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.

Wisdom Wednesday: Urine Hormone Testing

I have written several blogs about HRT (hormone replacement therapy) including bio-identical hormone therapy. Sometimes, HRT is prescribed based on the age of the patient and/or their symptoms. However, most of the time some sort of laboratory panel is run to evaluate hormone status prior to treatment. These tests are often repeated over time to measure the effect of the therapy.

Clinically, I use hormone testing to verify my QA (Quintessential Applications) findings and assess the patient response to nutritional therapy.

Some hormones can be tested from blood and many more from saliva. More recently, the dried urine test has become the most comprehensive, cost effective method for hormone analysis.

Serum testing from blood was the industry standard for many years and is still performed by many gynecologists. The drawbacks are cost, convenience (requires a blood draw) and limitations. In order to adequately test cortisol, you need to perform four blood draws over the course of 24 hours. Although you can measure the major sex hormones, you cannot measure the metabolites from phase 1 liver detoxification.

Salivary hormone testing is much more convenient. It can be done from the home and although the preparation is a little tedious (time restrictions on food, brushing the teeth, etc.), you can easily spit in a test tube four times over 24 hours to measure the daily fluctuations in cortisol. However, like blood, you cannot measure hormone metabolites and it is relatively expensive.

DUTCH (dried urine test for comprehensive hormones) has the convenience of salivary testing, it very cost effective, and is much more comprehensive than either blood or saliva.