Prognostic assessment of ovarian reserve.
OBJECTIVE
To review the literature regarding diminished ovarian reserve, the screening techniques that are currently available, and their appropriate application in clinical practice.


METHODS
Directed Medline searches.


RESULTS
Ovarian reserve screening identifies women with greatly diminished chances of achieving pregnancy. The screening techniques include the clomiphene citrate challenge test, basal day 3 FSH measurements, and the GnRH agonist stimulation test. All have been evaluated in assisted reproduction programs and the predictive values of an abnormal test for failing to conceive is very high. When abnormal, these tests allow physicians to counsel patients that their prognosis for conception is poor. Although the presence of a normal result does indicate better long-term chances for conception, an age-related decline in fecundity remains and patient age should still be considered when counseling patients with normal screening results. Clinicians are urged to validate the threshold values with the assay system used in their own laboratory before the application of these tests.


CONCLUSIONS
The literature consistently demonstrates the value of diminished ovarian reserve screening.
Scott
R T
RT
Uniformed Services University, Bethesda, Maryland 20814.
Hofmann
G E
GE
D000328:Adult; D000375:Aging / Q000502:physiology; D002996:Clomiphene; D005260:Female; D005298:Fertility / Q000502:physiology*; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D010050:Ovarian Function Tests; D010053:Ovary / Q000502:physiology*; D011247:Pregnancy; D011379:Prognosis
D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D005640:Follicle Stimulating Hormone