Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 53923

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"

Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2012 | Month : April | Volume : 6 | Issue : 2 | Page : 166 - 168

Ovarian Reserve Tests for Sub-fertility: When to Intervene

Kalaiselvi V.S., Saikumar P., Prabhu K.

1. Associate Professor, Department of Bio Chemistry 2. Professor, Department of Physiology 3. Associate Professor, Department of Anatomy Sree Balaji Medical College and hospital, Chennai, India.

Correspondence Address :
Dr. Kalaiselvi V.S., M.D.
Assoicate Professor
Department of Biochemistry
Sree Balaji Medical College and hospital,
No. 7, CLC Works Road, Chrompet,
Chennai- 600 044, India.
Phone: 9884218580


Back ground:
During the past two decades , a greater majority of women have been known to plan their pregnancies in the thirties, often because of carrier priorities and as a result, they have to face the consequences of their declining fecundity (reproductive potential). Hence, it was decided to assess the ovarian reserve, which is an estimate of the follicular pool, the production of follicles being the primary function of the ovary. Our work highlights the assessment of the ovarian reserve in sub-fertile women.
To assess the ovarian reserve in subfertile women by doing hormonal assays and by using ultrasonographic methods.
Materials and Methods:
50 subfertile women of the childbearing age, without an issue even after 3 years of unprotected sexual acts, were included in this study. The subjects who were under study were divided into two groups. Group 1- sub-fertile women with their ages ranging from 20-25 years and Group 2- sub-fertile women of comparatively older ages, whose ages ranged from 26-33 years. For both the groups, hormones like the Follicular Stimulating Hormone (FSH) and oestradiol (E2) were measured by ELISA. The Antral Follicular Count (AFC) and the ovarian volume (OV) were measured by transvaginal ultrasound. The correlations between the various parameters were analyzed and the StudentÂ’s t-test was performed between the two groups by using SPSS.
Statistically significant correlations between age and antral follicular count (AFC), ovarian volume (OV) and FSH were observed. Elevated FSH, and decreased AFC and OV were observed in sub-fertile women of comparatively older ages and their mean values were also statistically different between the two groups.
Women with elevated FSH and E2 and decreased AFC and OV should be insisted to proceed for Assited Reproductive Technique (ART) as early as possible, irrespective of their ages, as parenthood is undeniably one of the most universally desired goals in adulthood.


FSH, Oestradiol ovarian reserve

The production of mature and viable oocytes is the primary function of the female ovary, which should be capable of fertilization, subsequent embryo development and implantation. Women are born with a pre-determined number of ovarian follicles, approximately two million, and these are subsequently reduced by apoptosis and ovulation. So, at birth, the ovary contains a finite number of oocytes which are available for folliculogenesis. This finite number of available oocytes is termed as the ovarian reserve. None of the ovarian reserve tests directly measures the total number of actual oocytes. Rather, it is assumed that the antral follicular count is directly related to the total oocyte pool. The ovarian volume and AFC which can be measured by Trans Vaginal Ultrasonography (TVS), can be useful indicators of the menopausal status and the ovarian function (1). Day 3 FSH has also been considered as a bio marker of the ovarian reserve, as it provides a glimpse of how well the hypothalamic pituitary gonadal axis is functioning through ovarian feedback to the pituitary (2). Day 3 oestradiol has also been estimated to assess the ovarian reserve (OR), as oestradiol is a product of the granulosa cells and as it can be considered as a reflection of the follicular activity. The remaining reproductive life time can be assessed by the ovarian reserve test. So, the success of IVF (in vitro fertilization) and ART (Assisted Reproductive Technique) can be predicted by estimating the ovarian reserve. This work highlights the assay of hormones Original Article Biochemistry Section and the ultrasonographic measurement of the ovarian volume and the antral follicular count in sub fertile women of younger ages and comparatively little older ages.

