Follicular density in ovarian biopsy of infertile women: a novel method to assess ovarian reserve

The ageing ovary appears to be characterized by depletion of primordialfollicles. The relationship between infertility and the number of folliclesin the ovarian cortex is not known. Moreover, there are no accurate markersor clinical methods to predict the decline in ovarian reserve. This studyinvestigates the correlation between early follicular follicle stimulatinghormone, ovarian size and follicular density in 60 infertile women aged19-45 years (mean = 34.4 +/- 5.5). An ovarian biopsy was taken from eachpatient while performing diagnostic laparoscopy (n = 28) or laparotomy fortubal surgery or myomectomy (n = 32). The median number of follicles wassimilar in tubal and unexplained infertility patients (9.5 versus 5.5).Increasing age showed a significant negative correlation with folliculardensity and ovarian volume (r = -0.46, P = 0.0003;. r = -0.43, P = 0.0016,respectively). In women > or = 35 years of age the ovarian volume showeda strong correlation with follicular density (r = 0.71, P < 0.0001). Ourresults indicate that infertile women in their late thirties and over havea decreased ovarian reserve which could possibly be predicted by ovarianvolume measurement. Ovarian biopsy may have a place as part of infertilityevaluation in older women.