Which of the following parameter can be measured any time during the menstrual cycle to test ovarian reserve?
Ovarian ReserveOvarian reserve refers to the size of the nongrowing, or resting, primordial follicle population in the ovaries. This, in turn, presumably determines the number of growing follicles and the "quality" or reproductive potential of their oocytes.Serum Day 3 Follicle Stimulating HormoneAs women age, FSH physiologically rises in the early follicular phase (cycle day 3), with levels of 5.74 IU/L at age 35 to 39 and 14.34 IU/L at age 45 to 59.In women in their 40s, levels greater than 20 IU/L are predictive of menopause. Basal Estradiol LevelBasal day 3 FSH is often combined with estradiol (E2) testing. Estradiol levels on day 3 of the menstrual cycle reflect follicular growth rather than the number of antral follicles.Clomiphene Citrate Challenge TestClomiphene citrate is thought to have antiestrogenic effects on the hypothalamic-pituitary axis, resulting in a decrease in E2-mediated suppression of FSH production by the pituitary. The clomiphene citrate challenge test (CCCT) involves the measurement of serum FSH and estradiol on day 3 of the menstrual cycle, and again on day 10 after administration of clomiphene citrate (100 mg orally each day) from days 5 to 9.Serum Inhibin BSerum inhibin B is secreted by ovarian granulosa cells staing at the preantral follicle stage and therefore reflects the size of the growing follicular cohoInhibin B alone has poor predictive value for ovarian response but improves the predictive value when added to the CCCT.Unlike basal testing, levels of inhibin B measured on the 5th day of ovarian Serum Antimullerian Hormone Antimullerian hormone (AMH) is produced by the granulosa cells of preantral and small antral follicles.The serum level of AMH in women with normal cycles declines with age and becomes undetectable after menopause.AMH appears to be a good predictor of both stimulation and were predictive of live bih following IVF/ICSI.excessive (>3.5 ng/mL) and poor (<1 ng/mL) IVF stimulation response and is strongly correlated to the antral follicle count (111,116,117). Unlike other serum markers, AMH can be measured at any time in the menstrual cycleAntral Follicular countUsing transvaginal ultrasound in the early follicular phase, all ovarian follicles 2 to 10 mm are counted and the total for both ovaries is called the basal antral follicle count (AFC). The AFC correlates well with chronologic age in normal feile women and appears to reflect what remains of the primordial follicular pool (104). Decreases in AFC with age are gradual rather than sudden (118). A total AFC less than 4 is predictive of poor response and higher cancellation rates with IVF.Reference: Novak's Gynecology; 14th edition; Chapter 32; Infeility and Assisted Reproductive Technology
Serum FSH
Serum estradiol
Serum Anti Mullerian hormone
Antral follicular count
Infertility