Recent Dynamic Ovarian Reserve Modalities

Abstract

Background: the pool of primordial follicles in the ovary or ovarian reserve is a major factor in the human fertility potential. The ageing ovary is characterized by reduction of the number of primordial follicles and this loss accelerates in the late 30's and precedes the menopause by 10-12 years. Woman's age alone or with combination of biochemical markers, dynamic tests and ultrasound measurement fail to predict this loss accurately. Aim of the Work: this study aimed to assess the recent dynamic ovarian reserve tests including antral follicle count, ovarian volume and ovarian blood flow (OBF) as a predictive value and less cheap method for evaluation of ovarian reserve. Patients and Methods: this randomized controlled trial was conducted on 200 women having unexplained infertility in outpatient clinic at Sohag General Hospital and private clinics during the period from 2016 to 2017 after taking a verbal consent from each case after explanation of the purpose of the study was taken. Results: mean baseline ovarian volume in cycle day 3 of infertility group was 15.28±12.1, while it was 12.6±4.8 in the control group. It also showed that the mean baseline total antral follicle count in cycle day 3 of infertility group was 5.98±1.74. While, it was 10.1±2.5 in the control group. The mean baseline resistance index of ovarian arteries of infertility group was 0.56±0.12. While, it was 0.47±0.058 in the control group. It also showed that the mean baseline pulsatility index of ovarian artery of infertility group was 0.75±0.15, while it was 0.9±0.26 in the control group. The differences between the two groups were significant regarding baseline total AFC, baseline OV and the rest of variables. It was even found that AFC compared to other predictors was considered the strongest predictor. Conclusion: antral follicular count and the mean ovarian volume measured through the transvaginal ultrasonography is a non-invasive method and easy to perform and can be considered as an accurate method for assessment of the ovarian reserve. Ovarian stromal blood flow may also become one of the parameters. Recommendations: perform transvaginal ultrasound at third day of the cycle in women undergoing infertility treatment is a good predictor for ovarian reserve. Early evaluation of ovarian reserve is very important step in the infertility work up especially in infertile women above the age of 35 years, women with unexplained infertility and women with poor response to ovulation induction.