Ovarian Reserve Testing (ORT) is used to assess the quality and function of the ovaries. This is not the same as testing whether or not you are ovulating, rather it is an assessment of how likely you are to get pregnant, and if this is unlikely, which fertility treatments would be most appropriate.

The result of this testing will either be 'normal' or 'poor.' A diagnosis of poor will often mean in western terms that you will be told that you are unlikely to get pregnant. However, in the experience of patients who have come with this diagnosis, especially when the assessment is done with a day 3 FSH test, this is not always the case.

In the experience of The Fertility Support Company, it is sometimes possible to alter these results through treatment, and patients typically show after a three month programme lowered FSH levels and a significant reduction in menopausal symptoms.

A day 3 FSH and/or Oestradial test is one which measures the hormones which occur on day 3 of a menstrual cycle. This should fall within certain parameters, and if the result is outside these parameters, then the diagnosis will be poor.

FSH is one of the most important hormones involved in the menstrual cycle, and the main hormone involved in producing eggs. If a test done shows an elevated level of FSH, even when the woman is relatively young, it shows that the body has entered premature menopause and would find it very difficult to conceive a baby.

'When a woman goes into menopause she is essentially running out of eggs in her ovaries. The brain senses that there is a low estrogen environment and more FSH is released from the pituitary gland in an attempt to stimulate the ovaries enough to produce a good follicle and estrogen.

By measuring a baseline FSH on day 3 of the cycle, one can often get an indication that the women is closer to menopause and has relatively less "ovarian reserve". Another way of saying this is that if the baseline FSH is elevated the ovarian reserve (how many eggs are left) is reduced and sometimes also the egg quality is reduced. In other words, an elevated FSH represents a reduced egg supply (in numbers of eggs remaining) and it might also reflect a compromise of egg quality.

A blood oestradiol level on day 3 of the menstrual cycle is a way to potentially discover some of those women with a normal day 3 FSH that may in fact have decreased egg quantity and quality. Ideally on day three there is a low FSH level in conjunction with a low oestradiol level. If the FSH is normal but the oestradiol level is elevated, the elevated oestradiol may be artificially suppressing the FSH level in to the normal range.

The idea of using day 3 oestradiol levels as an adjunct in evaluating egg quantity and quality is relatively new. Clearly defined cutoff values for normal and abnormal are not well defined and are also lab-dependent. There is not much data that suggests that an elevated day 3 oestradiol is a problem in itself. The problem is more so that it is potentially "masking" the detection of the poor ovarian reserve by suppressing an FSH level that would otherwise be elevated. (http://www.advancedfertility.com/day3fsh.htm)

The Chlomiphene Citrate Challenge Test (CCCT) is another test used to inform. Clomid stimulates the ovary to initiate egg production. Clomid works by 'shutting down the oestrogen receptors on the hypothalamus and tricking the hypothalamus into thinking the patient doesn't have enough oestrogen. In response, the hypothalamus works harder to induce the pituitary gland to produce more FSH and LH. This, in turn, initiates follicular growth. http://www.ivf.com/ovarianreserve.html

If this test reveals problems not picked up previously by a day 3 hormone test, then it should be considered in many ways more accurate.