Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs

1. Dr. Laxmi Shrikhande
MD; FICOG ;FICMU
• Director-Shrikhande Fertility Clinic, Nagpur
• President Menopause Society, Nagpur
• National Corresponding Editor-The Journal of Obstetrics & Gynecology of India
• Senior Vice President FOGSI 2012
• Vice Chairperson ICOG
• Governing Council member ICOG 2012-2017
• Governing Council Member ISAR 2014-2019
• Governing Council Member IAGE for 3 terms
• Patron-Vidarbha Chapter ISOPARB
• Chairperson-HIV/AIDS Committee, FOGSI (2007-09)
• Received Best Committee Award of FOGSI
• Received Bharat excellence Award for women’s health
• President Nagpur OB/GY Society 2005-06
• Associate member of RCOG
• Member of European Society of Human Reproduction
• Visited 96 FOGSI Societies as invited faculty
• Delivered 3 orations
• Publications-Thirteen National & seven International
• Presented Papers in FIGO, AICOG, SAFOG, AICC-RCOG conferences
• Conducted adolescent health programme for more than 15,000 adolescent girls

2. Markers of Ovarian reserve
Dr Laxmi Shrikhande
Chief Consultant | Shrikhande fertility Clinic
Nagpur [Maharashtra] INDIA

3. Ovarian reserve tests

4. Why we need markers of ovarian reserve ?
• Age of onset of decline in ovarian reserve is highly
variable
• Hence, the need for a marker to predict ovarian
reserve and fertility potential
• To identify young women with diminished ovarian
reserve
• To identify women with adequate OR even at the
age where natural fertility is lost (41 yrs)

5. AMH
• AMH is a glycoprotein
• Appears in females at puberty
• Produced by granulosa cells of pre-antral and small
antral follicles
• Reflects the growing pool of follicles in the ovary and
indirectly the entire pool of remaining eggs – the
“ovarian reserve”

6. AMH and its Interpretation
Ovarian Fertility
Potential
Pmol/L ng/ml
Optimal Fertility 28.6 to 48.5 4.0 to 6.8
Satisfactory Fertility 15.7 to 28.6 2.2 to 4.0
Low Fertility 2.2 to 15.7 0.3 to 2.2
Very low/ undetected 0.0 to 2.2 < 0.3
6

7. Antral follicular count
• Count of total follicles measuring 2 to
5mm in both ovaries on Day 2/3 of
periods.
• Inter observer variation is a limitation.
• cycle to cycle variability

8. • women over 30 years of age
• women with a history of exposure to a confirmed
gonadotoxin, i.e., tobacco smoke, chemotherapy,
radiation therapy.
• women with a strong family history of early menopause
or premature ovarian failure.
• women who have had extensive ovarian surgery, i.e.,
cystectomy and unilateral oophorectomy.
Whom to subject for marker tests ?

9. summary
• ORTs till date have modest predictive value for
pregnancy outcome as this is dependent on many
more factors apart from OR
• ORTs are indicative of ovarian reserve status in both
the quantitative and qualitative sense
• ORTs at best should be considered as screening
tests and not as diagnostic tests
• Treatment should not be denied based on these
tests to assumed ovarian aged woman

10. My World of
sharing happiness!
Shrikhande Fertility Clinic
Ph- 91 8805577600
shrikhandedrlaxmi@gmail.com