Ovarian Reserve Test Flawed Predictor of Fertility
Common fertility tests that estimate ovarian reserve, or the number of a woman’s remaining eggs, before menopause, do not appear to predict short-term chances of conception, according to a study of women with no history of infertility.
“Women are born with a set number of eggs that gradually declines through the reproductive years,” said Esther Eisenberg, M.D., of the fertility and infertility branch of the National Institute of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, which funded the study. “This study suggests that testing for biomarkers of ovarian reserve does not predict the chances for conception in older women still of reproductive age.”
As a woman ages and her egg supply declines, cells in the ovary secrete lower amounts of inhibin B and anti-Müllerian hormone, substances considered to be indicators of ovarian reserve. The ovaries also produce higher amounts of follicle stimulating hormone (FSH) in the days before ovulation. Although there is little research to support their use, tests for anti-Müllerian hormone are routinely offered in many fertility clinics on the assumption that women with a lower ovarian reserve would be less likely to respond to treatment. Moreover, home fertility tests of urinary FSH are commercially available.
The researchers enrolled 750 women, between 30 to 44 years of age, who had no health conditions known to affect fertility, and who had been attempting to conceive for three or fewer months. The women provided a urine and blood sample and checked for conception with home pregnancy test kits. The researchers statistically corrected for factors known to reduce fertility, such as smoking, recent use of oral contraceptives and obesity.
After six cycles of attempting to conceive, results did not differ significantly between women with low levels and normal levels of anti-Müllerian hormone — a 65% chance of conception, compared to a 62% chance. Similarly, results were not statistically different after 12 cycles: 82% versus 75% chance of conception.
Chances for conception also did not differ significantly according to high versus normal levels of FSH, with conception rates of 61% versus 62% after six cycles, and 82% versus 75% after 12 cycles. The researchers found no association of inhibin B levels and conception after six cycles or 12 cycles.
The takeaway? If you have no known health condition related to infertility (e.g. PCOS or endometriosis) and you score low on anti-Müllerian hormone or inhibin B, or high on FSH, take heart: It’s not a good predictor of whether you’ll be able to get pregnant.