Friday, October 20, 2017

Ovarian Reserve Tests Fail to Predict Fertility

Tests that estimate ovarian reserve, or the number of a woman’s remaining eggs, before menopause, do not appear to predict short-term chances of conception, according to a National Institutes of Health-funded study of women with no history of infertility. The study appears in the Journal of American Medical Association.

“Women are born with a set number of eggs that gradually declines through the reproductive years,” said Ester Eisenberg, M.D., of the Fertility and Infertility Branch of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, which funded the study. “This study suggests that the testing for biomarkers of ovarian reserve does not predict the chances for conception in older women still of reproductive age.”

As a women ages and her egg supply declines, cells in the ovary secrete lower amounts of inhibin B and anti-Mullerian hormone, substances considered to be indicators of ovarian reserve. The ovaries also produce higher amounts of follicle stimulating hormone (FSH) in the days before ovulation. Although there is little research to support their use, tests for anti-Mullerian hormone are routinely offered in many fertility clinics on the assumption that women with a lower ovarian reserve would be less likely to respond to treatment. Moreover, home fertility tests of urinary FSH are commercially available.

The researchers enrolled 750 women from 30 to 44 years of age who had been attempting to conceive for three or fewer months. Women were ineligible to participate if they had known fertility problems, such as polycystic ovarian syndrome, tubal blockage or endometriosis. The women provided a urine and blood sample and checked for conception with home pregnancy test kits. The researchers statistically corrected for factors known to reduce fertility, such as smoking, recent use of oral contraceptives and obesity.

After six cycles of attempting to conceive, results did not differ significantly between women with low levels and normal levels of anti-Mullerian hormone – a 65% chance of conception, compared to a 62% change. Similarly, results were not statistically different after 12 cycles: 82% versus 75%.

Chances for conception also did not differ significantly according to high versus normal levels of FSH, with conception rates of 61% versus 62% after six cycles and 82% versus 75% after 12 cycles. The researchers found no association of inhibin B levels and conception after six cycles or 12 cycles.

“Our study suggests that younger women with biomarker levels indicating lower ovarian reserve should not become anxious that they won’t be able to have a baby,” said Anne Steiner, M.D., first author of the study and professor of reproductive endocrinology and infertility at the University of North Carolina at Chapel Hill.

My Take:
I believe fertility clinics use these tests to convince women to submit to expensive procedures, like in vitro fertilization, to conceive. Men are rarely tested (sperm testing is cheap) and their health issues account for well more than 50% of infertility cases.

Often the stress of trying to conceive is a significant factor for both men and women. Clinically, I have found that giving both partners adrenal support in the form of an herbal adrenal adaptogen and some trace minerals often does the trick.

The DUTCH (dried urine test for comprehensive hormones) for the female is an excellent panel to evaluate fertility. For men, testing total testosterone, free testosterone, SHBG (sex hormone binding globulin), and sperm analysis is also recommended.

The Bottom Line:
If you are struggling to conceive do not put any faith in the ovarian reserve. I wouldn’t even run the test. It just increases your stress levels. Consider nutritional evaluation with a practitioner that has access to the lab tests noted above.

Source: October 10, 2017 National Institutes of Health

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