Ovarian biopsy has no role as a routine diagnostic test of ovarian reserve: a systematic review

Ovarian reserve describes a woman's reproductive potential and there are a variety of tests for this. This reflects the lack of a gold standard and the lack of a single test that provides sufficient accuracy. Ovarian biopsy has been proposed as a potential tool for assessing the ovarian reserve and therefore the ability or inability for a woman to bear a child with or without treatment. The literature assessing the diagnostic accuracy of ovarian biopsy as a test of ovarian reserve for predicting fertility outcomes (live birth rate, ongoing pregnancy, clinical pregnancy, biochemical pregnancy, embryos available, oocytes retrieved or cancelled cycles) was systematically reviewed. There were no studies identified that assessed the diagnostic accuracy of ovarian biopsy for predicting fertility outcomes but a number of studies provided evidence that ovarian follicles are distributed unevenly and randomly throughout the ovarian cortex. This leads to sampling error when ovarian biopsy is used to sample the ovarian reserve. It is concluded that ovarian biopsy should not be used as a test of ovarian reserve. Every woman is born with a limited number of eggs, and as women age, their ability to have children eventually decreases to zero due to the loss of these eggs. Ovarian reserve is a term that describes the remaining pool of eggs. Testing for ovarian reserve enables one to predict the ability or inability of a woman to have a child and how long a woman may be able to defer having a child. This is of importance as social trends in developed countries are leading to increasing numbers of women who have children at later stages of their lives. One test of ovarian reserve is an ovarian biopsy, where a woman undergoes an operation to have a small piece of her ovary removed. The number of eggs in this removed piece is counted, and from this, the number of eggs in the whole ovary can be estimated and calculated. We reviewed the literature for all studies that examined the accuracy of ovarian biopsy to predict fertility outcomes but found no studies that answered this question. A number of studies have found that eggs are distributed unevenly and randomly in an ovary. As such, the number of eggs in an ovarian biopsy sample does not represent the actual number of eggs remaining in the ovary. Because of this and the risks inherent in the operation to perform this test, we believe that ovarian biopsy should not be used as a test of ovarian reserve.