Material and Methods

This study was approved by the institutional ethical committee. Fifty women of the child bearing ages, but with out an issue even after 3 years of unprotected sexual acts, were included in this study. An informed consent was obtained from all the participants. The subjects who were under study were divided into two groups. Group 1 (n = 25); sub-fertile women with their ages ranging from 20-25 years. Group 2 (n = 25); sub-fertile women with comparatively older ages which ranged from 26-33 years. The general profile like age, height, weight and body mass index (BMI) were also recorded.
Exclusion Criteria
Thyroid disorders, a history of ovarian surgery, an irregular menstrual cycle and ovarian abnormalities which was assessed by the trans vaginal ultrasonogram method, hormonal conception and male infertility were excluded from this study. The ovarian volume and the antral follicular count were measured by Transvaginal Ultrasonograph Measurements (TVS). Trans vaginal ultrasound was performed to measure the number of antral follicles as well as the volume of both the ovaries. It was carried out on the cycle days 3-10. The volume of each ovary was determined by measuring the three perpendicular diameters and by applying the formula for the volume of an ellipsoid. Each ovary was scanned in three dimensions – D1 (longitudinal), D2 (anteroposterior) and D3 (transverse).The volume of each ovary was calculated from the three dimensions by applying the equation for the volume of an ellipsoid (D1*D2*D3*0.523cm3) (3). The volumes of both the ovaries were added to calculate the total ovarian volume (4), (5). All the sonography measurements were done by the same observer by using a 7.5 MHz trans vaginal probe. The examination of the ovary was established by scanning it from the outer to the inner margin. All the follicles which were 2-10 mm in size were measured and counted in each ovary. The sum of both the counts was the antral follicle count.
Hormonal Assay
Both the blood sampling and the ultrasonographic measurements were performed on the same day. Hormones like FSH, LH and E2 were measured in plasma by ELISA. The specimens were stored at -200C until they were processed.


A correlation test was done to find the correlation between the variables like, BMI, FSH, E2, AFC, OV and age for both the groups, and the test of significance of the above variables was assessed between the two groups. From the correlation table, the following results were inferred. Age was inversely related to the antral follicular count (r= -0.557, p = 0.001), which was statistically significant and it was also related to the ovarian volume (r=-0.278, p=0.075), as shown in (Table/Fig 1). The mean BMI was higher in Group 2 than Group 1. The mean ovarian volume in Group1 was 16.3cm3 and in Group 2, it was 7.65 cm3. The mean value of the OV was also statistically significant. Five women in Group 2 had the OV below 3cm3. The mean follicular number in both the ovaries was 16 in Group 1 and 5.1 in Group2 (Table/Fig 2). This was also statistically significant. The elevated levels of FSH was more in Group 2 and of these, five women showed an elevation of above 15 IU/l in that group.


During the past two decades, a greater majority of women have been known to plan their pregnancy in their thirties, often because of career priorities and as a result, they have to face the consequences of their declining fecundity (reproductive potential). The importance of age in fecundity has been shown by many observations. Although age is an important factor in sub-fertility , it does not exactly predict the reproductive potential. The estimation of serum FSH on day 3 is an indirect method of assessing the ovarian reserve. In one study by Martin et al (1996), no pregnancies were found in the cycles with a day 3 FSH concentration of above 20 IU/ml, while in other studies, age was seen to be a better predictor for the IVF outcome than the basal FSH concentration (6). Another study by Ahmed Ebbiary et al (1994) showed that subfertile women with a high FSH concentration had poorer follicular growth in a natural cycle as compared to subfertile women with a normal FSH concentration (7). Previous studies have revealed that women with normal ovulatory cycles had subtle elevations in the FSH in their early 30s and that these levels tended to increase with age.The day 3 FSH has been believed to represent the basal level or the non-suppressed level of the FSH reserve. This reflects the number and the quality of the oocytes, which at any given age, are available to produce a dominant follicle late in the follicular phase of the menstrual cycle and its value can be elevated due to the occurrence of rapid folliculogenesis (8). In our study, we noticed an elevated FSH level of above 15 IU/L in sub fertile women of comparatively older age. The authors of this article attributed this decline to a diminished ovarian reserve (9). Similarly, oestradiol was elevated significantly in the sub-fertile subjects of older ages, which was also an indication of diminished ovarian reserve. The oestradiol concentration, in combination with the basal FSH value and age was found to be a useful predictor of the fertility potential (10). But some authors found no relationship between the day 3 oestradiol concentration and the pregnancy rates (11). The number of antral follicles is related to the reproductive age in women with proven fertility and this might also reflect the ovarian reserve (4). It was found to be less in the sub-fertile population of older ages. The studies by Haadsma et al (2007) showed that the small antral follicles correlated not only with age, but also independently with the results of the various other endocrine ovarian reserve tests like Anti Mullerian Hormone (AMH) (12). During a womanÂ’s life, the ovarian volume changes from 0.7 cm3 at the age of 10 years to 5.8 cm3 at the age of 18 years (13). However, at the age of 40 years, the ovaries tend to decrease in size and they decrease even further after menopause. Syrop et alÂ’s (1995) study concluded that the OV might be an important predictor of the OR (5). But, Tomas et al (1999) showed that the ovarian volume was found to be a predictor of the number of growing follicles, but not of the number of recovered oocytes (14). In our study, the ovarian volume in the sub fertile population of older ages was lesser than that in the subfertile population of younger ages. Although age is an important factor in sub fertility, it is not very exact in predicting the reproductive potential. Some women will be unable to conceive either early or in their thirties, while others become pregnant in their forties. The ovarian reserve appears to be responsible for these differences (15). Many tests have been developed to screen the diminished ovarian Reserve.


