For the evaluation of the condition of the ovaries several hormones of the reproductive system are analysed as well as the woman’s overall reproductive status
The normal range of the hormones on the 2nd-3rd day of the cycle:
FSH → 3 – 10 IU/ml
E2 → 25 – 50 pg/ml
AMH → 0.5 – 2.1 ng/ml
A vaginal ultrasound scan is also performed on the 2nd or 3rd day of the cycle to count the number of the primordial follicles, which should be around 2-8mm in diameter and 6 to 8 in number in each ovary.
FSH (Follicular stimulating hormone)
An FSH value on the 2nd or 3rd of the cycle of over 10IU/ml is indicative of reduced ovarian function.
An FSH value of 10-20 IU/ml is considered high. The quality of the oocytes, if produced, is not the best. If the ovarian response, during stimulation, is poor the reduction of the FSH dosage may improve the quality and number of the oocytes produced.
An FSH value greater than 20IU/ml is considered very high and the attempt of ovarian stimulation with no attempt to reduce the FSH may not provide good results.
It is commonly observed that women with increased FSH, even under ovarian stimulation with high gonadotropin dosage, have only one follicle growing, which would have grown even without stimulation and is usually of poor quality.
Today, it is possible than a high percentage of women with increased FSH that can reach 70% to be aided medically with suitable regimes. We have observed us in studies performed in our Centre and published in international medical journals as well as in international Centres [1, 2, 3].
The increased E2 value on the 2nd or 3rd day of the cycle, is possible to occur due to a cyst that is developed in the last days of the previous cycle and is something commonly observed in women with high FSH. The presence or absence of this type of cysts is checked with the vaginal ultrasound scan. This confirms whether the E2 value is real or due to the cyst.
AMH (Anti – Müllerian Hormone)
The primordial follicles that contain good quality oocytes produce the AMH. It is an indicator of the ovarian reserve. The AMH value should be over 0.5ng/ml in women of 41 years and older and 2.1ng/ml in women of 33 years. The measurement of the AMH can be performed any day of the cycle.
Vaginal ultrasound scan on the 2nd or 3rd day of the cycle
As mentioned above the vaginal ultrasound together with the FSH and E2 measurement is an important examination as it is possible to count the primordial follicles with diameter 2-8mm, which are directly linked with the ovarian response during hormonal stimulation. There should be six to eight primordial follicles in each ovary. This number depends on the woman’s age. With the ultrasound scan the size of the ovaries is also checked and each ovary should be larger that 5 to 6 cm3.
It is important to note that even if the above indicators seem normal it is possible that the ovarian response is not satisfactory. The medical history may reveal this, for example a previous stimulation that was poor. In this case other methods of treatment can be offered.
- Gleicher N, Barad DH. (2011). Dehydroepiandrosterone (DHEA) supplementation in diminished ovarian reserve (DOR). Reprod Biol Endocrinol. 9: 67.
- Mamas L, Mamas E. (2009). Premature ovarian failure and dehydroepiandrosterone. 91(2): 644-6.
- Mamas L, Mamas E (2009). Dehydroepiandrosterone supplementation in assisted reproduction: rationale and results. 21(4):306-308.