What Is Ovarian Reserve?
If you have been researching fertility tests, you may have come across the term ovarian reserve. You may also have heard of AMH levels or antral follicle count (AFC).
These terms can sound confusing, particularly when you are trying to understand your chances of getting pregnant.
Ovarian reserve refers mainly to the number of eggs remaining in the ovaries. Doctors may assess it using blood tests and ultrasound to help plan fertility treatment and estimate how the ovaries might respond to stimulation.
However, ovarian reserve is only one part of fertility. A test result cannot, by itself, tell you whether you can become pregnant naturally or guarantee how fertility treatment will turn out.
In this guide, we explain what ovarian reserve means, which tests are commonly used, how to understand the results and when to discuss them with a fertility specialist.
What Does Ovarian Reserve Mean?
Ovarian reserve describes the remaining supply of eggs within the ovaries. These eggs are contained in small structures called follicles, which support their development.
A person is born with a finite supply of eggs. Over time, that supply naturally decreases. The decline continues throughout the reproductive years, even when menstrual cycles are regular.
Ovarian reserve is different from egg quality:
Ovarian reserve: Mainly concerns the number of eggs or follicles remaining.
Egg quality: Concerns an egg's potential to be fertilised and support normal embryo development.
Ovulation: Refers to the release of an egg from an ovary during the menstrual cycle.
These processes are connected, but they are not interchangeable. For example, someone may have a lower ovarian reserve and still ovulate, while a person with a higher reserve may have other factors affecting fertility.
Why Is Ovarian Reserve Important?
Understanding ovarian reserve can help a fertility specialist plan investigations and treatment.
Ovarian reserve tests are particularly useful when estimating how the ovaries may respond to fertility medicines used during treatments such as IVF.
The results may help a doctor:
Estimate whether the ovaries may produce a lower or higher number of eggs during stimulation.
Plan an appropriate ovarian stimulation approach.
Discuss possible responses to IVF treatment.
Interpret other fertility findings alongside age and medical history.
Explain the potential benefits and limitations of different treatment options.
However, ovarian reserve testing has limits. It is not a direct measurement of egg quality and cannot reliably predict natural conception on its own. A low result does not automatically mean that pregnancy is impossible.
What Tests Are Used to Assess Ovarian Reserve?
Doctors commonly use a combination of blood tests, ultrasound findings and medical history. The appropriate assessment depends on the reason for testing.
1. AMH Blood Test
AMH stands for anti-Müllerian hormone. It is produced by cells in small developing ovarian follicles, and its level can provide an indication of ovarian reserve.
An AMH test is performed using a blood sample. Unlike some other reproductive hormone tests, it can generally be measured at different points in the menstrual cycle, although certain circumstances and medications may affect interpretation.
AMH is often used in fertility care because it can help estimate the likely response to ovarian stimulation.
What AMH can tell you:
It can provide information about ovarian reserve.
It may help estimate the number of eggs that could be obtained during IVF stimulation.
It can contribute to planning an individual treatment approach.
What AMH cannot tell you on its own:
The exact number of eggs remaining.
The quality of your eggs.
Whether you will definitely conceive naturally.
Whether you will or will not become pregnant in the future.
AMH must be interpreted in context. A single result should not be treated as a complete assessment of fertility.
You can read more in our related guide, What Does AMH Tell You About Fertility?
2. Antral Follicle Count (AFC)
Antral follicle count is assessed using a transvaginal ultrasound. A trained clinician looks at the ovaries and counts the small antral follicles visible during the scan.
These follicles are not the same as mature eggs ready for release. Rather, their number provides information about the pool of follicles that may respond to stimulation.
AFC is often used alongside AMH to help assess ovarian reserve and plan IVF treatment.
The count can vary depending on factors such as the timing of the scan and the expertise of the person performing it. Your doctor will interpret the result in the context of your overall assessment.
3. FSH and Estradiol Blood Tests
FSH stands for follicle-stimulating hormone. It helps regulate the development of ovarian follicles.
Doctors may measure FSH alongside estradiol early in the menstrual cycle as part of a fertility assessment. These results can provide additional information about ovarian function.
FSH levels can vary between menstrual cycles, and interpretation may depend on the timing of the test and the estradiol result. FSH is therefore not usually interpreted in isolation.
AMH and AFC are generally more sensitive markers of ovarian reserve than an isolated FSH measurement. Your clinician will decide which tests are appropriate for you.
What Is a Normal Ovarian Reserve?
There is no single ovarian reserve number that is ideal for everyone.
AMH levels and antral follicle counts vary with age, individual biology, the laboratory or ultrasound method used, and other circumstances. Different laboratories may also use different reference ranges.
A result that is considered low in one context may need a different interpretation in another. Your doctor will consider:
Your age.
Your AMH level and/or antral follicle count.
Your menstrual and reproductive history.
Any known medical conditions.
Previous fertility treatment and ovarian response, if applicable.
Your current pregnancy plans.
It is best not to compare your results directly with a friend's or with a number found online without considering these differences.
What Does Low Ovarian Reserve Mean?
Low or diminished ovarian reserve generally means that the available egg supply, or the expected response to ovarian stimulation, is lower than would typically be expected for someone of a similar age.
It does not necessarily mean that the ovaries have stopped working. A person with diminished ovarian reserve may still have regular periods and may still conceive.
However, low reserve can be important when planning fertility treatment because the ovaries may produce fewer eggs during stimulation.
A specialist may discuss what the results could mean for the expected response to IVF, whether additional investigations are needed and which options fit your circumstances.
