Ovarian reserve screening: a scientific and ethical analysis.

Ovarian reserve (OR) screening of the general population is generally not advocated as it has not been conclusively established to reflect immediate potential for natural conception, while it may also potentially create anxiety for women. However, in this paper, we argue in support of screening of the general population for diminished OR. First, OR tests such as measurements of anti-Müllerian hormone and antral follicle count are predictive of the chances of IVF conception, and therefore predict a woman's total fertility potential (i.e. chances of natural and IVF-related conceptions). Since the requirement for assisted conception increases with age, this is an important point. Secondly, women identified as having low OR are at increased risk of early loss of fertility potential in the longer term, limiting their reproductive life span and the size of their family if they delay conception. Thirdly, women often disregard generic advice to avoid delaying conception beyond 30 years of age, yet studies suggest that personalized risk assessment tools such as OR testing can actually increase an individual's motivation for positive change. A poor OR screening test result is more likely to convince a woman to bring forward her plans for natural conception, or alternatively explore oocyte vitrification, at a stage when these approaches still have reasonable prospects of success. Finally, we believe that women have a right, based on the ethical concept of autonomy, to be made aware of OR screening, so that they themselves can determine if OR testing is useful in assisting them with reproductive life planning.