We always worry when a patient in her late 30’s or early 40’s has biomarkers such as early-follicular-phase serum antimullerian hormone (AMH), serum and urinary follicle-stimulating hormone (FSH) and serum inhibin B indicating a low ovarian reserve. But for some a new study indicates that low ovarian reserve may not indicate a problem conceiving.

Lab tests showing that women have low reserves of eggs in their ovaries may not necessarily mean they will struggle to get pregnant, a U.S. study suggests. For the study, researchers examined results from blood and urine tests for so-called biomarkers that indicate ovarian reserve, or egg supply, in 750 women ages 30 to 44. Women with test results indicating low ovarian reserve were no less likely to conceive within six or 12 months of attempts than women whose lab tests didn’t point to a limited egg supply, researchers report in JAMA.

The curious thing is that when a woman comes in at those ages for an evaluation and has low ovarian reserve we would never wait a year to see if they conceived on their own but would be much more proactive.

“These blood tests do predict how well a woman will respond to fertility treatment,” said lead study author Dr. Anne Steiner of the University of North Carolina at Chapel Hill.
“However, we found that they do not predict her likelihood of conceiving naturally,” Steiner said by email. “This challenges the clinical dogma that diminished ovarian reserve is a cause of infertility.”

The study examined tests of three biomarkers of ovarian reserve: early-follicular-phase serum antimullerian hormone (AMH), serum and urinary follicle-stimulating hormone (FSH) and serum inhibin B. Women with lower levels of AMH and elevated FSH, which can point to limited egg supplies, weren’t significantly less likely to get pregnant within 6 or 12 months of trying to conceive than women with normal test results, the study found. Results from tests of inhibin B levels also weren’t associated with fertility.The study examined tests of three biomarkers of ovarian reserve: early-follicular-phase serum antimullerian hormone (AMH), serum and urinary follicle-stimulating hormone (FSH) and serum inhibin B.

Women with lower levels of AMH and elevated FSH, which can point to limited egg supplies, weren’t significantly less likely to get pregnant within 6 or 12 months of trying to conceive than women with normal test results, the study found. Results from tests of inhibin B levels also weren’t associated with fertility.

I think most fertility specialists would be much more proactive with patients in the older age group, especially if their biomarkers suggested impaired ovarian reserve.