Ovarian reserve tests in infertility practice and normal fertile women

The decline in fecundity with the age of the woman is mainly attributed to the loss of follicles from the ovary and a decrease in oocyte quality. Eval uation of the aging status of the ovary in an individual woman has been ham pered by st lack of knowledge with regard to the relative contribution of t hese two factors. Most if not all so called ovarian reserve tests (ORT) ref lect indirectly the remaining follicle pool in the ovary. Direct a priori a ssessment of oocyte quality is not possible to date. In this section the pr edictive value of several ovarian reserve tests for the outcome of fertilit y treatment is listed and commented. In addition, the study of several of t he ORTs in normal, fertile women is described. From the data presented dyna mic testing of the ovarian function by the clomiphene citrate and GnRH agon ist stimulation test, as well as static testing by the use of ultrasound ba sed antral follicle counts seem to offer the highest clinical value. Studie s performing direct comparison of these tests are needed, as well as analys is of the way these tests should direct decision making in infertility diag nosis and treatment. (C) 1998 Elsevier Science Ireland Ltd. All rights rese rved.