian reserve. Dr Fauser thinks that this is what is making it hard to stimulate the ovaries. He thinks that a diagnosis for low ovarian reserve is sufficient to know that they will not respond well to traditional IVF/ICSI treatment.
If the woman is young and has a low AMH level, a low AFC (antral follicle? count) and irregular cycles it is recommended to test for fragile X and POF (premature ovarian failure).
Can patients with low ovarian reserve benefit from fertility treatment?
For these patients who have low ovarian reserve, the use of IVM (in vitro maturation) may be beneficial. Dr Patrizio thinks that IVM makes intuitive sense in particular as we have established that it is useless to “bombard” the ovaries with gonodotrophins when the ovarian reserve is low. He would however favour mild IVF rather than IVM in his practice, as not enough information is available for IVM in his view.
Dr Gleicher agreed that there was no clear protocol which works best for women with low ovarian reserve.
Dr Fauser warned specialists of stimulating the ovaries to a point that all potential eggs are released and which would cause early menopause. He calls for caution on this matter.
