International Fertility Experts Reveal 4 Golden Rules for Ovarian Function Assessment
Introduction: Ovaries – the “source of life” and the “biological clock of fertility” of women.
In the clinical notes of Spanish fertility scientist Dr. Elena Martínez, the ovary is described as “a sophisticated factory of life” – it perpetuates human reproduction through cyclic ovulation and maintains women’s youthfulness through the use of estrogen as a code. It maintains human reproduction through cyclic ovulation and maintains female youthfulness with estrogen as its code. However, this factory’s reserve resources (number and quality of follicles) decrease irreversibly with age:
After the age of 30: the ovarian reserve declines by about 9% per year
Tipping point at age 35: follicle depletion is three times faster than at age 25, and the risk of embryonic aneuploidy rises sharply6
Decline by age 40: about 1% of women face early onset ovarian insufficiency (POI), accompanied by an early menopause
Core paradox: Many women don’t realize that their ovaries are declining until they are blocked in their efforts to conceive. This article will dismantle the 4 golden assessment systems of ovarian function revealed by international reproductive experts to help you take the initiative to master fertility.
I. Golden Indicator Triple Check: The “Molecular Code” of Ovarian Reserve
(1) AMH: the “real-time monitor” of ovarian inventory.
Essence: secreted by the pre-sinus follicular granulosa cells, directly reflecting the size of the follicular pool that can be recruited
Breakthrough Advantages:
▶ Not affected by menstrual cycle, oral contraceptives, can be measured at any time
▶ Early warning of the decline of 3-5 years in advance of the FSH, the sensitivity is as high as 92%
Clinical Interpretation:
| AMH value (ng/ml) | ovarian status | Fertility advice window |
|---|---|---|
| >4.0 | High reserves (alert for PCOS) | Best chance of natural conception |
| 1.1-4.0 | Normal reserve | Pregnancy planned within 1-3 years |
| 0.7-1.0 | critical decline | Consultation with a fertility specialist within 6 months |
| <0.7 | serious recession | Immediate initiation of assisted reproduction |
Note: AMH values are generally lower in African-American women than in Caucasians and need to be interpreted in the context of ethnicity.
(2) Sinus follicle count (AFC): visualization of the ovarian “seed stock”.
Procedure: transvaginal ultrasound scanning of bilateral ovaries on days 2-4 of menstruation, counting sinus follicles 2-9 mm in diameter
Early warning thresholds:
▶ Bilateral AFC total <5-7: suggests significant reduction in reserve
▶ Unilateral ovary volume <3 cm³: reduced perfusion, decreased tolerance
Case: Sophia, a 36-year-old banker from London (AMH 1.2 ng/ml) who opted for embryo freezing because of an AFC of only 4 embryos, avoiding subsequent premature ovarian failure. Avoided the risk of subsequent premature ovarian failure
(3) Sex Hormone 6: “Dialogue Record” of Hypothalamic-Pituitary-Ovarian Axis
The best time to test: Day 2-4 of menstrual cycle (basal state)
Interpretation of key indicators:
● FSH >10 IU/L → decreased ovarian responsiveness (risk of misinterpretation: E2 >80pg/ml can suppress false normal FSH)
● FSH/LH ratio >3 → decreased follicular recruitment efficiency: ● E2 >80 pg/ml
● E2 > 80pg/ml → signal of premature follicular depletion
Note: 2 consecutive menstrual cycles are required for verification to avoid misleading occasional fluctuations.
II.Symptomatologic assessment guidelines for “distress signals” from the body
(1) The menstrual cycle – a “barometer” of ovarian function
Early stage of decline: shorter cycles (<21 days), suggesting an accelerated follicular phase.
Progressive stage of decline:
▶ Prolonged cycles (>35 days) → impaired follicular selection
▶ More than 50% decrease in menstrual flow → insufficient endometrial hyperplasia
Failure threshold: menopause ≥4 months + FSH >40 IU/L → diagnosis of premature ovarian failure (POF)
(2) Metabolic-neuroendocrine disorders
Estrogen withdrawal effect:
▶ Vasodilation: hot flashes (sudden cervico-thoracic fever), nocturnal sweating
▶ Neurocognition: anxiety and depression, memory loss (insufficient estrogen receptor activation in the hippocampus)
▶ Genitourinary: vaginal dryness, pain during sexual intercourse (reduced vaginal epithelial glycogen)
III.Age is not a number, it’s a scale of the “biological clock of fertility”
Three biological truths of ovarian aging
Follicular degeneration:
Accumulation of mitochondrial DNA mutations → embryonic aneuploidy rate reaches 80% at 40 years of age
Accelerated telomere shortening: a sudden drop in oocyte repair capacity
Microenvironmental decay:
Reduced interstitial blood flow to the ovary: 3D ultrasound reveals near-zero pregnancy rates with a VI (vascularization index) of <15%
Epigenetic alterations:
DNA methylation disorders: silencing of follicular development genes (e.g., GDF9, BMP15)
American Society for Reproductive Medicine (ASRM) Action Recommendation:
“Women over 35 years of age who have been preparing for pregnancy for >6 months without success need to immediately initiate an ovarian function triple test; over 38 years of age, simultaneous embryo genetic screening (PGT-A) is recommended. “
IV.Lifestyle: the underestimated “ovary guardian”
(1) Nutritional Targeted Intervention
Mitochondrial Empowerment Program:
▶ Coenzyme Q10 200mg/day + α-Lipoic Acid 600mg/day → Enhance ATP production in oocytes
Epigenetic Modulation:
▶ Activated Folic Acid (5-MTHF) 800μg/day → Correct Methylation Disorder in those with mutations in the MTHFR gene
(2) Environmental toxin defense
Bisphenol A (BPA) avoidance:
▶ Switch to glass food containers (plastic releases BPA to inhibit follicle development)
▶ Wash your hands thoroughly after touching cashier’s tickets (thermal paper coating contains BPA)
Heavy metal detoxification:
▶ Intake of 150g of wild blueberries per week (anthocyanin chelates lead and cadmium)
(3) Circadian Rhythm Calibration
Melatonin Secretion Optimization:
▶ Maintain a dark environment from 22:00-02:00 (promotes follicular antioxidants)
▶ Receive 10,000lux of natural light from 6:30-7:00 am (resets cortisol rhythm)
Conclusion: Beyond the Metrics – A Holistic View of Ovarian Health
“Assessing ovarian function is not a ‘death sentence’ for fertility, it is a personalized fertility map. ” — Dr. James Wilson, Director, Harvard Center for Reproductive Sciences
Core Action Principles:
✅ 30+ women: annual AMH+AFC baseline screening (even if menstrual patterns are regular)
✅ AMH <1.0 or AFC <5: initiate fertility specialist consultation within 3 months
✅ All women: avoid PM2.5 exposure (air pollution ↑ 29% risk of premature ovarian failure)