Which tests are used to assess ovarian reserve and what do they measure?

• A. Anti-Müllerian hormone (AMH) levels reflect ovarian reserve; Antral follicle count (AFC) via ultrasound also reflects ovarian reserve.
• B. FSH on day 3 reflects ovarian reserve; Estradiol levels reflect ovarian reserve
• C. Inhibin B levels reflect ovarian reserve; Luteal progesterone indicates ovarian reserve
• D. Ovarian volume on MRI reflects ovarian reserve; AMH levels reflect uterus reserve

Answer: (A)

Ovarian reserve reflects the remaining pool of recruitable follicles, and the most direct, reliable ways to gauge that pool are Anti-Müllerian hormone (AMH) levels and the antral follicle count (AFC) seen on ultrasound. AMH is produced by granulosa cells of small pre‑antral and early antral follicles, so its circulating level mirrors how many follicles remain. Because AMH doesn’t fluctuate much with the menstrual cycle, it provides a stable snapshot of reserve and helps predict how well someone might respond to ovarian stimulation. The antral follicle count is a direct ultrasound measure—the number of visible 2–10 mm follicles in the early follicular phase. Counting these follicles gives a tangible estimate of the available pool and, like AMH, informs expected response to treatment.

Other markers don’t align as tightly with the reserve concept. FSH on day 3 can indicate diminished reserve, but it varies between cycles and is influenced by other factors, making it less reliable on its own. Estradiol by itself is not a dependable reserve indicator. Inhibin B relates to follicular activity but isn’t as consistently standardized for clinical use as AMH or AFC. Luteal progesterone reflects corpus luteum function after ovulation, not the size of the primordial follicle pool. Ovarian volume on MRI or signals about uterine reserve don’t provide a validated measure of ovarian reserve.