There is some controversy as the accuracy of the tests used to predict<unk> . One systematic review concluded that the accuracy of predicting the occurrence of pregnancy is very limited. When a high threshold is used, to prevent couples from wrongly being refused IVF, only approximately 3% of IVF-indicated cases are identified as having unfavourable prospects in an IVF treatment cycle. Also, the review concluded the use of any ORT<unk><unk>  Testing) for outcome prediction cannot be supported. Also Centers for Disease Control and Prevention statistics show that the success rates for IVF with diminished<unk><unk>  vary widely between IVF centers. Follicle stimulating hormone Elevated serum follicle stimulating hormone (FSH) level measured on day three of the menstrual cycle. (First day of period flow is counted as day one. Spotting is not considered start of period.) If a lower value occurs from later testing, the highest value is considered the most predictive. FSH assays can differ somewhat so reference ranges as to what is normal, premenopausal or menopausal should be based on ranges provided by the laboratory doing the testing. Estradiol (E2) should also be measured as women who ovulate early may have elevated E2 levels above 80 pg/mL (due to early follicle recruitment, possibly due to a low serum inhibin B level) which will mask an elevated FSH level and give a false negative result. High FSH strongly predicts<unk>  IVF response in older women, less so in younger women. One study showed an elevated basal day-three FSH is correlated with diminished<unk><unk>  in women aged over 35 years and is associated with<unk>  pregnancy rates after treatment of ovulation induction (6% versus 42%). The rates for spontaneous pregnancy in older women with elevated FSH levels have not been studied very well and the spontaneous pregnancy success rate, while low, may be underestimated due to non reporting bias, as most infertility clinics will not accept women over the age of forty with FSH levels in the premenopausal range or higher. A woman can have a normal day-three FSH level yet still respond<unk> ly to<unk>  stimulation and hence can be considered to have<unk><unk> . Thus, another FSH-based test is often used to detect<unk> : the clomid challenge test, also known as CCCT (clomiphene citrate challenge test). Antral follicle count Transvaginal ultrasonography can be used to determine antral follicle count (AFC). This is an easy-to-perform and noninvasive method (but there may be some discomfort). Several studies show this test to be more accurate than basal FSH testing for older women ( AFC and Median Fertile Years Remaining Antral Follicle Count (Per Ovary See comment below as these figures are under dispute.) Median Years to Last Child Median Years to Menopause 5 __ 7.3 10 4.2 12.9 15 9.3 18.4 20 14.8 24.0 Note, the above table from Silber's book may be in error as it has no basis in any scientific study, and contradicts data from Broekmans, et al. 2004 study. The above table closely matches Broekmans' data only if interpreted as the total AFC of both ovaries. Only antral follicles that were 2–10 mm in size were counted in Broekmans' study. Age and AFC and Age of Loss of Natural Fertility (See Broekmans, et al. 2004) Antral Follicle Count (Both Ovaries) Age at Time of Count Age of Loss of Natural Fertility 6 30 29–33 6 35 33–38 6 40 38–41 10 30 33–38 10 35 38–41 15 30 38–41 (closer to 41) AFC and FSH Stimulation Recommendations for Cycles Using Assisted Reproduction Technology Antral Follicle Count Significance 12 Normal Other * Declining serum levels of anti-müllerian hormone. Recent studies have validated the use of serum AMH levels as a marker for the quantitative aspect of<unk><unk> . Because of the lack of cycle variations in serum levels of AMH, this marker has been proposed to be used as part of the standard diagnostic procedures to assess<unk>  dysfunctions, such as premature<unk>  failure. One study has shown AMH to be a better marker than basal FSH for women with proven (prior) fertility in measuring age related decline in<unk><unk> . * Inhibin B blood level. Inhibin B levels tend to decline in advanced reproductive aged women due to both fewer follicles and decreased secretion by the granulosa cells. Inhibin B levels start to rise around day zero and low day three levels are associated with<unk>  IVF outcome. * Ultrasound measurement of<unk>  volume. Lass and Brinsden (1999) report that the correlation between<unk>  volume and follicular density appears to only hold in women ≥ 35 years of age. * Dynamic Assessment Following GnRH-a Administration (GAST). This test measures the change in serum estradiol levels between cycle day two and three after administration of one mg of subcutaneous leuprolide acetate, a gonadatropin releasing hormone agonist. Patients with estradiol elevations by day two followed by a decline by day three had improved implantation and pregnancy rates than those patients with either no rise in estradiol or persistently elevated estradiol levels. * Home testing of FSH urine concentration to alert a woman to possible impaired<unk><unk>  became possible in June 2007 with the introduction of Fertell in the United States and UK, which claims a 95% equivalence to standard serum marker results.
Poor ovarian reserve
Male pregnancy
Pregnancy
Lactational amenorrhea
Anovulation
Estrogen-dependent condition
Androgen-dependent condition
Antiestrogen withdrawal response