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Hum. Reprod. Advance Access originally published online on March 25, 2004
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Human Reproduction, Vol. 19, No. 5, 1055-1059, May 2004
© 2004 European Society of Human Reproduction and Embryology

Assessment of ovarian reserve

Ovarian biopsy is not a valid method for the prediction of ovarian reserve

C.B. Lambalk1,4, C.H. de Koning1, A. Flett1, Y. van Kasteren2, R. Gosden3 and R. Homburg1

1 Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU Medical Centre, Amsterdam, 2 Department of Obstetrics and Gynaecology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands and 3 The Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk, VA, USA

4 To whom correspondence should be addressed at: Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Centre, De Boelelaan 1117, Postbus 7057, 1007 MB Amsterdam, The Netherlands. e-mail: cb.lambalk{at}vumc.nl

The evaluation of ovarian reserve, often critical for the elderly infertile woman, is notoriously difficult and inaccurate. The place of ovarian biopsy in this evaluation has been hotly disputed for three decades, but not resolved. To examine the feasibility of ovarian biopsy for this purpose, a project was designed to estimate the total number of oocytes in a human ovary and investigate whether any biopsy regimen is representative of the follicular reserve in an individual. Ovaries removed from patients of reproductive age during operations not involving ovarian pathology were utilized to count the number and type of follicles found in multiple biopsies of 2 and 5 mm and in the whole ovary. Representative results taking into account the total number of follicles found in the whole ovary showed that predicted values based on the biopsies were extremely varied. We concluded that due to the huge variation in the distribution of follicles across the surface of the ovary, there is no place for this procedure in clinical evaluation of reproductive ageing in the individual patient.

Key words: biopsy/ovarian reserve


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