TESTING THE OVARIAN RESERVE IN INFERTILE WOMEN

Women older than 35 presenting with infertility constitute the largest portion of the total infertility population. These women frequently u ndergo multiple testing, and most will require expensive and invasive therapies including assisted reproductive technologies (ART). These wo men also suffer from a higher incidence of pregnancy loss even after d ocumentation of fetal cardiac activity by ultrasound, This demonstrati on of diminished ovarian reserve is one of the earliest signs of the o nset of the perimenopausal period. Identifying these women presents a daily challenge to the practicing clinician. This manuscript reviews t he available methods to test the ovarian reserve in infertile women. W omen with markedly diminished ovarian reserve should be counseled on t heir low chances of conception using their own gametes, even with ART, and should be directed towards the use of donor oocytes or adoption. Longitudinal study of this group of women will eventually yield insigh t of the endocrinological transition and potential predictors of the m enopause.