In assisted reproduction, the concept of ovarian reserve is used to assess the number of eggs a woman has left. Contrary to what happens with sperm in men, the number of oocytes we have in women is finite. Women are born with a certain number of oocytes, and as the years go by we lose. How is low ovarian reserve valued? Roser Solernou, assisted reproduction specialist at FIVclínic, explains.

How is ovarian reserve assessed?

Today, we use two ovarian reserve markers:

• Anti-Müllerian hormone (AMH) produced by the granulosa cells of the ovary. We are told that the more AMH, the more ovarian reserve. It is considered normal when its values ​​are above 1.2 ng/ml.
• Antral follicle count (AFC), performed by transvaginal ultrasound and corresponds to the number of follicles a woman has in that cycle. A count of more than 7 between the two ovaries is considered normal.

Why is ovarian reserve important?

Ovarian reserve is significant for reproductive treatments, especially when we need to stimulate the ovaries for in vitro fertilization. It allows us to classify the patient as low ovarian reserve, normal reserve or high ovarian reserve and this helps us decide the treatment pattern that we will use to obtain more or less oocytes.

Why does the ovarian reserve go down?

The main factor that decreases the ovarian reserve is age, that is, as we get older the number of oocytes we have in the ovaries decreases. There are other factors that can speed up this loss such as chemotherapy, ovarian surgery or pelvic radiation therapy.

On the other hand, there are also genetic alterations that lead to a low ovarian reserve such as fragile X, among others. A family history of early menopause should also be considered.

I have low AMH and AFC. Now what?

AMH and AFC are just some of the markers that can tell us that ovarian stimulation can be more or less complicated and that we will get more or less oocytes, but a couple’s fertility depends on many other factors such as semen quality of the couple, the age of the patient, the gestational search time, the condition of the fallopian tubes.

What therapeutic options do patients with low ovarian reserve have?

The options are multiple depending on the various factors we discussed earlier and can be:

• Look for spontaneous pregnancy.
• Artificial insemination with semen from the couple or semen bank
• Stimulated in vitro fertilization 
• In vitro fertilization in natural cycle
• Reception of oocytes or embryos

That is why it is important to evaluate each case with the specialist in order to offer the best treatment for each patient/couple.

Roser Solernou. Gynecologist specializing in assisted reproduction from FIVClinic.