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 undergo multiple testing, and most will require expensive and invasive therapies including assisted reproductive technologies (ART). These women also suffer from a higher incidence of pregnancy loss even after documentation of fetal cardiac activity by ultrasound. This demonstration of diminished ovarian reserve is one of the earliest signs of the onset of the perimenopausal period. Identifying these women presents a daily challenge to the practicing clinician. This manuscript reviews the available methods to test the ovarian reserve in infertile women. Women with markedly diminished ovarian reserve should be counseled on their 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 insight of the endocrinological transition and potential predictors of the menopause.