L’évaluation de la réserve ovarienne

Abstract

This literature review attempts to answer the following questions: 1) When making an assessment of ovarian reserve (OR) in an infertile woman? and 2) what is the investigation that best identifies situations of low OR in order to guide patients towards appropriate care? Some elements of the clinical examination should prompt us to rapidly perform OR tests: patients over 35 years, with cycle disorders or a history of pelvic disease, chemotherapy or radiotherapy. The most widely used OR tests are FSH, estradiol, inhibin B, antral follicle count (AFC), ovarian volume, Antimüllerian hormone (AMH) and dynamic tests. Most studies evaluating these markers were performed within the frame of in vitro fertilization (IVF), and we have little information on their ability to predict spontaneous pregnancy. FSH seems an interesting marker to identify extreme situations of ovarian insufficiency when using a high threshold value. Estradiol assay must always be associated with it. The AFC and AMH both have a good ability to predict the response to ovarian stimulation in IVF. However, their association does not increase their strength of prediction. The ovarian volume, inhibin B as well as dynamic tests are not relevant markers. None of these markers can predict the chances of pregnancy in IVF. OR tests must be performed before assisted reproduction techniques (ART) and should include FSH, estradiol, and AMH or CFA. Each center must define its specific standards for the interpretation of results. This assessment will advise the couple about their chances of success in ART and the clinician to adapt its management.