Testing for Ovarian Reserve in Assisted Reproduction programs: the current point of view

Age related fertility decline varies considerably among women. Therefore, chronological female age, though informative on pregnancy prospects in assisted reproduction, will often not correctly express a woman’s reproductive potential. The value of quantitative ovarian reserve tests prior to IVF/ICSI treatment is still subject of debate. From a series of systematic reviews it has become clear that the added value of these tests upon knowing female age has not been clearly established. Still, several tests, like the AFC and AMH are considered adequate in predicting the response to ovarian stimulation. This claim seems to be truer for poor response prediction, compared to hyper response. Prediction of the outcome pregnancy has repeatedly shown to be cumbersome. As management options for predicted poor or hyper responders are not fully investigated to date, routine ovarian reserve testing is not to be recommended. A first cycle poor response to adequate stimulation in cases with otherwise no signs of advanced ovarian ageing (based on female age and ovarian reserve tests) may offer a tool to identify cases with sufficient prospects for continuation of ART treatment.