This study strongly emphasize that women with elevated Oestradiol, FSH and low AFC,OV should be insisted to proceed for ART as early as possible, irrespective of their ages. The above mentioned values in women of younger ages also are to be intervened for early counseling to go ahead for ART, as parenthood is undeniably one of the most universally desired goals in adult hood. So, an early intervention and educative counseling will help in reducing the rate of subfertility in our population.


Flaws JA, Langenberg P, Babus JK, Hirshfield AN, Sharara FI. Ovarian volume and antral follicle counts as indicators of the menopausal status. Menopuase 2001; 8:175-80.
Barnhart K, Osheroff J. Follicle stimulating hormone as a predictor of fertility. Curr. Opin. Obstet. Gynecol 1998;10:227-32.
Wallace HW, Kelsey TW. Ovarian reserve and reproductive age may be determined from the measurement of the ovarian volume by transvaginal sonography. Human Reproduction 2004;19: 1612-17.
Scheffer GJ, Broekmans FJM, Dorland M, et al. Antral follicle counts which are obtained by transvaginal ultrasonography are related to age in women with proven natural fertility. Fertil Steril 1999; 72:845-51.
Syrop CH, Willhotie A, Van Voorhis BJ. Ovarian volume: a novel outcome predictor for assisted reproduction. Fertil. Steril 1995; 64: 1167-71.
Martin JSB, Nisker JA, Tummon IS, et al. The future in vitro fertilization pregnancy potential of women with variable elevated day 3 folliclestimulating hormone levels. Fertil . Steril 1996; 65 :1238-40.
Ahmed Ebbiary NA, Lenton EA, Salt C, et al. The significance of the elevated basal follicle stimulating hormone in regularly menstruating infertile women. Hum. Reprod 1994; 9: 245-52.
Bancsi LF, Broekmans FJ, Eijkemans MJ, De Jong FH, Habbema JD, te Velde ER. Performance of the basal follicle-stimulating hormone in the prediction of poor ovarian response and failure to become pregnant after in vitro fertilization: A meta-analysis. Fertil Steril 2003; 79: 1091-100.
Perloe M, Levy DP, Sills ES. Strategies for ascertaining the ovarian reserve among women who were suspected to be having subfertility. Int J Fertil Womens Med 2000: 215-24.
Buyalos RP, Daneshmand S, Brzechffa PR. Basal estradiol and folliclestimulating hormone levels predict the fecundity in women of advanced reproductive ages, who undergo ovulation induction therapy. Fertil. Steril 1997; 68: 272-77.
Scott RT, Toner JP, Muasher SL, et al. The follicle-stimuating hormone levels on the cycle day 3 are predictive of the in-vitro fertilization outcome. Fertil. Steril 1989; 51: 651-54.
Haadsma ML, Bukman A, Groen H, Roeloffzen EMA, Groenewoud ER, Heineman MJ, et al. The number of small antral follicles (2-6 mm) determines the outcome of the endocrine ovarian reserve tests in a subfertile population. Human Reproduction 2007 ;22: 1925-31.
Ivarsson SA, Nilsson KO, Persson PH. Ultrasonography of the pelvic organs in prepubertal and postpubertal girls. Arch Dis Child 1983;58:352-54.
Tomas C, Nuojua-Huttunen S, Martikainen H. Pre-treatment transvaginal ultrasound examination predicts the ovarian responsiveness to gonadotrophins in in-vitro fertilization. Hum. Reprod 1997 ;12: 220-23.
Bukman A, Heineman MJ. Ovarian reserve testing and the use of prognostic models in patients with sub fertility. Hum. Reprod 2001;7 (6): 581-90.

DOI and Others

DOI: JCDR/3909:1940


Date Of Submission: Oct 24, 2011
Date Of Peer Review: Dec 25, 2011
Date Of Acceptance: Jan 10, 2012
Date Of Publishing: Apr 15, 2012

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)