What Can Ovarian Reserve & AMH Tests Tell Us?

By BSc, MSc (embryologist) and BA, MA (fertility counselor).
Last Update: 02/12/2015

Ovarian reserve can be assessed by counting the antral follicles thanks to an ultrasound, endocrine markers such as FSH, Estradiol, AMH and inhibin B, or thanks to a dynamic test, which investigates the ovarian response to different stimulating drugs.

Normally, the gynaecologist uses several of these methods in order to achieve a clear diagnosis. The most commonly used tests are ultrasounds and hormonal analysis.

Below you have an index with the 8 points we are going to deal with in this article.

Ultrasound and antral follicle count

Follicles are found in the ovaries and are an accumulation of spherical cells, which cover the oocyte. They are structures from where eggs originate. An antral stage follicle has a diameter of approximately 2 and 9 mm and their count provides important information about the ovarian reserve state.

This test should be performed during the follicular phase of women's menstrual cycle, that is, between the 3rd and 5th day of the cycle.

This marker is widely used in assisted reproduction. In IVF, and when compared to FSH values, it has a predictable value.

There is another ultrasound marker, the ovarian volume, which can also provide information about the ovarian reserve. Ovarian volume also decreases with age.

antral follicles ultrasound


As age increases, the ovarian reserve diminishes and FSH values grow.

Basal FSH levels should be measured between the 3rd and 5th day of the menstrual cycle. This indirect measurement gives us information about the size of the ovarian follicles. FSH levels above 10 indicate a low ovarian reserve.


Basal estradiol levels should also be measured during the first days of the menstrual cycle (3rd-5th). Estradiol is secreted by pre-ovulation follicles. When the number of follicles decreases, the product of the excretion between the follicles and estradiol (E2) also diminishes.

Anti-Müllerian hormone (AMH)

AMH is a glycoprotein, present in women since their 36th week of gestation until the beginning of menopause, even though it is not detectable in the blood until puberty. Its values decrease as the woman grows older.

Unlike FSH, AMH can be measured at any time during the cycle. It is the marker that best reflects, not only the patient's response to stimulation treatments, but also her chances of getting pregnant.

AMH levels between 0.7 and 3.5 are considered normal. Levels below 0.7 indicate a low ovarian reserve.

Inhibin B

Inhibin B concentration is inversely related to FSH values during the cycle proliferative phase. Its serum determination is a good indicator of follicular function and, indirectly, of the ovarian reserve.

An inbibina B value of less than 45 pg / mL reveals alterations in ovarian reserve. During IVF treatments, it reveals a poor ovarian response.

Dynamic test

Ovarian response to stimulating drugs, such as clomiphene citrate (CC) or GnRH analogues, is evaluated.

Clomiphene citrate stimulates the ovary for 5 days, normally from the 3rd or 5th day of the cycle onwards. After, the ovarian hormonal response is evaluated and controlled through ultrasounds.

GnRH analogues testing allows for changes in serum estradiol between the 2nd and 3rd day after the administration of a GnRH agonist to be measured. The normal results of this test show elevated estradiol levels.

Ovarian reserve test


Thanks to results obtained using these tests and assessing the patient's age, gynaecologists can predict, to some extent, the woman's ability to get pregnant either naturally or through assisted reproduction techniques. Results allow doctors to know how the patient will respond to the ovarian stimulation and if the treatment can be successful.

Once a woman reaches the age of 37, her ovarian reserve decreases. This can be easily observed through ultrasounds. The primordial follicles pool and the ovarian volume decrease after menopause. The ovarian volume decreases from 4,9ml to 2, 2,ml.

Clomiphene tests compare FSH and estradiol values obtained after the ovarian stimulation with basal values.

An abnormal FSH test result is indicative of a poor pregnancy prognosis and of an almost inexistent chance of pregnancy using the woman's own eggs. This clomiphene test is one of the most widely used functional tests because it has better results and is cheaper.

It is important to keep in mind that all these tests have a prognostic value, determine ovarian reserve and do not indicate that a woman can get pregnant. These tests are very useful in assisted reproduction treatments that include a prediction of the woman's response to ovarian stimulation.

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 Teresa Rubio Asensio
Teresa Rubio Asensio
BSc, MSc
Master's Degree in Medicine and Reproductive Genetics from the Miguel Hernández University of Elche (UHM). Teacher of different Clinical Embryology courses at the UHM. Member and writer of scientific contents at ASEBIR and ASPROIN. Embryologist specializing in Assisted Procreation at UR Virgen de la Vega. More information about Teresa Rubio Asensio
Adapted into english by:
 Sandra Fernández
Sandra Fernández
Fertility Counselor
Bachelor of Arts in Translation and Interpreting (English, Spanish, Catalan, German) from the University of Valencia (UV) and Heriot-Watt University, Riccarton Campus (Edinburgh, UK). Postgraduate Course in Legal Translation from the University of Valencia. Specialist in Medical Translation, with several years of experience in the field of Assisted Reproduction. More information about Sandra Fernández

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