Assessment of ovarian reserve - is there a role for ovarian biopsy?

The pool of primordial follicles in the ovary or 'ovarian reserve' is a major factor in the human fertility potential. The ageing ovary is characterized by reduction of the number of primordial follicles and this loss accelerates in the late 30's and precedes the menopause by 10-12 years. Woman's age alone or with a combination of biochemical markers, dynamic tests and ultrasound measurements fail to predict this loss accurately. In this manuscript, a novel approach of histopathological examination of ovarian biopsy for the evaluation of infertility, especially in unexplained infertility and in women in the later part of reproductive life, is discussed.