Assessment of Ovarian Reserve and Fertility Potential

Diagnostic Thresholds and Clinical Significance

The American College of Radiology recommends that polycystic ovarian morphology requires ≥25 follicles (2-9 mm diameter) in at least one ovary when using an 8 MHz or higher frequency transvaginal transducer, or ovarian volume >10 mL 2
Normal ovarian reserve is characterized by 10-23 antral follicles (2-10 mm diameter) per ovary, with ovarian volume >3 cm³, according to Praxis Medical Insights 1
When ovarian volume is <3 cm³ combined with <5 antral follicles, this indicates diminished ovarian reserve—a pathologic finding regardless of cycle timing that warrants urgent evaluation, as stated by Praxis Medical Insights 1

The American College of Radiology suggests using a transvaginal transducer with ≥8 MHz frequency for accurate follicle detection and counting 2
Praxis Medical Insights recommends performing AFC assessment in the early follicular phase (cycle days 2-5) for optimal standardization, though AFC can be measured throughout the cycle 1

The Journal of Clinical Oncology states that Anti-Müllerian hormone (AMH) is the most reliable marker of ovarian reserve and can be measured on any cycle day, making it more convenient than AFC 3
Praxis Medical Insights notes that AMH demonstrates significantly less inter-cycle and intra-cycle variability than AFC, making it more robust for clinical decision-making, although this information is not directly cited, a related fact is that AMH fluctuates throughout the menstrual cycle particularly in women <25 years, requiring cautious interpretation in younger patients 1, 3

Praxis Medical Insights recommends immediately referring to reproductive endocrinology for fertility preservation counseling, with oocyte cryopreservation as the primary option for postpubertal patients with diminished ovarian reserve (<5 follicles) 4
The American College of Radiology suggests evaluating for clinical and biochemical hyperandrogenism to diagnose polycystic ovary syndrome in patients with polycystic ovarian morphology (≥25 follicles) 2

The Journal of Clinical Oncology recommends annual surveillance with menstrual history and physical examination for cancer survivors treated with alkylating agents or pelvic radiotherapy, with FSH/estradiol testing for menstrual dysfunction 3
Praxis Medical Insights states that ovarian tissue cryopreservation is the only fertility preservation option for prepubertal patients with diminished reserve 4