Ovarian Reserve Assessment in Assisted Reproductive Technology

Ovarian reserve assessment underpins individualised strategies in assisted reproductive technology (ART) by estimating the pool of recruitable follicles and anticipating ovarian response to stimulation. Common biomarkers include serum anti-Müllerian hormone (AMH), antral follicle count (AFC) determined by transvaginal ultrasound and, to a lesser extent, basal follicle-stimulating hormone (FSH) levels. These measures guide choice of gonadotrophin dosing, protocol selection and prognostic counselling. Although AMH and AFC correlate closely, discordance can arise and influence clinical decision making. Beyond quantity, recent research has explored the relationship between reserve markers and oocyte quality, embryo competence and cumulative live-birth rates. Novel approaches integrate genetic evaluation, machine-learning algorithms and dynamic monitoring to refine prediction of response and outcome. Globally, improved assessment reduces cycle cancellation, tailors patient care and optimises resource use. Nevertheless, variability in assay methods, age-related decline and inter-individual differences continue to prompt refinement of reserve testing and consensus on best practice in ART.

Research from Nature Portfolio

One foundational study examined whether AMH predicts oocyte quality in women aged 37 years and older undergoing IVF/ICSI. Despite markedly lower AMH levels in one group, rates of normal fertilisation, blastocyst formation and implantation per transferred top embryo were comparable to those with higher AMH. Clinical pregnancy, miscarriage and live-birth outcomes did not differ significantly when adjusted for age and embryo quality. The work challenges reliance on AMH as a surrogate for oocyte quality in advanced-age patients, and supports a strategy of cumulative embryo accumulation through multiple retrievals rather than exclusion based on low AMH alone.

Ovarian Reserve Assessment in Assisted Reproductive Technology publication trend

The graph below shows the total number of articles in ovarian reserve assessment in assisted reproductive technology across all publications each year (not limited to Nature Index journals).

Technical terms

Anti-Müllerian hormone (AMH): A glycoprotein produced by small antral and pre-antral follicles; reflects the size of the growing follicle pool and remains relatively stable throughout the menstrual cycle.

Antral follicle count (AFC): The number of follicles measuring 2–10 mm observed by ultrasound in both ovaries early in the follicular phase; indicates the quantity of recruitable follicles.

Ovarian reserve: The functional potential of the ovary in terms of remaining primordial follicles and capacity to produce oocytes capable of fertilisation.

Follicle-stimulating hormone (FSH): A pituitary gonadotrophin measured on day 2–3 of the cycle; elevated levels may indicate diminished feedback from the ovary and reduced follicular reserve.

Preimplantation genetic testing for aneuploidy (PGT-A): A technique to screen embryos for chromosomal normality prior to transfer, aiding selection of embryos with highest implantation potential.

References

1. AMH independently predicts aneuploidy but not live birth per transfer in IVF PGT-A cycles. Reproductive Biology and Endocrinology (2023).
2. Assessment and quantification of ovarian reserve on the basis of machine learning models. Frontiers in Endocrinology (2023).
3. Comparison of anti-Müllerian hormone and antral follicle count in the prediction of ovarian response: a systematic review and meta-analysis. Journal of Ovarian Research (2023).
4. AMH has no role in predicting oocyte quality in women with advanced age undergoing IVF/ICSI cycles. Scientific Reports (2020).
5. Discordance between antral follicle counts and anti-Müllerian hormone levels in women undergoing in vitro fertilization. Reproductive Biology and Endocrinology (2019).