Testing and interpreting measures of ovarian reserve A committee opinion

Authors:
Practice Committee of the American Society for Reproductive Medicine

Volume 103, Issue 3, Page e9

Abstract:

Currently there is no uniformly accepted definition of decreased ovarian reserve (DOR), as the term may refer to three related but distinctly different outcomes: oocyte quality, oocyte quantity, or reproductive potential. Available evidence concerning the performance of ovarian reserve tests is limited by small sample sizes, heterogeneity among study design, analyses and outcomes, and the lack of validated outcome measures.

  • Dan

    This is excellent – and one of the most useful, clear, objective representations of how to weigh and balance testing for DOR, and get educated on how to address insurance denials that may not be founded in the complete truth, or approach as objectively as they should be in actually trying to assess if IVF is suitable treatment and should be covered (I live in MA where it is suppose to be covered). Really just excellent committee opinion and overview of real data/facts.

    In particular I am focused on the AMH section – relation to DOR, ovarian response, pregnancy outcome. I understand that the medical opinion is AMH decreases over woman’s life (not discussed in paper), and as stated in paper is consistent across her cycle. Our case had AMH of .18 move to AMH 1.0 4 months later. after that .18 – 1st IVF went quite well… 10 AFC->7 Oocytes->5 fertilized->4 grew to excellent D3 embryos. Pregnancy resulted but ended with trisomy 2. This was not at max stimulation either. Post 1.0 value IVF #2 occurred 12 AFC->9 oocytes->6 fertilized->6 excellent D3 embryos, went through 2 frozen transfers with no pregnancy. D3 Estrodial/FSH all within range. so we clearly show sufficient ovarian response and not DOR – yet being denied on the AMH alone as of now as indicator of DOR (going through appeal process).

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