#3 Can I reassure my patient about her reproductive potential using these tests?
Normal findings on ovarian reserve testing suggests that a woman might have a normal (that is, commensurate with age-matched peers) number of eggs in her ovaries. But normal test results do not mean she will have an easy time conceiving. Similarly, abnormal results do not mean that she will have difficulty conceiving.
Ovarian reserve testing reflects only the number of oocytes, not their quality, which is primarily determined by maternal age.35 Genetic testing of embryos during IVF shows that the percentage of embryos that are aneuploid (usually resulting from abnormal eggs) rises with advancing maternal age, beginning at 35 years.5 The increasing rate of oocyte aneuploidy is also reflected in the rising rate of loss of clinically recognized pregnancies with advancing maternal age: from 11% in women younger than age 34 to greater than 36% in women older than age 42.4
Furthermore, ovarian reserve testing does not reflect other potential genetic barriers to reproduction, such as a chromosomal translocation that can result in recurrent pregnancy loss. Fallopian tube obstruction and uterine issues, such as fibroids or septa, and male factors are also not reflected in ovarian reserve testing.
#4 My patient is trying to get pregnant and has abnormal ovarian reserve testing results. Will she need IVF?"
Not necessarily. Consultation with a fertility specialist to discuss the nuances of abnormal test results and management options is ideal but, essentially, as the American Society for Reproductive Medicine states, “evidence of [diminished ovarian reserve] does not necessarily equate with inability to conceive.” Furthermore, the Society states, “there is insufficient evidence to recommend that any ovarian reserve test now available should be used as a sole criterion for the use of ART.”
Once counseled, patients might elect to pursue more aggressive treatment, but they might not necessarily need it. Age must figure significantly into treatment decisions, because oocyte quality—regardless of number—begins to decline at 35 years of age, with an associated increasing risk of infertility and miscarriage.
In a recently published study of 750 women attempting pregnancy, women with a low AMH level (<0.7 ng/mL) or high FSH level (>10 mIU/mL), or both, did not have a significantly lower likelihood of achieving spontaneous pregnancy within 1 year, compared with women with normal results of ovarian reserve testing.3
Continue to: #5 My patient is not ready to be pregnant