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Poor ovarian reserve doesn’t equal infertility


 

FROM OBSTETRICS AND GYNECOLOGY

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Poor results on ovarian reserve testing don’t signal an absolute inability to conceive “and should not be the sole criteria considered to limit or deny access to infertility treatment,” according to a policy statement from the American College of Obstetricians and Gynecologists.

Ovarian reserve tests can be predictive of the ovarian response to fertility treatment, but they do not reliably predict failure to conceive, according to the statement from ACOG’s Committee on Gynecologic Practice, which was published on Dec. 22 (Obstet. Gynecol. 2015;125:268-73).

The committee’s statement includes a discussion of the advantages and disadvantages of 10 available screens for ovarian reserve, as well as a list of seven general recommendations for clinicians.

In general, ovarian reserve testing should be performed for women older than 35 years who have not conceived after 6 months of trying and for women who are at increased risk for diminished ovarian reserve. This includes women who have a history of cancer treated with gonadotoxic therapy, pelvic irradiation, or both; those who have medical conditions treated with gonadotoxic therapy; and those who have undergone ovarian surgery for endometriomas.

For most ob.gyns., the most appropriate screening tests are basal follicle-stimulating hormone (FSH) plus estradiol levels or antimullerian hormone (AMH) levels. An antral follicle count (AFC) also may be useful if transvaginal ultrasound is already going to be performed for other indications, according to ACOG.

When test results suggest diminished ovarian reserve, it may be appropriate to initiate an infertility evaluation.

“It is reasonable to counsel the woman that her window of opportunity to conceive may be shorter than anticipated, and attempting to conceive sooner rather than later is encouraged,” ACOG wrote.

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