Invited review
Ovarian reserve testing: systematic review of the literature

To determine which ovarian reserve tests and imaging criterion have an optimal predictive value for ovarian response to controlled hyperstimulation and fertility outcomes with assisted reproduction cycles. This systematic review was initiated by an extensive search of Medline-Ovid, EMBASE, Cochrane Collaboration database, BIOSIS and Meeting Abstracts from 1986 to 2008, as well as manual searching of review articles and cross references. Two hundred and twenty relevant articles about ovarian reserve tests, including basal follicle stimulating hormone, serum anti-Mullerian hormone, serum inhibin B, ovarian volume and total antral follicle count were studied and analyzed. The review included 90 indexed articles from PubMed that were published within the last decade. Two ultrasound markers; the ovarian volume and total antral follicle count have proven to be more promising than basal blood tests such as basal follicle stimulating hormone, serum anti-Mullerian hormone and serum inhibin B. Among the ultrasound markers, the total antral follicle count had a higher sensitivity and specificity than ovarian volume. Currently, no single ovarian reserve test is sufficiently sensitive and specific to accurately predict ovarian reserve. And there is no test which can precisely predict the fertility outcomes for counseling patients and also accurately exclude patients from treatment and consider options such as oocyte donation. However, basal blood markers and ultrasound markers can compliment each other to best predict the outcome.