213:
process of recruiting preantral follicles. Around fifteen years before menopause, a gradual decrease in AMH levels follows a logarithmic pattern. This decline continues until about five years before menopause, at which point AMH levels reach a notably low point. However, for people with increased AMH due to PCOS that has been adequately managed with diet, exercise, and/or bariatric surgery, fertility improves even when AMH returns to normal levels. In particular, an AMH level between 7.14-25 pmol/L indicates a normal ovarian response. In contrast, an AMH level of less than 7.14 pmol/L and an AMH level greater than 25 pmol/L indicate a low ovarian response and a high ovarian response, respectively. High levels however can be present in women with
Polycystic Ovarian Syndrome which compromises female fertility and therefore a combination of AMH and a transvaginal ultrasound to count the number of antral follicles is probably the best way to assess ovarian reserve and future fertility. This combination is sometimes referred to as the Biological Body Clock Test.
17:
212:
Although FSH and more recently
Inhibin B have been shown to have some correlation with ovarian reserve, it is now well established that anti-Müllerian Hormone or AMH is more useful biochemical test. AMH appears to play a role not only in the selection of the primary follicle but also in the overall
92:
The mitosis starts the 3rd week of embryo intrauterine life and between the 5th and 7th week, there are already about 10.000 oogonias. However, the ovarian reserve is at maximum value in sixth month old embryos. Then this amount is only decreasing, as there is no new synthesis and differentiation.
204:
level to indicate that the FSH level was drawn when the estrogen level was low. In a patient with infrequent menstruation, an FSH level and estrogen level could be measured at random and is valid if the estrogen level is low. Generally FSH levels are expected to be below 10
93:
There is a huge decrease before the child is born, being this pool reduced from over 8 million potential oocytes to 2 million. The amount continues decreasing progressively until reaching the age of 30 years old, in which there is a dramatic decrease.
183:
Women who are 35 years or older who have attempted to get pregnant unsuccessfully for 6 months should undergo testing for ovarian reserve. The most commonly used test to assess this ovarian reserve is the
209:/ml in women with reproductive potential (levels of 10-15 miu/ml are considered borderline), however the exact numbers returned will depend on the type of assay used in a particular laboratory.
96:
There are about 1 to 2 million oocytes when a woman is born. From them, 400000 oocytes will reach the stage of puberty and only 400 will rise maturation and ovulation. The rest of them reach
489:
Titus, Shiny; Li, Fang; Stobezki, Robert; Akula, Komala; Unsal, Evrim; Jeong, Kyungah; Dickler, Maura; Robson, Mark; Moy, Fred; Goswami, Sumanta; Oktay, Kutluk (2013).
120:
only accounts for approximately up to 10 egg cells per month, thus accounting for only a small fraction of the actual loss of egg cells throughout the lifetime.
54:
While there is no known method for assessing the ovarian reserve of individual women, indirect determination of ovarian reserve is important in the treatment of
47:, the number of egg cell that can be successfully recruited for a possible pregnancy declines, constituting a major factor in the inverse correlation between
227:
and to determine their size as ovaries depleted of egg cells tend to be smaller and to examine the number of antral follicles visible by sonography.
66:
The ovary is generally thought of as an egg bank from which the woman draws during her reproductive life. The human ovary contains a population of
74:
contains its peak number of follicles (about 300,000 in the average case, but individual peak populations range from 35,000 to 2.5 million).
794:
252:
112:
one egg cell is released by ovulation. In addition, the remaining follicles that were recruited towards maturation are lost by
590:
Scott, Richard T.; Toner, James P.; Muasher, Suheil J.; Oehninger, Sergio.; Robinson, Shirley.; Rosenwaks, Zev. (April 1989).
148:
240:
189:
693:"Ovarian reserve and reproductive age may be determined from measurement of ovarian volume by transvaginal sonography"
224:
160:
734:"Ovarian volume and antral follicle count for the prediction of low and hyper responders with in vitro fertilization"
123:
One additional contributory mechanism for the decline in the ovarian reserve with age appears to be a decreased
152:
132:
113:
97:
48:
292:
Broekemans FJ; et al. (1998). "Ovarian reserve tests in infertility practice and normal fertile women".
