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The Eggs Have It…Ovarian Reserve

a blog by Reproductive Medicine Institute- Chicago, September 16, 2013

Diagnosis of Reduced Ovarian Reserve:
Day 3 Bloodwork:
FSH > 10 mIU/ml
E2 > 75-100 pg/ml
AMH Antral Follicle Count (AFC)

When it comes to Infertility, determining ovarian reserve is crucial in creating a treatment plan. Ovarian reserve is a term that is used to determine the capacity of the ovary to provide healthy eggs that are capable of fertilization and further normal embryo development, resulting in successful pregnancy and live birth.

Testing for ovarian reserve is part of the evaluation for couples presenting with infertility. After initial evaluation, the patient might be noted to have normal ovarian reserve or diminished ovarian reserve, an important guide for moving forward.

Just as it can be said that location, location and…location are the three most important qualifiers in Real Estate, it can be said that age, age and…age (of the female partner) are the most important factors to predict normal ovarian reserve as well as normal egg quality. Egg quality and quantity slowly declines with (here’s that word again) age, with the decline becoming more significant after 35 and especially after 40 years of age.

The Tests of Time

While age of the female partner gives us an overall ‘guesstimate’ of ovarian reserve, a clearer picture is achieved by performing the following tests routinely used for measuring ovarian reserve:

  1. Day 3 FSH and corresponding estradiol serum levels. Ideally day 3 FSH should be below 12 mIU/ML and corresponding E below 65 pg/ml. Elevated FSH or estradiol level might specify that the women is getting closer to transition from normal reproductive function to perimenopause, and might have less eggs available then her age-matched peers. There is some data that elevated FSH might

  2. Antral follicle count. Ultrasound is performed and antral follicles are visualized and counted in both ovaries. Identification of 10 or more antral follicles in both ovaries is consistent with normal ovarian reserve.

  3. Anti-mullerian hormone serum level. AMH is produced by granulosa cells in primary, pre-antral and antral ovarian follicles. The levels are quite constant for 6-12 months and can be measured on any day of the menstrual cycle. AMH level of 1 ng/ml and above is consistent with normal ovarian reserve.

  4. Previous clinical performance. Poor response to gonadotropins during controlled ovarian hyperstimulation or an IVF cycle, as well as poor quality of the eggs retrieved during IVF and poor embryo development, can also serve as an indication of diminished ovarian reserve.

The Whole Picture

In general, once testing for ovarian reserve is performed, as well as the rest of the clinical evaluation for infertility, the couple can be counseled about their individual chances to conceive, and the best treatment options available to them.

Age is always our guide when it comes to Infertility. Testing for Ovarian Reserve can either confirm or question that which a woman’s age tells us, allowing for the most comprehensive understanding and approach.


As one of the field’s devoted female reproductive endocrinologists, Elena Trukhacheva, MD, MSCI, demonstrates a unique rapport and understanding of her patients. As a woman and a mother, she takes pride in providing comprehensive care and strives to bring hope and support to her patients. Dr. Trukhacheva is Board Certified in the specialty of obstetrics and gynecology and in the subspecialty of reproductive endocrinology and infertility.

Dr. Elena Trukhacheva has devoted her professional life to academic medicine, research, and clinical practice in the field of Reproductive Endocrinology and Infertility. She received her medical degree from the Russian State Medical University in Moscow, Russia. She graduated magna cum laude in 2000 and received multiple awards for research and academic excellence during her studies. Dr. Trukhacheva completed her residency in Obstetrics and Gynecology at Baylor College of Medicine, consistently rated among the top medical schools in the country.

Following her residency, Dr. Trukhacheva entered a three-year fellowship in Reproductive Endocrinology and Infertility at Northwestern University in Chicago. During her fellowship she also received a Master of Science degree in Clinical Investigation. She has formal training in biostatistics, epidemiology, and design of the clinic.

Dr. Trukhacheva is a speaker for the American College of Obstetrics and Gynecology. She also serves as a reviewer for the Fertility and Sterility journal and is a member of the nominating committee for the Preimplantation Genetic Diagnosis International Society (PGDIS). She is actively involved in teaching medical students and OBGYN residents at the Midwestern University and at the Illinois Masonic Medical Center.

Her clinical interests include Invitro fertilization, previous IVF failures, special approaches for poor responders, prenatal genetic screening and diagnosis, as well as advanced laparoscopic and hysteroscopic gynecologic surgery.

Dr. Trukhacheva is fluent in English, Russian, and Ukrainian. A native of Russia, she now calls Chicago home.

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