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Testing for Ovarian Reserve

Delayed childbearing is one of the most common underlying causes of infertility. The statistics on this are telling:

Chart of Fertility and Miscarriage Rates as a Function of Maternal Age

Unfortunately, many women remain unaware of the fact that their most fertile years are during their 20’s and early 30’s, and choose to delay childbearing voluntarily. At GENESIS, it is not uncommon for women who have been married for many years to report prolonged contraception use simply because they were not ready to conceive. When confronted with the underlying cause of their difficulties – decreased ovarian reserve – they are shocked, incredulous.

As the major providers of health care for women, it is our job to educate young women about the biological facts of egg depletion and
 
 
fertility potential. Although the American Society for Reproductive Medicine recently attempted to take the lead in just such an aware-ness campaign, the issue became politicized, with complaints from some groups that the message was oppressive to younger women. As a result, the campaign was tabled. It remains in the court of the generalist ob gyn, therefore, to counsel women about the impact of aging on fertility.
It is by now well established that the number of eggs available in the ovary – the so-called ovarian reserve” – is directly correlated with fertility potential. The usefulness of basal follicle stimulating hormone (FSH) levels as a marker of ovarian reserve has also been well established. Measuring FSH levels on day 3 of the cycle is not, however, without limitations. FSH levels may vary widely from month to month within the same woman. Also, in certain situations, especially in younger women, an elevated FSH does not necessarily indicate an ability to conceive. Certainly, normal FSH levels in older women cannot predict normal fertility.
More recently, biochemical markers have been developed that may provide earlier, more sensitive assessment of changes in ovarian reserve. The most promising on the horizon appears to be Mullerian Inhibiting Substance, or MIS. Dr. David Seifer, co-director of GENESIS, has demonstrated that MIS is an early product of follicular growth within the ovary and that, unlike other biochemical markers, it is a direct and very early marker of diminished ovarian reserve.
Independent investigators both in the United States and in Europe have corroborated Dr. Seifer’s findings. In a recent collaborative effort, they demonstrated a better accuracy of MIS in assessing ovarian reserve as well as the outcome of fertility therapy. We are currently considering the use of MIS in assessing the ovarian reserve of our patients. We believe that this may provide a better assessment of a woman’s potential of conceiving regardless of what treatment she may choose to pursue.
May 2005
Phone: (718) 283-8600 Genesis Fertility & Reproductive Medicine
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