Both the quantity of eggs and their quality are strong influences on IVF outcome. Markers of ovarian reserve, such as basal follicle-stimulating hormone (FSH) and basal antral follicle (BAF) counts, are good predictors of the quantity of eggs which can be induced to grow. However, the quality of those eggs seems better predicted by the age of the women. In women past age 40, current success rates are low overall, even among those who make many eggs; at this age, quantity does not make up for quality. By contrast, young women with limited ovarian reserve can have good success. | __3 Testing Ovarian Reserve James P. Toner Atlanta Center for Reproductive Medicine Atlanta Georgia . INTRODUCTION Both the quantity of eggs and their quality are strong influences on IVF outcome. Markers of ovarian reserve such as basal follicle-stimulating hormone FSH and basal antral follicle BAF counts are good predictors of the quantity of eggs which can be induced to grow. However the quality of those eggs seems better predicted by the age of the women. In women past age 40 current success rates are low overall even among those who make many eggs at this age quantity does not make up for quality. By contrast young women with limited ovarian reserve can have good success rates despite their limited cohort of eggs because the eggs themselves are of high quality here quality matters more than quantity. The ramifications of these observations include the following Diminished ovarian reserve should not be used as an exclusionary criterion in young women because overall they still have satisfactory pregnancy rates though their risk of cancellation is increased. In women past age 40 normal ovarian reserve testing is not reassuring because even reduced egg quality is likely to limit the opportunity for successful pregnancy no matter how many eggs are available. Seventeen years ago Muasher and Oehninger from the Norfolk in vitro fertilization IVF program reported that basal follicle-stimulating hormone FSH levels predicted ovarian response and pregnancy outcome in IVF cycles 1 . Since then more than a hundred articles have sought to refine our understanding of the link between markers of ovarian reserve 29 30 Toner and pregnancy in assisted reproductive technology ART . Although there have been important refinements to our original understanding the essence of the initial message has only been confirmed in the numerous studies that followed. In this chapter we will consider the biological basis for the links .
