II. Physiology

  1. Ovarian follicles decrease with aging to Perimenopause (thousands of follicles) to Menopause (<1000 follicles)

III. Labs

  1. Anti-Mullerian Hormone (AMH)
    1. Stable marker of ovarian reserve (gradually declines from age 25 to Menopause)
    2. AMH <1.0 suggests decreased ovarian reserve
  2. Follicle Stimulating Hormone (FSH)
    1. Obtain on day 3 of cycle
    2. FSH >10 IU/L suggest decreased ovarian reserve (but poor reliability due to variable levels)
  3. Estradiol (E2)
    1. Obtain on day 3 of cycle
    2. Estradiol decreased in decreased ovarian reserve

IV. Imaging

  1. Pelvic Ultrasound
    1. Ovarian Volume
    2. Antral follicle count
      1. Count follicles 2-10 mm in diameter during early Follicular Phase

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