Which way to assess ovarian reserve in 1999?

Fertility and results of infertility therapies are submitted to a major dro p in relation with the age of the female patient and her so-called ovarian reserve. Although there is no clear definition of what is exactly the ovari an reserve, the consequence of its decline is a greater difficulty to produ ce ovocytes with a capacity of becoming living embryos after fertilization. Several tests have been developped to assess the ovarian reserve in order to evaluate the prognosis of spontaneous fertility, the results of infertil ity therapy and assisted procreation techniques, and to make necessary tech nical adaptations. Basal determinations of FSH, estradiol and inhibin B at day 3 of the cycle an all reflect the ovarian potential, but only FSH refle cts a decline infecundability reliable enough to be used as a screening tes t Challenge tests such as the clomiphene citrate, the exogenous FSH or the GnRH challenge tests have the purpose to reveal an exaggerated liberation o f FSH or an insufficient secretion of estradiol after stimulation. None of these tests have demonstrated a better sensibility together with a higher s pecificity and they should be considered as evaluating fools in specific ca ses only. In conclusion, assessing the ovarian reserve has become a clinical necessit y in the following situations : ovulation defect, unexplained infertility, before undergoing ovarian stimulation for assisted procreation, in particul ar in women above the age of 35. This assessment can be made by determining the basal FSH level on day 3 of a cycle and should be renewed every year.