44:
491:"Impairment of BRCA1-related DNA double-strand break repair leads to ovarian aging in mice and humans"
789:
592:"Follicle-stimulating hormone levels on cycle day 3 are predictive of in vitro fertilization outcome"
391:
236:
86:
67:
36:
381:
206:
116:. Few if any egg cells are replenished during the reproductive years. However, this loss by the
765:
714:
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Women with poor ovarian reserve are unlikely to conceive with infertility therapy. Also see
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117:
109:
395:
760:
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369:
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16:
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632:
196:
level is expected to be low, a critical feature, as FSH levels are subject to a
55:
217:
128:
650:
Practice
Committee of the American Society for Reproductive Medicine (2003).
467:
709:
692:
558:
543:"BRCA-related ATM-mediated DNA double-strand break repair and ovarian aging"
458:
441:
345:
328:
267:
201:
172:
40:
769:
718:
677:
576:
524:
475:
423:
354:
750:
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313:
89:
have an adverse effect on the early establishment of the ovarian reserve.
329:"A systematic review of tests predicting ovarian reserve and IVF outcome"
193:
168:
82:
78:
32:
440:
Richardson, M. C.; Guo, M.; Fauser, B. C. J. M.; Macklon, N. S. (2013).
100:, a natural apoptotic process leading to the breakdown of the follicle.
262:
164:
200:. Thus any determination of FSH needs to include the corresponding
386:
272:
156:
144:
140:
136:
77:
The size of the initial ovarian reserve is strongly influenced by
71:
28:
15:
631:
Deadmond, Amanda; Koch, Christian A.; Parry, J. Preston (2000).
192:
on cycle day 3. Cycle day 3 is chosen because at this time the
442:"Environmental and developmental origins of ovarian reserve"
20:
Model of ovarian reserve from conception to the menopause
370:"Human Ovarian Reserve from Conception to the Menopause"
27:
is a term that is used to determine the capacity of the
691:Wallace, W. Hamish; Kelsey, Thomas W. (July 2004).
435:
433:
171:have lower ovarian reserves and experience earlier
220:challenge test is a variation on this approach.
167:of humans and other species. Women with BRCA1
155:repair of DNA double-strand breaks mediated by
223:Another approach is to examine the ovaries by
541:Turan, Volkan; Oktay, Kutluk (January 2020).
70:. At 18–22 weeks post-conception, the female
8:
536:
534:
188:. This blood test determines the level of
759:
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708:
667:
607:
566:
514:
457:
413:
403:
385:
344:
284:
39:resulting in a healthy and successful
7:
652:"Use of clomiphene citrate in women"
175:than women without these mutations.
327:Broekemans FJ; et al. (2006).
14:
253:DNA damage (naturally occurring)
368:Wallace WHB, Kelsey TW (2010).
495:Science Translational Medicine
1:
669:10.1016/s0015-0282(03)01184-1
609:10.1016/s0015-0282(16)60615-5
306:10.1016/S0378-5122(98)00075-9
507:10.1126/scitranslmed.3004925
405:10.1371/journal.pone.0008772
241:Follicle-stimulating hormone
225:gynecologic ultrasonography
811:
732:Kwee; et al. (2007).
153:Homologous recombinational
633:"Ovarian Reserve Testing"
547:Human Reproduction Update
446:Human Reproduction Update
133:homologous recombination
127:of proteins involved in
49:age and female fertility
795:Reproduction in mammals
596:Fertility and Sterility
243:for treatment options.
738:Reprod Biol Endocrinol
21:
751:10.1186/1477-7827-5-9
710:10.1093/humrep/deh285
559:10.1093/humupd/dmz043
459:10.1093/humupd/dmt057
346:10.1093/humupd/dml034
45:advanced maternal age
19:
237:poor ovarian reserve
163:weakens with age in
87:prenatal development
68:primordial follicles
35:that are capable of
396:2010PLoSO...5.8772W
697:Human Reproduction
639:. MDText.com, Inc.
