Dynamic evaluation of ovarian reserve and abnormal androgen excess in women.

The evaluation of the ovarian reserve is an important area of clinical investigation that gives information on endowment and functional activity of remaining follicles within the ovary, thus concerning the female reproductive potential. In neonatal and pediatric age, an ovarian failure is commonly due to disorders of sexual differentiation. In adults, the basal and dynamic tests that predict the ovarian reserve are particularly useful in women undergoing assisted reproductive programs. Transvaginal ultrasound study of ovarian folliculogenesis performed simultaneously with the evaluation of cervical score, FSH, LH and estradiol plasma levels, evidentiates follicular rupture and ovulation, indicating also the optimum timing of hCG administration. Basal day 3 FSH, 17-beta-estradiol and inhibin B plasma levels give information on the ovarian potential. Clomiphene citrate challenge test (CCCT) and GnRH agonist stimulation test (GAST) have clinical utility as indicators of ovarian reserve but their accuracy does not allow to be predictive in terms of number-per-unit tissue of the remaining follicle within the ovary. In the present paper the strategies to study hyperandrogenism and polycystic ovarian syndrome, a common cause of ovarian reserve reduction and subfertility, are also reviewed. The abnormal androgen excess in women can be referred to the ovary, the adrenal glands, or the peripheral conversion of androgen precursors. Dynamic tests may be useful for determining the amount of androgens rising from each of these sites helping the therapeutic strategies.