Ovarian reserve testing: What you should know if you're trying to conceive

Are you considering starting a family? Perhaps you've been trying to conceive for a while and wondering why it's not happening as quickly as you hoped. If this sounds like you, it might be time to explore ovarian reserve testing.

This simple procedure can provide invaluable insights into your fertility and guide your family planning journey. In this article, we'll dive into all things ovarian reserve testing, including what it is, when to consider it, how it's done, potential risks and limitations, costs in Singapore, and what to expect afterwards.

What is ovarian reserve testing?

Before we get into the nitty-gritty details, let's start with the basics. Ovarian reserve testing is a set of diagnostic procedures used to assess a woman's current fertility status. It helps determine how many eggs she has left in her ovaries and their quality. In other words, it gives you a sneak peek into your reproductive future.

How do you know if your ovarian reserve is low?

A low ovarian reserve is often associated with difficulties in getting pregnant. However, it's essential to understand that having a low ovarian reserve doesn't necessarily mean you can't conceive - it just means it might be more challenging. Signs of a low ovarian reserve can include:

1. Irregular menstrual cycles.
2. Experiencing menopausal symptoms at a relatively young age.
3. A family history of early menopause.
4. Previous surgeries on the ovaries.

What factors affect ovarian reserve?

Several factors can influence your ovarian reserve. These include:

1. Age: The most significant factor. As you get older, the quantity and quality of your eggs decline.
2. Smoking: Smoking can accelerate the loss of ovarian function and decrease fertility.
3. Genetics: Family history can play a role in early menopause or a diminished ovarian reserve.
4. Chemotherapy or radiation therapy: Cancer treatments can harm ovarian function.
5. Certain medical conditions: Conditions like polycystic ovary syndrome (PCOS) can affect ovarian reserve.
6. Ovarian surgery: Previous surgeries on your ovaries can reduce your reserve.
7. Endometriosis: Severe endometriosis can harm ovarian tissue and reduce egg quantity.

When should I have ovarian reserve testing?

The timing for ovarian reserve testing largely depends on your individual circumstances. However, there are some general guidelines to consider. If you're:

1. Under 35 and trying to conceive for over a year: If you're under 35 and have been trying to get pregnant for over a year without success, it might be time to consider ovarian reserve testing.
2. Over 35 and trying for six months: Women over 35 are advised to seek testing after trying for six months. This is because fertility tends to decline more rapidly as you age.
3. Planning for the future: Some women choose to assess their ovarian reserve proactively, especially if they're planning to delay pregnancy due to career or personal reasons. This can help them make informed decisions about fertility preservation options.

How is ovarian reserve testing done?

Ovarian reserve testing typically involves the following methods:

1. Blood tests: These measure levels of hormones such as anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH). These hormones provide insights into the quantity and quality of your eggs.
2. Transvaginal ultrasound: This involves inserting a small ultrasound probe into the vagina to examine the ovaries and count antral follicles (tiny fluid-filled sacs that house immature eggs).
3. Clomiphene challenge test: It combines blood tests taken on specific days of your menstrual cycle before and after taking a fertility drug called Clomiphene. This can reveal how your ovaries respond to stimulation.
4. Ovarian biopsy: A more invasive procedure that requires taking a small tissue sample from the ovaries for a more in-depth analysis.

How do I prepare for ovarian reserve testing?

Preparation for ovarian reserve testing is relatively straightforward. Here are some general guidelines:

1. Consult your healthcare provider: Discuss your plans with a healthcare provider who can guide you on when and which tests are suitable for your situation.
2. Understand the tests: Make sure you understand the tests you'll be undergoing and their purpose. Knowledge is power.
3. Timing: Some tests, like blood tests for FSH and LH, need to be performed on specific days of your menstrual cycle. Your healthcare provider will guide you on this.
4. Stay hydrated: Drinking water before transvaginal ultrasound can help provide a clearer image of your ovaries.
5. Relax: Stress can affect hormone levels, so try to stay calm before the tests.

Frequently asked questions

Is ovarian reserve testing painful?

Most women find ovarian reserve testing to be uncomfortable rather than painful. The transvaginal ultrasound can cause a sensation of pressure, but it's usually well-tolerated. Blood tests involve a simple needle prick, which can cause mild discomfort for a brief moment.

Are there any risks of ovarian reserve testing?

The risks associated with it are minimal. The procedures are generally safe and non-invasive. However, some possible risks and considerations include:

1. Discomfort: Transvaginal ultrasounds might cause some discomfort but are usually well tolerated.
2. Infection: Although rare, there's a slight risk of infection with any procedure involving medical instruments.
3. Emotional Impact: The results of these tests can be emotionally challenging if they reveal a low ovarian reserve. It's essential to have a support system in place.
4. Cost: While not a direct risk to your health, the cost of this procedure an be a consideration, especially if it's not covered by insurance.

What are the limitations of ovarian reserve testing?

Ovarian reserve testing is a valuable tool, but it's not without limitations. Some of the constraints to keep in mind are:

1. Not a guarantee of fertility: A low ovarian reserve doesn't necessarily mean you can't conceive, and a normal result doesn't guarantee easy conception. It's just one piece of the puzzle.
2. Quality vs. quantity: These tests focus on quantity but don't provide a complete picture of egg quality.
3. Varied accuracy: The accuracy of ovarian reserve tests can vary, and results can fluctuate from one cycle to the next.
4. False positives/negatives: In some cases, these tests can yield false positive or false negative results.

What is the normal range for ovarian reserve testing?

Normal ranges can vary between different laboratories and tests, but generally, a higher AMH level and a lower FSH level are considered better indicators of ovarian reserve. However, it's crucial to remember that the interpretation of these results should be done by a healthcare professional in the context of your individual situation.

How much does ovarian reserve testing cost in Singapore?

The cost of ovarian reserve testing in Singapore can vary based on the type of tests, where you get them done, and whether you have insurance. On average, a transvaginal ultrasound may cost between $200 to $500, while blood tests can range from $80 to $300 per test. Some clinics might offer packages for multiple tests.

What can I expect after ovarian reserve testing?

After your ovarian reserve testing, you can expect:

1. Results and discussion: You will receive your test results, and your healthcare provider will explain what they mean in the context of your fertility and family planning goals.
2. Treatment options: If your results indicate a diminished ovarian reserve, your healthcare provider can discuss various fertility treatment options, including in-vitro fertilisation (IVF) and egg freezing.
3. Emotional support: Dealing with the results, especially if they are not what you expected, can be emotionally challenging. It's essential to have a support system in place, which may include counselling or support groups.

In conclusion, ovarian reserve testing is a valuable tool for those trying to conceive. It provides essential information about your fertility potential and can guide your family planning journey. However, it's important to remember that fertility is a complex interplay of various factors, and testing is just one piece of the puzzle.

Discuss your options and results with a healthcare provider, and always remember that you are not alone in this journey.

ALSO READ: How can I tell if I am pregnant if I have irregular periods? Here's what you should know

This article was first published in theAsianparent.