22:
333:Hum Reprod Update
198:negative feedback
81:. Also, elevated
802:
774:
773:
763:
753:
729:
723:
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712:
703:(7): 1612–1617.
688:
682:
681:
671:
662:(5): 1302–1308.
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640:
628:
622:
621:
611:
587:
581:
580:
570:
538:
529:
528:
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501:(172): 172ra21.
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428:
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389:
365:
359:
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324:
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258:Folliculogenesis
810:
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181:
125:gene expression
118:menstrual cycle
110:menstrual cycle
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64:
25:Ovarian reserve
12:
11:
5:
808:
806:
798:
797:
792:
782:
781:
776:
775:
724:
683:
642:
623:
602:(4): 651–654.
582:
530:
481:
452:(3): 353–369.
429:
360:
339:(6): 685–718.
319:
283:
282:
280:
277:
276:
275:
270:
265:
260:
255:
248:
245:
232:
229:
186:day 3 FSH test
180:
177:
105:
102:
85:levels during
63:
60:
13:
10:
9:
6:
4:
3:
2:
807:
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747:
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656:Fertil Steril
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361:
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323:
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311:
307:
303:
300:(2): 205–14.
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62:Establishment
61:
59:
57:
52:
50:
46:
42:
38:
37:fertilization
34:
30:
26:
18:
741:
737:
727:
700:
696:
686:
659:
655:
645:
636:
626:
599:
595:
585:
553:(1): 43–57.
550:
546:
498:
494:
484:
449:
445:
380:(1): e8772.
377:
373:
363:
336:
332:
322:
297:
293:
287:
234:
231:Implications
222:
215:
211:
185:
182:
122:
107:
95:
91:
76:
65:
53:
24:
23:
790:Gynaecology
56:infertility
31:to provide
784:Categories
279:References
218:clomiphene
179:Assessment
129:DNA repair
468:1355-4786
387:1106.1382
294:Maturitas
268:Oogenesis
202:estradiol
173:menopause
169:mutations
41:pregnancy
33:egg cells
770:17362511
719:15205396
678:14607612
637:Endotext
577:31822904
525:23408054
476:24287894
424:20111701
374:PLOS ONE
355:16891297
247:See also
194:estrogen
135:such as
83:androgen
79:genetics
761:1847823
618:2494082
568:6935693
516:5130338
415:2811725
392:Bibcode
314:9871914
263:Meiosis
165:oocytes
114:atresia
104:Decline
98:atresia
43:. With
768:
758:
717:
676:
616:
575:
565:
523:
513:
474:
466:
422:
412:
353:
312:
744:: 9.
382:arXiv
273:Ovary
157:BRCA1
145:Rad51
141:MRE11
137:BRCA1
108:Each
72:ovary
29:ovary
766:PMID
715:PMID
674:PMID
614:PMID
573:PMID
521:PMID
472:PMID
464:ISSN
420:PMID
351:PMID
310:PMID
239:and
159:and
147:and
756:PMC
746:doi
705:doi
664:doi
604:doi
563:PMC
555:doi
511:PMC
503:doi
454:doi
410:PMC
400:doi
341:doi
302:doi
207:miu
190:FSH
161:ATM
151:.
149:ATM
131:by
786::
764:.
754:.
740:.
736:.
713:.
701:19
699:.
695:.
672:.
660:80
658:.
654:.
635:.
612:.
600:51
598:.
594:.
571:.
561:.
551:26
549:.
545:.
533:^
519:.
509:.
497:.
493:.
470:.
462:.
450:20
448:.
444:.
432:^
418:.
408:.
398:.
390:.
376:.
372:.
349:.
337:12
335:.
331:.
308:.
298:30
296:.
216:A
143:,
139:,
58:.
51:.
772:.
748::
742:5
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707::
680:.
666::
620:.
606::
579:.
557::
527:.
505::
499:5
478:.
456::
426:.
402::
394::
384::
378:5
357:.
343::
316:.
304::
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