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Physiology

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Endocrinology

Question
3 out of 50
 

Best indicator for ovarian reserve (AIIMS MAY 2010)


A LH
B FSH

C FSH/LH ratio
D Estradiol

Ans. B FSH

Ovarianreserveis a term used to describe the functional potentialof the ovary and reflects the number and quality of oocyteswithin it.

Tests of ovarian reserve:

  1. Cycle day 3 FSH. Many studies have shown that an increasing FSH level is associated with a decreased pregnancy rate. Women in their early 40s were found to have elevated FSH levels associated with accelerated follicular phases of the menstrual cycle compared to younger patients.
  2. Clomiphene Citrate Challenge Test. This simple test involves a day 3 FSH level, 100 mg clomiphene from day 5-9, and a day 10 FSH level. An abnormal test is an elevated day 10 FSH level. An elevated day 3 FSH is a positive test. This is a ‘provocative test’, which will unmask patients which might be missed with a day 3 FSH level. It is 2-3 times more sensitive than a day 3 FSH level. This may be the best screening test to date. A positive or abnormal test is associated with a poor chance to conceive (<5%).

Results

FSH <15 good
FSH >15<20 borderline
FSH >20 poor

  1. Serum inhibin levels.Inhibin is a protein that is secreted by the follicles of the ovary to inhibit FSH secretion by the pituitary. An ovary with decreased ‘reserve’ will secrete less inhibin and thus will have a higher day FSH level and worse prognosis. This blood test is done in research labs, at present.
  2. Ovarian volume/follicles. Several studies have shown that patients with decreased ovarian volume and baseline follicles have decreased reserve. Using ultrasound scanning to count the number of antral follicles in the ovary is more accurate than measuring ovarian volume to assess ovarian reserve.

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