Ovarian volume decreases significantly in each 10-year period of a woman's fertile life. The ovarian size decreases in women greater than 40 years old. The volume of each ovary is calculated by measuring in three perpendicular directions and applying the formula for an ellipsoid. Using the largest cross-sectional sagittal view of the ovary, the mean ovarian diameter could be calculated from measurement of two perpendicular diameters. The combination of transvaginal ultrasound and pulsed color Doppler is increasingly used in gynecology to assess the hemodynamic changes in various physiological and pathological situations of the pelvic organs. Only one study has compared the predictive value of antral follicle count (AFC) measurement made using both two-dimension and three-dimension ultrasound in determining the outcome of response to ovarian stimulation as measured by the number of follicles that develop, the number of oocytes retrieved, and the pregnancy rate following assisted reproductive technologies (ART).

A number of tests have been used to predict ovarian ageing/poor ovarian reserve. Despite the large number of tests in current use, an ideal test has yet to be developed. The most comprehensive systematic review for tests of ovarian reserve concluded that an in vitro fertilisation (IVF) cycle itself may be a more reliable predictor of ovarian response to stimulation than any of the existing tests. The predictive value of four of the most commonly used tests are: basal serum follicle-stimulating hormone, antral follicle count (AFC), serum inhibin B and serum antimillerian hormone (AMH). Internationally, a number of fertility prediction tests have been marketed, and the tests have been mainly developed within an IVF setting, using data on outcomes of ovarian stimulation. Serum AMH concentration and AFC tests can predict oocyte yield but not oocyte quality or pregnancy.