Comprehensive Review of Ovarian Reserve Assessment Techniques

Abstract

Ovarian reserve assessment techniques play a pivotal role in the management of female subfertility, specifically for predicting the response to in vitro fertilization (IVF). In this study we have discussed a plethora of static and dynamic tests in order to determine the clinically preferred marker of ovarian reserve. Nine randomized and quasi-randomized clinical trials on AMH and other ovarian reserve markers, published over the last 20 years were selected for review. Markers used in the prediction of ovarian response include age, BMI, AMH, AFC, FSH, Inhibin B, Estradiol, LH, basal ovarian volume, CCCT, GAST and EFORT. After an in-depth review of the nine studies, AMH appears to be the preferred marker of ovarian reserve in the detection of both poor and hyper response to ovarian stimulation. However, combinations of markers have proven to be superior in the prediction of ovarian response and can result in reduced rates of IVF cycle cancellation. In conclusion, the overall performance of AMH with regard to intra and inter cycle variability, sensitivity and specificity is superior to the other assessment techniques included in this study.