Ovarian reserve is a medical term used to describe the quantity and quality of oocytes (eggs) a woman has at any given time. Think of it as a “fertility bank account.” As a woman moves through her reproductive years, this balance naturally declines, but for some, the decline happens faster than expected.

1. What is Decreased Ovarian Reserve (DOR)?

Decreased ovarian reserve means your ovaries have a lower-than-average number of eggs compared to other women of your age. Clinically, it is diagnosed using two main markers:

• AMH (Anti-Müllerian Hormone): A value below 0.5 – 1.1 ng/ml is often indicative of low reserve.
• AFC (Antral Follicle Count): During an ultrasound, seeing fewer than 5 to 7 follicles suggests a reduced egg pool.

2. Why Does Egg Count Decline?

Aging is the natural and irreversible cause, but certain factors can accelerate the loss:

3. The Challenges and Reality

Low ovarian reserve does not mean you cannot conceive, but it does mean that time is of the essence. It is associated with:

• Lower response to fertility medications.
• Higher risk of pregnancy loss due to declining egg quality.
• Reduced success rates in simple treatments like IUI.

4. Best Treatment Strategies

For women with DOR, IVF (In-Vitro Fertilization) offers the highest probability of success. At our center, we prioritize the Antagonist Protocol, which is tailored to maximize the retrieval of every available healthy egg.

In cases where multiple IVF attempts do not yield results, we offer compassionate counseling for alternative paths like Oocyte (Egg) Donation or adoption to help you complete your family.

Polycystic Ovarian Syndrome (PCOS) is a complex hormonal condition, and Ultrasound remains one of the cornerstone criteria for its diagnosis. At Talwar Fertility & Child Health Centre, we use high-sensitivity Transvaginal Sonography (TVS) to identify polycystic ovaries in approximately 75% of women who present with clinical symptoms of PCOS.

What are Antral Follicles?

Antral follicles are small, fluid-filled sacs in the ovary (measuring 2-9 mm) that contain immature eggs. In a normal menstrual cycle, these follicles grow over 10-12 days until one “dominant” follicle is selected to release an egg. However, in PCOS, this selection process is often disrupted.

Diagnostic Ultrasound Criteria for PCOS

Medical guidelines for PCOS have evolved to become more precise. Here are the key ultrasound markers we look for:

Why Accuracy Matters

Identifying the exact nature of polycystic ovaries helps in tailoring fertility treatments. Whether it is ovulation induction or managing insulin resistance, a clear ultrasound mapping of the ovarian stroma and follicle distribution allows us to predict how your body will respond to medication.

A baseline ultrasound of the ovaries is a critical step in assessing a woman’s reproductive health. It helps us evaluate the ovarian reserve, track the menstrual cycle, and screen for abnormalities. Here is what we look for in a normal, healthy ovary during a scan.

1. Anatomy and Volume

The ovaries are oval-shaped structures located on either side of the uterus within the ovarian fossa.

• Mean Volume: Approximately 4.9 ml is considered normal.
• Position: They usually lie near the internal iliac artery and vein, though their position can vary.

2. Antral Follicle Count (AFC)

The best time to evaluate the ovaries is on Day 2 or Day 3 of the menstrual cycle (Follicular Phase). During this time, we measure Antral follicles (small sacs containing immature eggs) ranging from 2-9 mm.

3. Ovulation and Color Doppler

In a natural cycle, one follicle becomes “dominant,” reaching a size of 17–24 mm before releasing the egg (ovum).

• Blood Flow: Normal stromal blood flow velocity is 6–12 cm/sec. Flow velocity typically increases just before and immediately after ovulation.
• Corpus Luteum: After the egg is released, the follicle transforms into the Corpus Luteum. On ultrasound, it appears as a round cystic mass with thick, echogenic walls.
• The “Ring of Fire”: On Power Doppler, the Corpus Luteum displays a characteristic “Ring of Fire” appearance due to highly increased blood flow around it.

In the field of reproductive medicine, ultrasound is the most fundamental diagnostic tool. It allows us to visualize the uterus, ovaries, and other pelvic structures with high precision. Depending on the clinical requirement, ultrasound is performed using two primary methods:

Clinical Benefits of Fertility Ultrasound

Ultrasound helps in the comprehensive evaluation of the reproductive system to detect any underlying issues:

• Uterus: We assess the size, shape, mobility, and position. We look for the Endometrial Thickness (ET) and use Color Doppler to predict uterine receptivity. It also helps detect fibroids, polyps, or adenomyosis.
• Ovaries: We measure ovarian volume and the Antral Follicle Count (AFC). It helps in identifying cysts (follicular, dermoid, or endometriotic) and tumors. Color Doppler of a dominant follicle helps assess oocyte quality.
• Fallopian Tubes: While normal tubes aren’t usually visible, conditions like Hydrosalpinx (fluid-filled tubes) are easily detected on USG.
• Adnexa: Identifying other pelvic masses, such as pedunculated fibroids or paraovarian cysts.

In the world of fertility, an ultrasound is much more than just a picture; it is a vital diagnostic window. It helps us understand your reproductive health and tailor a treatment plan specifically for you.

How Is It Done? TAS vs. TVS

Depending on your comfort and medical requirement, we use two methods:

Timing: When Should You Have A Scan?

In fertility treatments, the timing of the scan is crucial. We usually monitor on three specific days of your cycle:

• Day 2 (D2): To check Antral Follicular Count (AFC). A normal count is 5-10 follicles in each ovary. This helps us predict how your body will respond to treatment and rules out old cysts.
• Day 9 (D9): To look for the Endometrial Lining. We look for a “triple-layer” pattern and use color Doppler to ensure healthy blood flow for embryo receptivity.
• Day 21 (D21): To confirm secretory changes in the lining, ensuring the environment is ready for a pregnancy.