Ovarian Reserve Assessment

Primary Tests for Ovarian Reserve Assessment

Antral follicle count (AFC) by transvaginal ultrasound remains the most established method for assessing ovarian reserve in adult women, despite not being part of current clinical criteria for premature ovarian insufficiency (POI) 1
AFC shows a strong positive correlation with AMH levels, however, AFC is operator and equipment-dependent, limiting accuracy and reproducibility, and requires expensive equipment and trained personnel 2, 3
The American College of Obstetricians and Gynecologists recommends that AFC by transvaginal ultrasound should be used as a primary test for assessing ovarian reserve in adult women 1

AMH is inversely correlated with increasing age in women ≥25 years, making it a clinically useful marker of ovarian reserve in this population, according to the American Society for Reproductive Medicine 1
The Endocrine Society suggests that AMH interpretation is most reliable in women ≥25 years where validated normative data exist 1

At-risk postpubertal females without signs of POI who desire assessment of future fertility should be referred for specialist consultation rather than relying on a single test, as recommended by the American College of Obstetricians and Gynecologists 4
The American Society of Clinical Oncology recommends that AMH is frequently used as a marker of ovarian reserve in survivors of childhood cancer treated with alkylating agents and/or radiotherapy 1
The European Society of Human Reproduction and Embryology suggests that AMH could serve as a valuable surrogate marker or alternative to ultrasound for detection of polycystic ovarian morphology (PCOM) 2, 3

The lack of an international standard for AMH limits comparison between different AMH assays, and direct comparison of results remains problematic, according to the National Institute of Child Health and Human Development 1
The American College of Obstetricians and Gynecologists recommends that there are no studies describing the value of AMH in the diagnosis of POI in either cancer survivors or the general population, despite its use as a marker of ovarian reserve 1

AMH levels can fluctuate throughout the menstrual cycle, particularly in young women under 25 years, and may be useful in identifying women at risk for premature ovarian insufficiency (POI) 5
For women ≥25 years, AMH is inversely correlated with increasing age and can provide information about remaining reproductive lifespan, and AMH testing may be valuable for women who have undergone potentially gonadotoxic treatments such as chemotherapy or radiation 5
AMH interpretation should be cautious in women under 25 years due to potential fluctuations 5