Ovarian reserve is a measure of egg quantity and egg quality; it is best measured by combining chronologic age, antral follicle count (AFC) on sonogram, and antimullerian hormone (AMH). AFC less than 11 reflects diminished ovarian reserve (DOR) and less than 6 is severe. AMH levels below 1.6 have been shown to reduce the number of eggs retrieved with IVF and may predict pregnancy outcome. Levels below 0.4 are severe. The use of a screening test for DOR in a population at low risk for DOR will yield a larger number of false-positive results (i.e., characterizing a woman as DOR when in fact she has normal ovarian reserve). A recent article in JAMA demonstrated no difference in natural pregnancy rates in women aged 30-44 irrespective of AMH levels.
Very low AMH levels (<=0.4) effects the outcome of IVF cycles. in 2016, a study in Fertility and Sterility, using SART data from a population of women with mean age of 39.4, cycle cancellation was 54%; of all retrieval attempts, no oocytes were obtained in 5.4% and no embryo transfer occurred in 25.1% of cycles; and the live birth rate per embryo transfer was 20.5% (9.5% per cycle start and 16.3% per retrieval) from a mean age of 36.8.
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