Screening for ovarian reserve

Background: The most important aspect of diminished ovarian reserve is the associated decline in reproductive potential. It has been a major challenge to the reproductive endocrinologist to predict prospectively patients who will be 'low responders' and to counsel appropriately and treat women undergoing controlled ovarian hyperstimulation for in vitro fertilization. Methods: Medline searches were conducted to review the screening techniques that are currently available. Results: Traditional methodology used to assess ovarian reserve has consisted of baseline values of hormones (i.e., basal serum levels of estradiol and progesterone, basal levels of serum follicle-stimulating hormone) on cycle day 3. Dynamic or provocative tests such as the clomiphene citrate challenge test and the gonadotropin-releasing hormone against stimulation test have been proposed as predictors of ovarian reserve. The search has persisted for a rapid, noninvasive screening test to identify prospective patients who respond poorly to controlled ovarian hyperstimulation. Conclusion: All infertile women should be screened accurately for evidence of diminished ovarian reserve before starting an expensive, time consuming, and rather stressful procedure like in vitro fertilization. Patients with abnormal values should be counselled that their chances for conception are poor and that they should consider other options - a donor program or adoption.