Low ovarian reserve is not the same as infertility, and it does not automatically mean you cannot become pregnant.
Can You Have a Low AMH Level and Still Get Pregnant?
Yes, pregnancy may still be possible with a low AMH level.
AMH is mainly useful for assessing ovarian reserve and estimating response to ovarian stimulation. It is not a reliable stand-alone test of the chance of natural conception.
Age, ovulation, sperm health, the fallopian tubes, the uterus and other medical factors also influence the likelihood of pregnancy.
If your AMH result is low, ask your fertility specialist to explain how it fits with your age, medical history and other test results. Avoid assuming that one result determines your future fertility.
Does Ovarian Reserve Decrease With Age?
Ovarian reserve naturally declines as a person gets older. This is part of the reproductive ageing process.
Age also matters for egg quality. As age increases, the likelihood of chromosome abnormalities in eggs rises, which can affect embryo development and pregnancy outcomes.
However, ovarian reserve and egg quality are different. A reserve test cannot directly measure the quality of an individual's eggs.
This is why doctors consider age alongside ovarian reserve results rather than relying on AMH or AFC alone.
Can You Improve Ovarian Reserve?
At present, there is no proven diet, supplement or lifestyle routine that can replenish the natural supply of eggs or reliably increase ovarian reserve.
Healthy habits can still support general health and preparation for pregnancy. These include avoiding smoking, eating a balanced diet, reviewing medications with a healthcare professional and managing existing medical conditions.
Be cautious of supplements or treatments advertised as guaranteed ways to increase AMH or restore ovarian reserve. A change in a laboratory result does not necessarily mean that the number or quality of eggs has improved, or that the chance of pregnancy has increased.
If you are concerned about declining ovarian reserve or considering fertility preservation, discuss your options with a qualified fertility specialist rather than delaying care while trying unproven remedies.
Should Everyone Have an Ovarian Reserve Test?
Not necessarily.
Ovarian reserve tests are not recommended as a general screening test to predict future fertility in people who have not been diagnosed with infertility. A result may not reliably predict whether someone will conceive naturally.
These tests are more useful when there is a specific clinical reason, such as infertility assessment or planning fertility treatment.
If you are considering egg freezing or delaying pregnancy, a discussion with a fertility specialist may help you understand your age-related fertility considerations and the limitations of ovarian reserve testing.
When Should You Speak to a Fertility Specialist?
Consider seeking professional advice if:
You have been trying to conceive for 12 months and are under 35.
You have been trying for 6 months and are 35 or older.
You are over 40 and planning pregnancy.
Your periods are irregular or absent.
You have a medical condition or treatment history that may affect ovarian function.
You have received an abnormal AMH or AFC result and need help understanding it.
You are considering fertility preservation.
These are general guidelines; your doctor may recommend an earlier assessment depending on your circumstances.
Frequently Asked Questions
1. Is ovarian reserve the same as fertility?
No. Ovarian reserve mainly relates to the number of eggs remaining in the ovaries. Fertility also depends on egg quality, ovulation, sperm health, the reproductive tract and other factors.
2. Does low AMH mean I cannot get pregnant naturally?
No. Low AMH does not automatically mean natural pregnancy is impossible. AMH is more useful for assessing ovarian reserve and predicting response to ovarian stimulation than for predicting natural conception on its own.
3. Is AMH or AFC better for assessing ovarian reserve?
Both AMH and AFC are useful markers, and they can provide similar information when assessed appropriately. Your doctor may recommend one or both depending on your circumstances and the purpose of testing.
4. Can ovarian reserve be increased naturally?
There is no established natural method that replenishes the egg supply or reliably increases ovarian reserve. Healthy habits can support overall health, but they should not be considered a proven way to reverse ovarian ageing.
5. Can I have regular periods and still have low ovarian reserve?
Yes. Regular periods do not necessarily mean that ovarian reserve is high. A person may have regular menstrual cycles and a low AMH result or a lower-than-expected antral follicle count.
6. Does low ovarian reserve mean IVF will fail?
No. A lower reserve may mean that fewer eggs are expected during stimulation, but it does not by itself determine the outcome. Your age, egg quality, embryo development and other factors also matter.
Where to Go Next
Continue learning about female fertility with these Dream Baby articles:
Egg Quality and Fertility: Learn what egg quality means and how it differs from ovarian reserve.
Fertility Tests for Women: Discover the assessments that may form part of a fertility evaluation.
Medical Disclaimer
This article is for general educational purposes only and is not a substitute for individual medical advice, diagnosis or treatment. Ovarian reserve test results should be interpreted by a qualified healthcare professional in the context of your age, medical history and fertility goals. This article has not been medically reviewed by a Dream Baby doctor.
References
1. American Society for Reproductive Medicine (ASRM). Testing and Interpreting Measures of Ovarian Reserve: A Committee Opinion (2020). https://www.asrm.org/practice-guidance/practice-committee-documents/testing-and-interpreting-measures-of-ovarian-reserve-a-committee-opinion-2020/
2. American Society for Reproductive Medicine (ASRM). Fertility Evaluation of Infertile Women: A Committee Opinion (2021). https://www.asrm.org/practice-guidance/practice-committee-documents/fertility-evaluation-of-infertile-women-a-committee-opinion-2021/
3. American College of Obstetricians and Gynecologists (ACOG). The Use of Antimüllerian Hormone in Women Not Seeking Fertility Care. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/04/the-use-of-antimullerian-hormone-in-women-not-seeking-fertility-care