In the past decades postponement of childbearing has led to increased rates of age related female subfertility. Reproductive ageing in the female is almost exclusively based on changes in the ovaries. The decrease in follicle numbers and reduction of oocyte quality dictate the occurrence of menopause and natural loss of fecundity, respectively. The decline in fertility with age has been clearly shown in assisted reproduction technology (ART) programs. The rate of ovarian ageing is highly variable among women. Identification of subfertile women who have severely decreased ovarian reserve for their age is therefore clinically relevant. Tests for ovarian reserve (ORT) relate mainly to the quantitative aspect of ovarian reserve. Basal endocrine, ultrasound morphological and challenge tests all have been proposed as possible outcome predictors enabling patient tailored treatment. Tailored treatment may imply refusing IVF treatment, applying adjusted dosages of gonadotropins or treatment schedules or just counselling on reduced prospects. From recent systematic reviews and meta-analyses the accuracy and true clinical value of ORTs to predict poor ovarian response and the occurrence of pregnancy after IVF have become more apparent. It was shown that the best performing tests to date (AFC, AMH, basal FSH) have a rather good accuracy in predicting poor ovarian response. However, the value of the prior identification of a poor responder remains to be established for two reasons. First, poor response is not unequivocally related to a poor prospect for pregnancy. Second, measures like FSH dose increase, co medication or agonist/antagonist schedule adaptations in predicted poor responders may neither increase response nor the chances for pregnancy. Moreover, current comparative trials suggest that FSH doses of 200 and over will not further improve ovarian response.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.