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Clinical methods for evaluation of ovarian reserve

Dr. Elena Tomova - short business card


Dr. Elena Tomova graduated from Medical University, Sofia in 2015, after which she obtained a specialty in Obstetrics and Gynecology at Acibadem City Clinic Hospital Tokuda. Over the years, he carried out a number of internships in Italy, Austria and Germany.


Dr. Tomova has a marked interest in the field of transvaginal and transabdominal 2D and 3D ultrasound in AG. Performs folliculometry, hysterosonography, smear smear, colposcopy, targeted biopsy, electroconization (LLETZ), hysteroscopy (diagnostic and operative), primary infertility consultation, pregnancy diagnosis and follow-up, etc.


Dr. Tomova has been part of the MC MARKOVS team since 2023.

What is the so-called assessment of ovarian reserve?

The evaluation of the ovarian reserve gives information about the capacity of the ovary to provide eggs in the female organism, which can be fertilized accordingly and lead to the realization of a successful pregnancy. In practice, this represents an assessment of the functional potential of the ovary. With advancing age, it physiologically decreases.



Why is the assessment of ovarian reserve performed?

Estimation of ovarian reserve is used to predict the likelihood of spontaneous pregnancy occurring. Ovarian reserve correlates directly with the success rate of a future IVF procedure. In the absence of plans to become pregnant soon, the reduced ovarian reserve may be a reason to discuss the possibility of possible egg freezing.



What can have a negative impact on the existing ovarian reserve?

After surgery on the ovary, it is possible to observe a decrease in its reserve. This is especially characteristic after the removal of large ovarian formations. Some oncological diseases requiring chemotherapy and radiotherapy also have an adverse effect on the ovarian reserve. There is also a genetic predisposition - daughters of mothers whose menopause occurred earlier often also have a reduced ovarian reserve for their age.



What are the methods for determining ovarian reserve?

The evaluation of the ovarian reserve is carried out using an ultrasound examination of both ovaries in combination with some hormonal tests. The latter require taking venous blood on certain days of the menstrual cycle.



How is the ultrasound assessment of ovarian reserve performed?

Sonographic assessment of ovarian reserve includes determination of antral follicle count (AFC) and measurement of ovarian volume. Antral follicles are follicles between 2 and 10 mm in diameter. The presence of fewer than 5 antral follicles in the ovary during the early follicular phase of the menstrual cycle is suspicious for reduced ovarian reserve. In the course of an ultrasound examination, in the same phase, the volume of the ovary is also measured in the three planes. This method can be supplemented by 3D ultrasound and Doppler examination of the blood supply to the ovary.



What to expect during the ultrasound examination?

Ultrasound examination for evaluation of ovarian reserve is a non-invasive method that does not require special preparation on the part of the patient. The examination is performed on a gynecological chair using transvaginal ultrasound. It is very important that the ultrasound examination is planned and performed in the first few days after menstruation (in the early follicular phase).



What does the hormonal analysis to assess ovarian reserve include?

Hormonal analysis to assess ovarian reserve is performed by taking venous blood. This is done at a certain period of the menstrual cycle. Follicle-stimulating hormone (FSH) and estradiol are tested in the early follicular phase - between days 3 and 5 of the menstrual cycle. The recommended time to check inhibin B values is on the 3rd day of the menstrual cycle. Anti-Mullerian hormone (AMH) is tested regardless of the day of the menstrual cycle.



What are the main limitations of ovarian reserve assessment methods?

Methods for evaluating the ovarian reserve provide information about the functional state of the ovary, but in practice do not provide information about the quality and fertilization potential of the eggs.



What would you say in conclusion?

Assessment of ovarian reserve is complex and usually based on several complementary methods. It is an integral part of the initial consultation for any couple with suspected infertility.



Dr. Elena Tomova