Reply: Ovarian reserve screening: A scientific and ethical analysis

We thank the correspondents for their interest in our paper and would like to respond to their comments. Professor Findlay et al. appear primarily to object to our suggestion that serum anti-Müllerian hormone (AMH) and ultrasound assessed antral follicle count (AFC) are valid screening tests of ovarian reserve, since neither AMH nor AFC directly measure ovarian reserve. Ovarian reserve has been defined as the remaining pool of non-growing follicles in the ovary at any given age (Kelsey et al., 2012; Findlay et al., 2014). Since AMH is principally produced by antral follicles of up to 10 mm in size (Jeppesen et al., 2013), the same population quantified as AFC by ultrasound assessment, we of course agree that neither AMH nor AFC can strictly speaking be seen as direct measures of ovarian reserve (non-growing primordial pool). However, we argue that such semantic distinctions between direct and indirect measures of ovarian reserve are not particularly helpful clinically, and certainly were not the focus of our paper.